Controlled Multiplanar Distraction of the Mandible, Part II: Laboratory Studies of Sagittal (Anteroposterior) and Vertical (Superoinferior) Movements
Controlled Multiplanar Distraction of the Mandible, Part II: Laboratory Studies of Sagittal (Anteroposterior) and Vertical (Superoinferior) Movements
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下颌骨的受控多平面牵引，第二部分：矢状（前后）和垂直（上下）运动的实验室研究
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发表时间：
1998
期刊：
影响因子：
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通讯作者：
J. McCarthy
中科院分区：
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作者：
Joseph K. Williams;N. Rowe;R. Mackool;J. Levine;L. Hollier;M. Longaker;C. Cutting;B. Grayson;J. McCarthy
牵张成骨技术在颅颌面外科的应用显著改变了先天性下颌骨缺损的治疗方法。然而，对动物研究和临床病例结果的评价显示了不足之处，特别是在两个方面。首先，在前后方向上使用单平面装置牵张可导致持续性前牙开咬。第二，偏侧牵引的半下颌骨往往是有限的，与不足的增量增益在bigonial距离。为了克服这些缺点，开发了一种多平面牵引装置，并在犬模型中进行了测试。本报告详细介绍了解决第一个问题的犬研究：前后或矢状（z轴）和上下或垂直（y轴）运动的组合。六只狗接受了双侧下颌骨牵引与外部（口外），多平面设备和完成矢状加垂直牵引。评价包括临床检查（面部形态、颌骨位置和咬合）、摄影、头颅X线片（后前位、基底位和侧位）、三维计算机断层扫描重建和干颅骨检查。平均矢状牵张18.5 mm（15-20 mm），垂直牵张41.0°（21-50°）。显着的前开咬后产生的垂直牵引继发于过早接触的上颌和下颌磨牙。垂直方向的牵张也具有增加矢状面增益约5%至10%的附加效应。总之，多平面牵引装置（具有在三个平面上牵引的潜力）可有效增加下颌前后推力（矢状牵引），也可有效创建前牙开咬（垂直或上下牵引）。垂直牵引可能需要双侧截骨术以获得最佳结果。在第二个平面（垂直和水平）中牵引后，矢状长度的初步增益被修改（减少或增加）。具体来说，向下方向的垂直牵引（形成开咬）也会导致前后平面的孤立增加。相反，垂直牵引在上级方向（关闭一个开咬），如在人类错牙合，可能会导致孤立的减少，在前后平面，但这个问题仍然有待研究在实验室中。
The application of distraction osteogenesis in craniofacial surgery has significantly altered the treatment of congenital mandibular deficiencies. However, evaluation of results in both animal studies and clinical cases has revealed deficiencies, particularly in two areas. First, distraction using a uniplanar device in an anteroposterior direction can result in a persistent anterior open bite. Second, the lateralization of the distracted hemimandible was often limited, with insufficient incremental gain in the bigonial distance. To overcome these shortcomings, a multiplanar distraction device was developed and tested in the canine model. This report details canine studies addressing the first problem: combined anteroposterior or sagittal (z-axis) and superoinferior or vertical (y-axis) movements. Six dogs underwent bilateral mandibular distraction with an external (extraoral), multiplanar device and completed sagittal plus vertical distraction. Evaluation included clinical examination (facial form, jaw position, and occlusion), photography, cephalograms (posteroanterior, basilar, and lateral), three-dimensional computed tomography reconstructions, and examination of dry skulls. The dogs averaged 18.5 mm (range, 15–20 mm) of sagittal distraction and 41.0° (range, 21–50°) of vertical distraction. Marked anterior open bites were produced after vertical distraction secondary to premature contact of the maxillary and mandibular molars. Distraction in the vertical direction also had the additive effect of increasing the sagittal gains by approximately 5% to 10%. In conclusion, a multiplanar distraction device (with the potential for distraction in three planes) was effective in increasing mandibular anteroposterior thrust (sagittal distraction) and also in creating an anterior open bite (vertical or superoinferior distraction). Vertical distraction probably requires bilateral osteotomies to obtain optimal results. The preliminary gains in sagittal length are modified (reduced or increased) after distraction in a second plane (vertical and horizontal). Specifically, vertical distraction in the inferior direction (creating an open bite) also leads to isolated increases in the anteroposterior plane. Conversely, vertical distraction in the superior direction (closing an open bite), as seen in a human malocclusion, may lead to isolated decreases in the anteroposterior plane, but this question remains to be investigated in the laboratory.