Le Fort III Advancement with Gradual Distraction Using Internal Devices
Le Fort III Advancement with Gradual Distraction Using Internal Devices
复制标题
Le Fort III 使用内部设备逐渐分散注意力的进步
DOI：
--
复制
发表时间：
1997
影响因子：
3.6
通讯作者：
B. Toth
中科院分区：
文献类型：
--
作者：
M. Chin;B. Toth
患者;本报告的目的是展示一种实用的临床方法，采用Le Fort III型截骨术和渐进式牵张术联合推进中面部。介绍了内潜式牵引装置的使用和对伊利扎罗夫牵引方案的修改。病例报告显示，通过消除潜伏期、术中开始牵张、术后迅速牵张节段来脱离Ilizarov方案的效果。本文描述了一种通过调节截骨部位内的压力来控制碎片牵张率的方法。介绍了内牵张器的设计和手术应用。9例颅面畸形所致中脸发育不全患者行Le Fort III型截骨术，辅以渐进式牵张术。年龄从4岁到13岁不等。采用定制的内牵引装置来满足每位患者的独特需求。牵张装置的激活是通过一根经皮针来完成的，该针保持在原位3至5天。通过调节分散部位内的力来确定运输速率。内装置放置6个月用于固定移位碎片。中脸前移，以眶下缘前移位来测量，范围从16到30毫米，平均为20毫米。当移动超过10 mm时，产生Le Fort III型截骨术增量运动所需的典型力在7至9 kg之间。4例阻塞性睡眠呼吸暂停患者手术前病情得到缓解。所有中面部进展均保持临床稳定。通过手术检查证实了骨连续性的建立，其中4例患者的牵张装置已被移除。术中推进Le Fort III型截骨术与渐进式牵张术相结合，可获得比常规截骨术和单纯刚性固定更大的活动。小儿颅面骨骼对牵张的反应与骨科骨骼不同。消除潜伏期，术中建立实质性骨间隙，术后迅速分散碎片对这些患者的骨愈合没有不利影响。该装置设计的内部可潜水特性在患者接受、固定稳定性和伤口管理方面具有优势。这种Le Fort III型中面推进法在临床上是实用和有效的。(塑料。Reconstr。外科杂志100:819,1997。)
&NA; The purpose of this report is to demonstrate a practical clinical method for advancement of the midface using a combination of Le Fort III osteotomy and gradual distraction. Use of internal, submergible distraction devices and modification of the Ilizarov distraction protocol are presented. Case reports show the effect of departing from the Ilizarov protocol by eliminating the latency period, initiating distraction intraoperatively, and rapidly distracting the segments postoperatively. A method of controlling fragment distraction rate by regulating pressures within the osteotomy site is described. The design and surgical application of internal distraction devices are shown. Nine patients with midface hypoplasia related to craniofacial anomalies underwent Le Fort III osteotomies assisted by gradual distraction. Ages ranged from 4 to 13 years. Custom internal distraction devices were employed to meet the unique requirements of each patient. Activation of the distraction device was accomplished by a percutaneous pin that remained in place for 3 to 5 days. The rate of transport was determined by regulating the forces within the distraction site. The internal devices remained in place for 6 months for fixation of the transported fragment. Midface advancement, measured as the anterior displacement of the infraorbital rim, ranged from 16 to 30 mm, with a mean of 20 mm. The typical force required to produce incremental movement of the Le Fort III osteotomy was found to be between 7 and 9 kg as transport exceeded 10 mm. Four patients with obstructive sleep apnea prior to surgery had resolution of the disorder. All the midface advancements remained clinically stable. Establishment of osseous continuity was verified by surgical examination in the four patients in whom the distraction devices have been removed. Combining intraoperative advancement of the Le Fort III osteotomy with gradual distraction consistently resulted in larger movements than could be achieved with conventional osteotomies and rigid fixation alone. The pediatric craniofacial skeleton responds differently to distraction than does the orthopedic skeleton. Eliminating the latency period, establishing a substantial bone gap intraoperatively, and rapidly distracting the fragment postoperatively did not adversely affect the osseous union in these patients. The internal, submergible feature of the device design offers advantages in patient acceptance, fixation stability, and wound management. This method of Le Fort III midface advancement has been shown to be clinically practical and effective. (Plast. Reconstr. Surg. 100: 819, 1997.)