半侧颜面短小畸形下颌骨牵引成骨手术安全性评估及疗效评价

发布时间：2018-03-03 16:28

  本文选题：半侧颜面短小畸形　切入点：下颌骨牵引成骨　出处：《北京协和医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的半侧颜面短小畸形(Hemifacial microsomia)是一种常见的以下颌骨发育不良为主要表现,常合并面部肌肉软组织缺损的先天性颅面畸形。下颌骨牵引成骨技术能有效延长下颌骨升支,目前已经成为治疗半侧颜面短小畸形的常主要治疗手段。本研究主要针对半侧颜面短小畸形下颌骨牵引成骨过程中以及术后不良事件进行统计分析,进行手术安全性评估;同时评估下颌骨牵引成骨手术对于半侧颜面短小畸形患儿咬肌体积的变化,探讨骨延长手术对于咬肌生长的影响。方法回顾性研究2010年2月到2015年3月期间在中国医学科学院整形外科医院颌面整形外科中心就诊的71例采用下颌骨牵引成骨手术治疗的半侧颜面短小畸形患者。术前采用三维CT重建、计算机辅助设计、快速成形技术,术中进行下颌骨截骨术并置入延长器,术后4-7天以1mm/d的速率牵引成骨,下颌骨升支延长距离为20-40mm,牵引完成固定4-13个月后取出延长器,记录牵引过程中以及牵引术后遇到的所有不良事件。同时统计CT资料完整,没有感染、血肿等影响咬肌测量并发症的半侧颜面短小畸形患者共25例,借助Mimics软件重建患儿咬肌及头颅骨的三维立体图像,测量下颌升支后缘高度及咬肌体积。结果71例半侧颜面短小畸形患儿平均随访34.4个月,所有不良事件的发生率是36.6%,轻微不良事件发生率18.3%,包括局部感染和神经损伤,中等不良事件发生率是12.7%,包括暂时性颞骨吸收、牵引器松动和严重瘢痕增生,严重不良事件发生率是5.6%,包括牙齿或牙胚损伤和重度张口受限。对25例患儿进行了头颅CT三维重建并测量咬肌体积。下颌骨延长术后患侧下颌升支后缘高度显著增加(32.2±6.4mm vs 39.2±5.9mm,P0.001)。术后健侧咬肌体积无显著差异(9633±297mm3 vs 9821±362mmm3,P=0.37),而患侧咬肌体积术后较术前明显增加(5343±342mm3 vs 6580±413mm3,P=0.008)。ⅡA型和ⅡB型半侧颜面短小畸形患儿牵引成骨术后咬肌增加量无显著差异(740±830mm3 vs 1658±457mm3,P=0.33);下颌升支后缘高度增加量与咬肌体积增加量无显著相关性(相关系数R2=0.025,P=0.45)。结论下颌骨牵引成骨手术是治疗半侧颜面短小畸形的一种相对安全的治疗方式,重视牵引过程中以及牵引后所有不良事件的发生,并进行妥善处理、改善治疗流程非常重要。同时,下颌骨牵引成骨一方面可以矫正下颌骨发育不良,延长患侧下颌升支高度,改善颅颌骨不对称程度;另一方面,下颌骨牵引成骨可能有助于促进患侧咬肌生长,增加咬肌体积,改善半侧颜面短小畸形肌肉软组织缺损情况。
[Abstract]:Objective Hemifacial microsomia (Hemifacial microsomia) is a common congenital craniofacial malformation, which is often associated with facial muscle and soft tissue defects. Mandibular distraction osteogenesis can effectively prolong the mandibular ramus. At present, it has become the main treatment for short facial deformities. In this study, the adverse events during and after mandibular distraction osteogenesis of hemifacial short facial deformities were statistically analyzed, and the safety of operation was evaluated. At the same time, the changes of masseter muscle volume in children with hemifacial short facial deformity were evaluated by mandibular distraction osteogenesis. To investigate the effect of bone lengthening operation on masseter muscle growth. Methods from February 2010 to March 2015, 71 cases of mandibular traction were treated by mandibular traction in maxillofacial plastic surgery center, orthopedic hospital, Chinese academy of medical science. Patients with short hemifacial deformity treated by bone surgery. Three-dimensional CT reconstruction was performed before operation. Computer aided design (CAD), rapid prototyping (RP), mandibular osteotomy and placement of lengthening apparatus were performed during the operation. Distraction osteogenesis was performed at a rate of 1 mm / d 4 to 7 days after operation. The lengthening distance of the ramus of the mandible was 20-40 mm, and the lengthening device was removed after 4 to 13 months of fixation. All the adverse events encountered during traction and after traction were recorded. At the same time, there were 25 cases of hemifacial short facial malformation with complete CT data, no infection, hematoma and other complications affecting the measurement of masseter muscles. Three-dimensional images of masseter muscle and cranial bone were reconstructed by Mimics software to measure the height of posterior edge of mandibular ramus and the volume of masseter muscle. Results 71 children with short hemifacial malformation were followed up for an average of 34.4 months. The incidence of all adverse events was 36.6 and the incidence of minor adverse events was 18.3, including local infection and nerve injury. The incidence of moderate adverse events was 12.7, including temporary temporal bone resorption, loosening of tractor and severe scar hyperplasia. The incidence of severe adverse events was 5.6, including tooth or tooth germ injury and severe limitation of mouth opening. Ct 3D reconstruction and measurement of masseter muscle volume were performed in 25 children. The height of posterior edge of mandibular ramus was significant after mandibular lengthening. The volume of masseter muscle increased by 32.2 卤6.4mm vs 39.2 卤5.9mm P0.001.The volume of contralateral masseter muscle was not significantly different after operation (9633 卤297mm ~ 3 vs 9821 卤362mm ~ (-3)), but the volume of affected masseter muscle increased significantly after operation (5343 卤342mm ~ 3 vs 6580 卤413mm ~ (3) P _ (0.008)). There was no significant increase in masseter muscle volume after distraction osteogenesis in children with type 鈪，

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