输送盘牵张成骨修复重建下颌骨节段性缺损  

Application of transport distraction osteogenesis in reconstruction of mandibular segmental defects

作　　者：苏成利 祝颂松[1] 李运峰[1] Su Chengli;Zhu Songsong;Li Yunfeng(State Key Laboratory of Oral Diseases,National Clinical Research Center for Oral Diseases,West China Hospital of Stomatology,Sichuan University,Chengdu 610041,Sichuan Province,China)

机构地区：[1]口腔疾病研究国家重点实验室,国家口腔疾病临床医学研究中心,四川大学华西口腔医院正颌及关节外科,四川省成都市610041

出　　处：《中国组织工程研究》2021年第35期5604-5609,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:近年来,牵引成骨已经成为下颌骨节段性骨缺损修复重建的重要替代方案。目的:探讨输送盘牵张成骨技术用于重建下颌骨节段性骨缺损和后期牙种植治疗的临床可行性和效率。方法:纳入6例诊断为成釉细胞瘤或牙源性角化囊性瘤的患者,通过计算机断层扫描和X射线全景片拍摄进行术前评估和手术计划,肿瘤切除后应用输送盘牵张成骨技术重建缺损。牵张后的固定期为16-25周,取决于术后牵张间隙内的骨化程度。第2次手术用来移除牵引装置,并采用骨移植物和坚固内固定技术恢复输送盘和骨缺损残端之间的间隙。最后在牵张间隙内的新骨上行牙种植治疗恢复咬合关系。结果与结论:①所有患者均顺利完成了整个治疗期,未发生牵引装置故障或肿瘤复发;牵张长度为45-57 mm;通过影像学检查和术中观察证实了牵张间隙内满意的新骨形成和高度钙化;②在6例患者中,1例患者发生了感染,其症状通过外科换药得到控制;2例患者发生了涎漏,通过加压包扎和口服阿托品治愈;③所有患者最终获得了满意的面部外形和咬合功能;④结果表明,输送盘牵张成骨技术用于重建下颌骨节段性骨缺损和进一步的牙种植治疗在临床上是可行的,效果令人满意。BACKGROUND:In recent years,distraction osteogenesis has become an important alternative option to the reconstruction of mandibular segmental bone defects.OBJECTIVE:To explore the clinical feasibility and efficiency of transport distraction osteogenesis for reconstruction of segmental mandibular bone defect and later dental implantation.METHODS:Six patients with ameloblastoma or keratocystic odontogenic tumor were included in this study.Computed tomography and panoramic film were performed for preoperative evaluation and surgical planning.Transport distraction osteogenesis was used to reconstruct the defect after tumor resection.The fixation period after distraction varied from 16 to 25 weeks,depending on the degree of ossification in the distraction space after operation.The second operation was performed to remove the traction device and restore the gap between the delivery disc and the residual bone defect with bone graft and rigid internal fixation.Finally,the occlusal relationship was restored by dental implantation on the new bone in the distraction space.RESULTS AND CONCLUSION:All patients successfully completed the whole treatment period without traction failure or tumor recurrence.The stretch length ranged from 45 to 57 mm.Satisfactory new bone formation and high calcification in the distraction space were confirmed by imaging examination and intraoperative observation.Of the six patients,one developed infection,and the symptoms were controlled by surgical dressing change;two had salivary leakage,and were cured by pressure bandaging and atropine.All patients eventually achieved satisfactory facial appearance and occlusal function.The findings of this study indicate that transport distraction osteogenesis can be used to reconstruct segmental mandibular bone defect and further used in clinical dental implant treatment,and moreover,the therapeutic effect is satisfactory.

关 键 词：下颌骨缺损 牵张成骨 输送盘 牙种植 咬合关系 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]