Mandibular Bone transport Reconstruction Plate

描述（由申请人提供）：头颈部硬组织和软组织的手术切除或高冲击性创伤可导致主要组织缺损。下颌的重建通常包括骨、牙龈和牙齿。目前的下颌牵引装置与重建板联合使用，但重建板采用下颌轮廓，而牵引装置具有线性矢量。该装置的牵引距离也有限，只能产生短段直骨，因此不能一次手术就适应较大的缺损。这种组合装置的大小使得它不可能移动齿状骨段。口腔外装置具有外固定架和骨运输牵引装置的功能，可以重建下颌副骨节和下巴。然而，由于软组织的压力，新形成的下颌骨被退回，下颌骨的正常曲率无法实现。本课题第一阶段的目标是建立和测试一个口腔内下颌牵引装置的原型，其中重建板、推进机构和骨运输装置组合为一个单元。该原型被证明是机械坚固，易于放置和使用，并且能够在活山羊模型中成功地将齿状骨段运输过2厘米的骨间隙。该提案第二阶段的目标是构建和测试该设备的第二代和第三代。这些装置将使齿状骨段能够在包括下颌中线在内的大弯曲距离上运输，并防止软组织压力对形成的抑制。这些装置的目的是允许在手术切除后立即重建下颌骨，消除了植骨或二次重建的需要。该设备的优点是，它们将使我们能够恢复原始下颌骨的机械完整性和形状，并允许在植入重建骨时进行适当的咬合。这将在不增加手术难度、持续时间或并发症的情况下完成。该装置的一个关键特征是它们不受骨间隙的大小、形状或位置的限制，也不受装置低位的限制；在固定过程中，运输盘可以安全地携带活牙，而不会损伤牙根。“检查点截骨”技术将首次使恢复正常弯曲或原始下颌骨成为可能，并保留原始的下面部尺寸，因为软组织施加在运输盘上的牵引力被运输板刚性屏蔽。

DESCRIPTION (provided by applicant): Surgical excision of hard and soft tissues of the head and neck or high impact trauma can lead to lead to major tissue deficits. Reconstruction of the lower jaw typically involves bone, gingiva, and teeth. Current mandibular distraction devices are used in combination with reconstruction plates, but while the reconstruction plates take the contour of the jaw, the distraction devices have a linear vector. The devices also have a limited distraction distance, producing short segments of straight bone and so cannot accommodate large deficits with a single procedure. The size of the combined apparatus makes it impossible to move dentate bone segments. Extra-oral devices function both as external fixator and bone-transport distraction devices, with which it is possible to re-build the mandibular parasymphysis and chin. However, the newly formed mandible is retruded due to soft tissue pressure and normal curvature of the mandible is not achieved. The objective of Phase I of this proposal was to build and test a prototype of an intra-oral mandibular distraction device in which the reconstruction plate, advancing mechanism and bone transport device are combined into a single unit. The prototype was built and shown to be mechanically robust, easy to place and use, and able to successfully transport a dentate bone segment across a 2cm bony gap in a live goat model. The objective of Phase II of this proposal is to build and test the second and third generations of this device. These devices will enable transport of dentate bone segments over large curved distances including the midline of the jaw, and prevent the inhibition of form by soft tissue pressure. The purpose of these devices is to allow immediate reconstruction of mandibular bone following surgical excision, eliminating the need for bone grafting or secondary reconstruction. The advantage of the devices is that they will enable us to regain the mechanical integrity and shape of the original mandible, and allow appropriate occlusion to occur when implants are placed in the reconstructed bone. This will be done without adding to the difficulty, duration, or complication of surgeries. A critical feature of the devices is that they are not limited by the size, shape, or location of the bone gap and because of the low position of the device; the transport disc can safely carry viable teeth without injuring the roots during fixation. The "check-point osteotomy" technique will make it possible for the first time to regain the normal curvature or the original mandible, and preserve the original lower facial dimensions as the traction force exerted by the soft tissue over the transport disc is rigidly shielded by the transport plate.