摘要
目的通过头影测量牵张成骨术后下颌骨的变化,评估手术的长期稳定性并探讨影响术后复发的因素。方法筛选2009—2018年于中山大学附属口腔医院口腔颌面外科因患有下颌骨畸形而接受下颌牵张成骨治疗的5例患者,对比不同治疗阶段[T0(下颌骨牵张成骨术前)、T1(牵张成骨治疗完成时/取出牵张器时)、T2(术后最长随访时间)]的头影测量数据,检测记录牵张成骨治疗过程中下颌骨长度(Go-Gn、Ar-Gn)及升支高度(Cr-Go)、下颌后缩程度(SNB角)的数值变化,评估牵张成骨治疗的长期稳定性。采用配对t检验的方法对头影测量数据进行统计学分析。结果全颌曲面断层片显示,患者下颌骨长度在下颌牵张成骨手术后随访时比手术前平均增长6.09 mm(t=2.97,P=0.025),下颌升支平均增长5.72 mm(t=3.21,P=0.018)。侧位片显示患者下颌骨长度在下颌牵张成骨手术后随访时比手术前平均增长8.17 mm(t=5.21,P=0.006),下颌总长度平均增长12.58 mm(t=4.34,P=0.01),下颌升支平均增长6.36 mm(t=4.26,P=0.01),SNB角平均增大6.28°(t=5.28,P=0.006)。但是测量结果示:升支高度在手术后随访时比手术刚完成时平均降低2.25 mm(t=-3.42,P=0.014)。结论牵张成骨手术对下颌骨畸形患者的下颌骨体部长度和升支高度有明显的效果,并且具有良好的长期稳定性,但术后1～3年全颌曲面断层片可检测到升支高度的轻微复发现象。
Objective The aim of this study was to evaluate the long-term stability of mandibular distractions by cephalometric analysis before and after the distractions and discuss the factors that influence the recurrence. Methods Five patients with mandibular deformities who underwent distraction osteogenesis from 2009 to 2018 were selected. The cephalometric data of T0(before distraction osteogenesis),T1(distraction osteogenesis was completed/distraction distractor was removed),and T2(the longest follow-up after distraction osteogenesis)were compared. The length of mandible(Ar-Gn,GoGn,Co-Go)were measured and recorded. The numerical changes of data were compared to evaluate the stability of distraction therapy. SPSS 20.0 was used for statistical analysis,and paired t-test was used to obtain statistical analysis results. Results Panoramic films showed that the mandibular length increased by 6.09 mm(t =2.97,P =0.025)and the mandibular ramus increased by 5.72 mm(t =3.21,P =0.018)at the follow-up after distraction osteogenesis. The cephalometric images showed that mandibular length increased by 8.17 mm(t =5.21,P =0.006),total mandibular length increased by 12.58 mm(t =4.34,P =0.01),ramus height increased by 6.36 mm(t =4.26,P =0.01),and SNB increased by 6.28°(t =5.28,P =0.006). However,the results of panoramic tomography showed that the height of ramus decreased on average at the time of follow-up compared with that at the time of completion of surgery by 2.25 mm(t =-3.42,P =0.014). Conclusions Mandibular distraction osteogenesis has obvious effect on improving mandibular malformation and good long-term stability. However,slight recurrence of ramus height can be detected on panoramic films 1-3 years postoperatively.
引文
[1]El-Bialy TH,Razdolsky Y,Kravitz ND,et al.Long-term results of bilateral mandibular distraction osteogenesis using an intraoral tooth-borne device in adult ClassⅡpatients[J].Int J Oral Maxillofac Surg,2013,42(11):1446-1453.DOI:10.1016/j.ijom.2013.05.004.
[2]Chow A,Lee HF,Trahar M,et al.Cephalometric evaluation of the craniofacial complex in patients treated with an intraoral distraction osteogenesis device:a long-term study[J].Am JOrthod Dentofacial Orthop,2008,134(6):724-731.DOI:10.1016/j.ajodo.2007.01.029.
[3]Aizenbud D,Hazan-Molina H,Thimmappa B,et al.Curvilinear mandibular distraction results and long-term stability effects in a group of 40 patients[J].Plast Reconstr Surg,2010,125(6):1771-1780.DOI:10.1097/PRS.0b013e3181d9937b.
[4]McCarthy JG,Stelnicki EJ,Mehrara BJ,et al.Distraction osteogenesis of the craniofacial skeleton[J].Plast Reconstr Surg,2001,107(7):1812-1827.
[5]McCarthy JG,Schreiber J,Karp N,et al.Lengthening the human mandible by gradual distraction[J].Plast Reconstr Surg,1992,89(1):1-8;discussion 9-10.DOI:10.1097/00006534-199289010-00001.
