下颌骨外板劈开珊瑚人工骨植入在治疗半侧颜面短小中的应用基础与临床研究
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摘要
采用下颌骨外板劈开珊瑚人工骨植入的方法来治疗半侧颜面短小,对此国内外尚无文献报道。我们采用下颌骨外板劈开珊瑚人工骨植入的方法进行了动物试验及相关临床病例的治疗,并对此方法进行了基础和临床的研究。
动物实验研究:8-12月龄成年小香猪10头,随机分为A,B两组,每组5头。每只实验动物分别进行下颌骨外板劈开,之后将塑形好的珊瑚人工骨植入下颌骨内外板之间的间隙内。A组:一侧为空白对照,一侧植入厚0.5cm的珊瑚人工骨;B组:一侧植入厚0.5cm珊瑚人工骨,一侧植入厚1cm珊瑚人工骨。分别于术前、术后即刻及术后6个月进行CT检查。术后第3个月,每组随机挑选1只试验动物处死后取下颌骨标本进行组织学检查(HE染色、扫描电镜),剩余动物于术后6个月处死,对其中6只的下颌骨标本进行生物力学检测,对另外2只的骨标本进行组织学检查(HE染色、扫描电镜、Azan-mallory特殊染色)。结果发现:①下颌骨外板劈开珊瑚人工骨植入后,下颌骨厚度明显增加,组织学的超微结构均与正常骨组织无显著差异,对下颌骨最大应力的影响不大,论证了下颌骨外板劈开珊瑚人工骨植入是扩展下颌骨厚度的有效手段,为其应用于临床打下基础;②珊瑚人工骨于植入后的6个月组织学达到基本修复,大体观察可见试验侧下颌骨创面均已基本愈合,下颌骨下缘局部可见凹陷及软组织长入,此种现象在珊瑚人工骨厚度为1cm时更加明显。下颌角区可见增生的骨结节。
临床应用研究:采用下颌骨外板劈开珊瑚人工骨植入的方法治疗半侧颜面短小11例。应用CT分割技术对术前、术后即刻、术后6个月的下颌骨厚度变化情况进行测量分析,并对患者面部进行形态观察,结果:(1)下颌骨术后6个月厚度明显增加,术后即刻比术前平均增厚5.80mm,术后6个月比术前平均增厚4.81mm;(2)由于珊瑚植入侧下颌骨相应部位厚度增加,术后6个月患者面下部1/3不对称畸形得到明显改善。
本文结论:下颌骨外板劈开珊瑚人工骨植入后,间隙内有新骨生成,组织学结构可基本修复,下颌骨厚度明显增厚。虽然局部有软组织长入,但对下颌骨最大应力的影响不大。术后即刻与术后6个月相比下颌骨存在一定的骨质吸收,但无显著差异。动物实验结果支持下颌骨外板劈开珊瑚人工骨植入法矫正半侧颜面短小的临床应用。对吸收率的量化可更好的指导临床应用,但动物实验与临床研究中得到的下颌骨吸收率不完全一致,尚需进一步改进实验条件并加大样本量进行研究。
There is no report about osteotomy of the outer mandibular cortex combined with coral implantation for treatment of hemifacial microsomia at home and abroad. This article illustrates our study about osteotomy of the outer mandibular cortex combined with coral implantation in the basic and clinic area, and reports the results of our research.
