自体下颌角骨质游离移植隆颏术的实验和临床研究(1)
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[摘要]目的：研究应用自体下颌角区骨质游离移植隆颏术的可行性。方法：分为两部分，第一部分动物实验：将小型猪的下颌角截除，并用截除的下颌角骨质移植到颏部，用钛钉固定，术后用三维CT进行效果评定。第二部分，临床应用，在46例应用双侧下颌角截骨术治疗方脸畸形的同时，应用下颌角骨质进行隆颏术，术后随访，观察治疗效果。结果：动物实验中游离移植的骨质完全被吸收。临床病人中73.9%的患者吸收率达到50%以上。结论：通过动物实验和临床应用观察，我们认为临床中应用下颌角截除的自体骨游离移植隆颏术需要谨慎实施。
[关键词]隆颏；下颌角；吸收；游离移植
[中图分类号]R622 Q813.1 [文献标识码]A [文章编号]1008-6455(2012)02-0244-03
Experimental and clinical analysis of chin augmentation with mandibular bone
TANG Xiao-jun,ZHANG Zhi-yong,NIU Feng,YU Bing,LUO Jin-chao,GUI lai
(Department of Craniomaxillofacial Surgery,Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100144,China)
Abstract: Objective The aim was to study the feasibility of the chin augmentation with the bone from the mandible angle osteotomy. Methods Two parts were including in the article. The first part was animal experiment. The chinese miniatrue pigs were performed the operations of mandible angle osteotomy. The mandibular angle bone was transplanted freely on the pig's mental fixed with titanium nail. After the procedure, the effects were assessed by three dimensional computerized tomography. The second part was the applications in clinique. 46 patients were obtained the operations of the mandible angle osteotomy and chin augmentation with the bone from the mandibular bone. The patients were followed up and checked by X-ray. Results The bones grafted were absorbed totally in animal experiments. Over 50% resorption of the free bone grafts took place in 73.9% of the patients in clinic. Conclusions From the animal experiment and experience in clinic, we consider that the chin augmentation with free bone grafts from mandible angle osteotomy need to be performed prudently.
Key words:chin augmentation;mandibular angle;resorption;free grafting
颏部是直立行走赋予脊椎动物的特殊的礼物，在面部美容与和谐中起重要的作用，是面部变化最为活跃的部位，细微的改变就可以引起人的面部和气质改变。小颏畸形的治疗方法分为隆颏术和颏成形术。对于轻度和中度小颏畸形往往采用隆颏术，对于重度的小颏畸形往往采用颏成形术。在我国“方脸型”的患者也是比较常见的，治疗的方法目前多集中在下颌角体部的截骨缩小，颧骨截骨降低配合隆颏术或颏成形术[1-3]。自1996年开始，我们曾经设想应用自体下颌骨截骨获得的骨质游离移植进行轻度的小颏畸形治疗。初期获得了良好的效果[4]，但是经过长期的观察发现，游离移植的骨质发生了不同程度的吸收。为了能够详细分析该手术方法的可行性，我们分别进行了动物实验和临床病例分析。
1 动物实验
1.1 实验动物：试验用6～8个月中国小型猪(北京农业大学实验动物中)3个。体重20～30kg，雌雄各半。麻醉为速眠新(军事医学科学院军事兽医研究所研制)0.08～0.1ml/kg，配合盐酸氯胺酮注射液(福建古田药业有限公司生产)0.16～0.2ml/kg肌肉注射麻醉。
1.2 实验过程：取下颌下缘切口，逐层暴露至骨面。在下颌角区内、外侧面的骨膜下向上离断肌肉附着，约在下颌神经管下方平行神经管做直线形截骨(图1)。截除骨质仔细保留备用。在猪颏部正中联合部位的龈颊沟处切开粘骨膜，骨膜下剥离显露骨性颏部，将下颌角区截除骨质仔细打磨至适合形状和大小，植于颏部并用钛钉固定(图2)。庆大盐水冲洗 ......
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