[6]Ko EW,Hung KF,Huang CS,et al.Correction of facial asymmetry with multiplanar mandible distraction:a one-year follow-up study[J].Cleft Palate Craniofac J,2004,41(1):5-12.DOI:10.1597/02-132.
[7]Swennen G,Schliephake H,Dempf R,et al.Craniofacial distraction osteogenesis:a review of the literature:Part 1:clinical studies[J].Int J Oral Maxillofac Surg,2001,30(2):89-103.DOI:10.1054/ijom.2000.0033.
[8]Pluijmers BI,Caron CJ,Dunaway DJ,et al.Mandibular reconstruction in the growing patient with unilateral craniofacial microsomia:a systematic review[J].Int J Oral Maxillofac Surg,2014,43(3):286-295.DOI:10.1016/j.ijom.2013.11.001.
[9]Peacock ZS,Salcines A,Troulis MJ,et al.Long-Term Effects of Distraction Osteogenesis of the Mandible[J].J Oral Maxillofac Surg,2018,76(7):1512-1523.DOI:10.1016/j.joms.2017.12.034.
[10]Grabb WC.The first and second branchial arch syndrome[J].Plast Reconstr Surg,1965,36(5):485-508.DOI:10.1097/00006534-196511000-00001.
[11]Chidzonga MM.Temporomandibular joint ankylosis:review of thirty-two cases[J].Br J Oral Maxillofac Surg,1999,37(2):123-126.DOI:10.1054/bjom.1997.0089.
[12]Molina F.Mandibular distraction osteogenesis:a clinical experience of the last 17 years[J].J Craniofac Surg,2009,20Suppl 2:1794-800.DOI:10.1097/SCS.0b013e3181b5d4de.
[13]Ortiz Monasterio F,Molina F,Andrade L,et al.Simultaneous mandibular and maxillary distraction in hemifacial microsomia in adults:avoiding occlusal disasters[J].Plast Reconstr Surg,1997,100(4):852-861.DOI:10.1097/00006534-199709001-00005.
[14]Batra P,Ryan FS,Witherow H,et al.Long term results of mandibular distraction[J].J Indian Soc Pedod Prev Dent,2006,24(1):30-39.DOI:10.4103/0970-4388.22835.
[15]Meazzini MC,Mazzoleni F,Bozzetti A,et al.Comparison of mandibular vertical growth in hemifacial microsomia patients treated with early distraction or not treated:follow up till the completion of growth[J].J Craniomaxillofac Surg,2012,40(2):105-111.DOI:10.1016/j.jcms.2011.03.004.
[16]Lu TC,Kang GC,Yao CF,et al.Simultaneous maxillomandibular distraction in early adolescence as a single treatment modality for durable correction of typeⅡunilateral hemifacial microsomia:Follow-up till completion of growth[J].JCraniomaxillofac Surg,2016,44(9):1201-1208.DOI:10.1016/j.jcms.2016.07.002.
[17]Rachmiel A,Aizenbud D,Eleftheriou S,et al.Extraoral vs.intraoral distraction osteogenesis in the treatment of hemifacial microsomia[J].Ann Plast Surg,2000,45(4):386-394.DOI:10.1097/00000637-200045040-00006.
[18]Stelnicki EJ,Lin WY,Lee C,et al.Long-term outcome study of bilateral mandibular distraction:a comparison of Treacher Collins and Nager syndromes to other types of micrognathia[J].Plast Reconstr Surg,2002,109(6):1819-1825;discussion 1826-1827.DOI:10.1097/00006534-200205000-00006.
[19]Moss ML,Rankow RM.The role of the functional matrix in mandibular growth[J].Angle Orthod,1968,38(2):95-103.DOI:10.1043/0003-3219(1968)038<0095:TROTFM>2.0.CO;2.
[20]I?eri H,Ki?ni?ci R,Altu?-Ata?AT.Ten-year follow-up of a patient with hemifacial microsomia treated with distraction osteogenesis and orthodontics:an implant analysis[J].Am JOrthod Dentofacial Orthop,2008,134(2):296-304.DOI:10.1016/j.ajodo.2006.12.014.
[21]Suh J,Choi TH,Baek SH,et al.Mandibular distraction in unilateral craniofacial microsomia:longitudinal results until the completion of growth[J].Plast Reconstr Surg,2013,132(5):1244-1252.DOI:10.1097/PRS.0b013e3182a48cf9.
[22]Bj?rk A.Sutural growth of the upper face studied by the implant method[J].Acta Odontol Scand,1966,24(2):109-127.DOI:10.3109/00016356609026122.