Animal experiment: 10 miniature pigs at age 8-12months were selected as the experimental animals which were divided into 2 groups randomly: group A and group B. In group A, the outer cortex of mandibular body and angle was split in one side and coral (thickness: 0.5cm) was implanted into the gap between the outer and inner cortex of mandible, with the other side as control. In group B, two kinds of coral (thickness: 0.5cm and 1cm) was implanted into the gaps with the same methods separately. Computer tomography (CT) was applied preoperatively, immediately after operation and 6 months after operation. 2 pigs were selected randomly in each group and were killed 12 weeks after coral implantation. Specimen was harvested from implantation site of mandible, and then histological study (HE stain, scanning electron microscopy) was performed. The rest animals were killed 6 months after operation. Gross inspection of the mandible was performed at that time including the condition of the coral. The bone of mandibular angle region was collected bilaterally in 6 pigs and sent for biomechanical test. Histological studies (HE stain, scanning electron microscopy, Azan Mallory special stain) were performed in the other 2 pigs. The results showed:①After the osteotomy of the outer mandibular cortex combine with coral implantation, mandibular body get thicker. There was no obvious difference between experimental side and normal side in the histology area and no obvious impact on the maximum stress of mandible. So osteotomy of the outer mandibular cortex combine with coral implantation is a suitable method for the expansion of mandible.②Gross inspection showed that the wound in the experimental side of mandible had almost been healed, and depression was seen at the inferior border of mandible. Soft tissue had grown into the coral, especially when the thickness of coral is 1cm. Bone tubercle can be found at angle area.
Clinical research: There were 11 patients of hemifacial microsomia treated with method above. Using computer tomography (CT) dissection technique, variables were observed and analyzed including the thickness of mandible preoperatively, immediately after operation, 6 months after operation; regeneration at 6 months after operation compared with immediate after operation; direct sight of the appearance of patient. The results showed:①thickness of the mandible immediately after operation became 5. 80mm thicker than that preoperatively, and thickness of the mandible 6 months after operation became 4.81m thicker than that preoperatively;②Asymmetry of lower 1/3 face has been improved obviously because of the accrescence in thickness of the mandible in corresponding side after coral implantation.
Conclusion: New bone regeneration in the gap and histological structure can almost repair after osteotomy of the outer mandibular cortex combined with coral implantation. Mandible got thicker obviously. Although soft tissue grew into the coral, there was no obvious impact on the maximum stress of mandible. Bone resorption happens after coral implantaion, but the thickness of mandible immediately after operation has no significant difference from 6 months after operation. Conclusion supports the clinical application of osteotomy of the outer mandibular cortex combined with coral implantation for the treatment of hemifacial microsomia. Quantization of bone resorption rate can guide its clinical application. The inconsistence of bone resorption rate between animal experiment and clinic research should be studied further with the improvement of experiment condition and augmentation of sample size.
动物实验研究:8-12月龄成年小香猪10头,随机分为A,B两组,每组5头。每只实验动物分别进行下颌骨外板劈开,之后将塑形好的珊瑚人工骨植入下颌骨内外板之间的间隙内。A组:一侧为空白对照,一侧植入厚0.5cm的珊瑚人工骨;B组:一侧植入厚0.5cm珊瑚人工骨,一侧植入厚1cm珊瑚人工骨。分别于术前、术后即刻及术后6个月进行CT检查。术后第3个月,每组随机挑选1只试验动物处死后取下颌骨标本进行组织学检查(HE染色、扫描电镜),剩余动物于术后6个月处死,对其中6只的下颌骨标本进行生物力学检测,对另外2只的骨标本进行组织学检查(HE染色、扫描电镜、Azan-mallory特殊染色)。结果发现:①下颌骨外板劈开珊瑚人工骨植入后,下颌骨厚度明显增加,组织学的超微结构均与正常骨组织无显著差异,对下颌骨最大应力的影响不大,论证了下颌骨外板劈开珊瑚人工骨植入是扩展下颌骨厚度的有效手段,为其应用于临床打下基础;②珊瑚人工骨于植入后的6个月组织学达到基本修复,大体观察可见试验侧下颌骨创面均已基本愈合,下颌骨下缘局部可见凹陷及软组织长入,此种现象在珊瑚人工骨厚度为1cm时更加明显。下颌角区可见增生的骨结节。
临床应用研究:采用下颌骨外板劈开珊瑚人工骨植入的方法治疗半侧颜面短小11例。应用CT分割技术对术前、术后即刻、术后6个月的下颌骨厚度变化情况进行测量分析,并对患者面部进行形态观察,结果:(1)下颌骨术后6个月厚度明显增加,术后即刻比术前平均增厚5.80mm,术后6个月比术前平均增厚4.81mm;(2)由于珊瑚植入侧下颌骨相应部位厚度增加,术后6个月患者面下部1/3不对称畸形得到明显改善。
本文结论:下颌骨外板劈开珊瑚人工骨植入后,间隙内有新骨生成,组织学结构可基本修复,下颌骨厚度明显增厚。虽然局部有软组织长入,但对下颌骨最大应力的影响不大。术后即刻与术后6个月相比下颌骨存在一定的骨质吸收,但无显著差异。动物实验结果支持下颌骨外板劈开珊瑚人工骨植入法矫正半侧颜面短小的临床应用。对吸收率的量化可更好的指导临床应用,但动物实验与临床研究中得到的下颌骨吸收率不完全一致,尚需进一步改进实验条件并加大样本量进行研究。
There is no report about osteotomy of the outer mandibular cortex combined with coral implantation for treatment of hemifacial microsomia at home and abroad. This article illustrates our study about osteotomy of the outer mandibular cortex combined with coral implantation in the basic and clinic area, and reports the results of our research.
