Long-term Skeletal Stability of Computer-Assisted Maxillary Distraction Osteogenesis for Patients with Cleft Lip and Palate-Related Midfacial Hypoplasia
Long-term Skeletal Stability of Computer-Assisted Maxillary Distraction Osteogenesis for Patients with Cleft Lip and Palate-Related Midfacial Hypoplasia
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计算机辅助上颌骨牵引成骨术治疗唇裂和腭裂相关面中部发育不全患者的长期骨骼稳定性
DOI：
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
J. Sekine
中科院分区：
文献类型：
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作者：
T. Kanno;S. Sukegawa;A. Shibata;Y. Furuki;H. Mori;J. Sekine
牵张成骨术（DO）已被接受用于治疗涉及严重上颌骨发育不全的唇腭裂相关畸形。现代计算机辅助外科（CAS）发展迅速，并已被纳入口腔颌面外科。在这项回顾性研究中，我们评估了在与唇腭裂相关的面中部发育不全患者中使用DO和CAS重新定位的上颌骨的长期骨骼稳定性。纳入了3名女性患者（平均年龄21.0岁），需要平均上颌骨前移，DO为11.0（范围10-12）mm。基于术前计算机断层扫描数据，虚拟现实手术计划上颌DO与实际的牵引组件的选择，使用三维快速成型模型。手术需要Le Fort I截骨术和应用半定制的口内牵引装置。在5天的潜伏期后，以1 mm/天的速率激活DO，直到获得适当的牵张量。保留4周后，进行坚固内固定和牵引器取出（T1）。分析DO前（T0）、T1、T1后6个月（T2）和T1后3年（T3）拍摄的头颅侧位片。使用法兰克福水平参考平面中的上颌骨点A评估每个时间点（T1-T3）上颌骨位置（x，y）的骨骼变化。在所有3例患者中，上颌DO是安全的，术前虚拟图像引导模拟CAS在牙齿和骨骼关系以及面部轮廓方面是可行的，上颌A点的平均变化为10.7 mm（水平7.0 mm，向前8.1 mm）。A点在T2时显示中等量的骨骼复发（水平1.0 mm，13.8%;上方1.3 mm，16.5%; P < 0.05），在T3时有少量的进一步复发（P > 0.05）。DO结合CAS可以实现长期的骨骼稳定性，是一种有前途的微创骨再生治疗唇腭裂相关的面中部发育不全。
: Distraction osteogenesis (DO) has gained acceptance for treating cleft-related deformities involving severe maxillary hypoplasia. Modern computer-assisted surgery (CAS) has progressed rapidly and has been incorporated into oral-maxillofacial surgery. In this retrospective study, we evaluated the long-term skeletal stability of the maxilla repositioned using DO with CAS in patients with cleft-related midfacial hypoplasia. Three female patients (mean age, 21.0 years) requiring a mean maxillary advancement with DO of 11.0 (range, 10-12) mm were included. Based on preoperative computed tomography data, virtual reality surgical planning for maxillary DO with selection of the actual distractor components was done using three-dimensional rapid prototyping models. Surgery entailed a Le Fort I osteotomy and application of semi-custom-made intraoral distraction devices. DO was activated after a 5-day latency period at a rate of 1 mm/day until the appropriate amount of distraction was obtained. After a 4-week retention period, rigid internal fixation and distractor removal were performed (T1). Lateral cephalometric films taken before DO (T0), at T1, 6 months after T1 (T2), and 3 years after T1 (T3) were analyzed. Maxillary point A in the Frankfort horizontal reference plane was used to assess skeletal changes in the maxillary position (x, y) at each time point (T1–T3). In all 3 patients, maxillary DO was safe and CAS with preoperative virtual image-guided simulation was feasible in terms of dental and skeletal relationships and facial profile, with a mean change at maxillary point A of 10.7 mm (7.0 mm horizontally, 8.1 mm inferiorly). Point A showed a moderate amount of skeletal relapse by T2 (1.0 mm, 13.8%, horizontally; 1.3 mm, 16.5%, superiorly; P < 0.05), with a small amount of further relapse at T3 (P > 0.05). DO with CAS can achieve long-term skeletal stability and is a promising minimally invasive bone regenerative treatment for cleft-related midfacial hypoplasia.
唇腭裂患者经窦上颌骨牵引的骨骼稳定性和并发症
影响因子：
0.9
作者：
Nkenke E;Vairaktaris E;Hanke S;Hoffmann B;Schlittenbauer T
通讯作者：
Schlittenbauer T