“夹心法”矫治半侧颜面短小的临床研究(1)
[摘要]目的：运用下颌骨外板劈开颗粒状珊瑚羟基磷灰石充填矫治半侧颜面短小导致的下颌骨发育不良畸形，评估该方法的术后效果并分析该手术方法的优点及适用范围。方法：5例患者采用下颌骨外板劈开珊瑚羟基磷灰石人工骨植入术进行以Pruzansky- Kaban分型为I型或者IIa型的半侧颜面短小所致下颌骨发育不良畸形的矫治。治疗后随访6～24个月，通过术前、术后的摄像、头颅CT三维重建进行术后效果的评估。结果：纳入本次研究的5例患者进行了最少6个月的随访，后期没有明显的并发症发生。所有患者对术后效果表示满意。结论：下颌骨外板劈开颗粒状珊瑚羟基磷灰石人工骨植入术矫治半侧颜面短小可取得较好的临床效果，术后并发症少，珊瑚人工骨的降解吸收率也较低，是一种修复半侧颜面短小行之有效的方法。
[关键词]下颌骨外板劈开术；珊瑚人工骨；半侧颜面短小；夹心法；下颌骨发育不良
[中图分类号]R782.2 [文献标志码]A [文章编号]1008-6455(2018)05-0128-04
, http://www.100md.com
The “Sandwich” Method for Treatment of Mandibular Hypoplasia Caused by Hemifacial Microsomia
XU Jia， LI Xi， QIAO Jia， LIU Jian-feng， NIU Feng， GUI Lai
(the Sixth Department of Plastic Surgery Hospital， Chinese Academy of Medical Sciences & Peking Union Medical College， Beijing 100144， China)
Abstract： Objective To observe the clinical effect of osteotomy of the outer mandibular cortex combined with CHA implantation for mandibular hypoplasia caused by hemifacial microsomia. To evaluate the postoperative effect of the method and analyse the range of application and the advantage of the method of the surgery may exist. Methods There were 5 patients of Pruzansky - Kaban type I or type IIa hemifacial microsomia treated with the method of osteotomy of the outer mandibular cortex combined with coralline hydroxyapatite implantation. Follow-up visits were conducted for 6 to 24 months to monitor. To observe the postoperative effect by the imaging and three-dimensional CT reconstruction. Results With the thickness of mandibular increased significantly after 6 months， significant improvements in the asymmetry of the mandible as well as in the aesthetic appearance of all the patients were observed. Conclusion On account of lower complications and bone absorption rate， the osteotomy of the outer mandibular cortex combined with CHA implantation is a useful method for hemifacial microsomia.
, 百拇医药
Key words： osteotomy of the outer mandibular cortex； coral； hemifacial microsomia；the “Sandwich” method； mandibular hypoplasia
半側颜面短小是整形外科临床工作中经常遇到的问题之一，其中下颌骨宽度的重建仍是一个具有挑战性的课题。目前，自体颅骨外板或下颌骨外板被认为是骨修复材料较好的选择[1-2]，但由于较高的骨吸收率限制了它的应用[3-4]。人工材料包括很多种，目前运用较多的是高密度多孔聚乙烯[5-6]和个性化钛合金修补体[7-8]。但这些方法也存在着感染、外露、价格昂贵等不足。珊瑚人工骨具有很好的组织相容性、可吸收，具有很强的骨传导能力，吸收后能完全被新生骨替代。珊瑚人工骨作为颅面部植骨的外源性骨源已有较多的临床应用和实验研究报道[9-10]，目前常用作贴附移植[11-12]。笔者科室前期研究及相关文献报道，贴附植骨成骨效率不高，是困扰其应用的棘手问题。归来等[13]提出下颌骨外板劈开天然珊瑚人工骨植入用以矫治下颌骨发育不良，取得了良好效果，但天然珊瑚成分复杂，降解过程中不可控因素较多，并且感染风险较大。因而，自2010年起，笔者科室对于这类半侧颜面短小患者采用下颌骨外板劈开珊瑚羟基磷灰石充填术来改善面下部宽度，临床效果满意，现报道如下。
1 资料和方法, 百拇医药(徐佳 李茜 乔嘉 刘剑锋 牛峰 归来)
[关键词]下颌骨外板劈开术；珊瑚人工骨；半侧颜面短小；夹心法；下颌骨发育不良
[中图分类号]R782.2 [文献标志码]A [文章编号]1008-6455(2018)05-0128-04
, http://www.100md.com
The “Sandwich” Method for Treatment of Mandibular Hypoplasia Caused by Hemifacial Microsomia
XU Jia， LI Xi， QIAO Jia， LIU Jian-feng， NIU Feng， GUI Lai
(the Sixth Department of Plastic Surgery Hospital， Chinese Academy of Medical Sciences & Peking Union Medical College， Beijing 100144， China)
Abstract： Objective To observe the clinical effect of osteotomy of the outer mandibular cortex combined with CHA implantation for mandibular hypoplasia caused by hemifacial microsomia. To evaluate the postoperative effect of the method and analyse the range of application and the advantage of the method of the surgery may exist. Methods There were 5 patients of Pruzansky - Kaban type I or type IIa hemifacial microsomia treated with the method of osteotomy of the outer mandibular cortex combined with coralline hydroxyapatite implantation. Follow-up visits were conducted for 6 to 24 months to monitor. To observe the postoperative effect by the imaging and three-dimensional CT reconstruction. Results With the thickness of mandibular increased significantly after 6 months， significant improvements in the asymmetry of the mandible as well as in the aesthetic appearance of all the patients were observed. Conclusion On account of lower complications and bone absorption rate， the osteotomy of the outer mandibular cortex combined with CHA implantation is a useful method for hemifacial microsomia.
, 百拇医药
Key words： osteotomy of the outer mandibular cortex； coral； hemifacial microsomia；the “Sandwich” method； mandibular hypoplasia
半側颜面短小是整形外科临床工作中经常遇到的问题之一，其中下颌骨宽度的重建仍是一个具有挑战性的课题。目前，自体颅骨外板或下颌骨外板被认为是骨修复材料较好的选择[1-2]，但由于较高的骨吸收率限制了它的应用[3-4]。人工材料包括很多种，目前运用较多的是高密度多孔聚乙烯[5-6]和个性化钛合金修补体[7-8]。但这些方法也存在着感染、外露、价格昂贵等不足。珊瑚人工骨具有很好的组织相容性、可吸收，具有很强的骨传导能力，吸收后能完全被新生骨替代。珊瑚人工骨作为颅面部植骨的外源性骨源已有较多的临床应用和实验研究报道[9-10]，目前常用作贴附移植[11-12]。笔者科室前期研究及相关文献报道，贴附植骨成骨效率不高，是困扰其应用的棘手问题。归来等[13]提出下颌骨外板劈开天然珊瑚人工骨植入用以矫治下颌骨发育不良，取得了良好效果，但天然珊瑚成分复杂，降解过程中不可控因素较多，并且感染风险较大。因而，自2010年起，笔者科室对于这类半侧颜面短小患者采用下颌骨外板劈开珊瑚羟基磷灰石充填术来改善面下部宽度，临床效果满意，现报道如下。
1 资料和方法, 百拇医药(徐佳 李茜 乔嘉 刘剑锋 牛峰 归来)