Animal experiment: 10 miniature pigs at age 8-12months were selected as the experimental animals which were divided into 2 groups randomly: group A and group B. In group A, the outer cortex of mandibular body and angle was split in one side and coral (thickness: 0.5cm) was implanted into the gap between the outer and inner cortex of mandible, with the other side as control. In group B, two kinds of coral (thickness: 0.5cm and 1cm) was implanted into the gaps with the same methods separately. Computer tomography (CT) was applied preoperatively, immediately after operation and 6 months after operation. 2 pigs were selected randomly in each group and were killed 12 weeks after coral implantation. Specimen was harvested from implantation site of mandible, and then histological study (HE stain, scanning electron microscopy) was performed. The rest animals were killed 6 months after operation. Gross inspection of the mandible was performed at that time including the condition of the coral. The bone of mandibular angle region was collected bilaterally in 6 pigs and sent for biomechanical test. Histological studies (HE stain, scanning electron microscopy, Azan Mallory special stain) were performed in the other 2 pigs. The results showed:①After the osteotomy of the outer mandibular cortex combine with coral implantation, mandibular body get thicker. There was no obvious difference between experimental side and normal side in the histology area and no obvious impact on the maximum stress of mandible. So osteotomy of the outer mandibular cortex combine with coral implantation is a suitable method for the expansion of mandible.②Gross inspection showed that the wound in the experimental side of mandible had almost been healed, and depression was seen at the inferior border of mandible. Soft tissue had grown into the coral, especially when the thickness of coral is 1cm. Bone tubercle can be found at angle area.
Clinical research: There were 11 patients of hemifacial microsomia treated with method above. Using computer tomography (CT) dissection technique, variables were observed and analyzed including the thickness of mandible preoperatively, immediately after operation, 6 months after operation; regeneration at 6 months after operation compared with immediate after operation; direct sight of the appearance of patient. The results showed:①thickness of the mandible immediately after operation became 5. 80mm thicker than that preoperatively, and thickness of the mandible 6 months after operation became 4.81m thicker than that preoperatively;②Asymmetry of lower 1/3 face has been improved obviously because of the accrescence in thickness of the mandible in corresponding side after coral implantation.
Conclusion: New bone regeneration in the gap and histological structure can almost repair after osteotomy of the outer mandibular cortex combined with coral implantation. Mandible got thicker obviously. Although soft tissue grew into the coral, there was no obvious impact on the maximum stress of mandible. Bone resorption happens after coral implantaion, but the thickness of mandible immediately after operation has no significant difference from 6 months after operation. Conclusion supports the clinical application of osteotomy of the outer mandibular cortex combined with coral implantation for the treatment of hemifacial microsomia. Quantization of bone resorption rate can guide its clinical application. The inconsistence of bone resorption rate between animal experiment and clinic research should be studied further with the improvement of experiment condition and augmentation of sample size.
引文
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