本文選題：半側顏面短小畸形　切入點：下頜骨牽引成骨　出處：《北京協(xié)和醫(yī)學院》2017年碩士論文　論文類型：學位論文

【摘要】：目的半側顏面短小畸形(Hemifacial microsomia)是一種常見的以下頜骨發(fā)育不良為主要表現(xiàn),常合并面部肌肉軟組織缺損的先天性顱面畸形。下頜骨牽引成骨技術能有效延長下頜骨升支,目前已經成為治療半側顏面短小畸形的常主要治療手段。本研究主要針對半側顏面短小畸形下頜骨牽引成骨過程中以及術后不良事件進行統(tǒng)計分析,進行手術安全性評估;同時評估下頜骨牽引成骨手術對于半側顏面短小畸形患兒咬肌體積的變化,探討骨延長手術對于咬肌生長的影響。方法回顧性研究2010年2月到2015年3月期間在中國醫(yī)學科學院整形外科醫(yī)院頜面整形外科中心就診的71例采用下頜骨牽引成骨手術治療的半側顏面短小畸形患者。術前采用三維CT重建、計算機輔助設計、快速成形技術,術中進行下頜骨截骨術并置入延長器,術后4-7天以1mm/d的速率牽引成骨,下頜骨升支延長距離為20-40mm,牽引完成固定4-13個月后取出延長器,記錄牽引過程中以及牽引術后遇到的所有不良事件。同時統(tǒng)計CT資料完整,沒有感染、血腫等影響咬肌測量并發(fā)癥的半側顏面短小畸形患者共25例,借助Mimics軟件重建患兒咬肌及頭顱骨的三維立體圖像,測量下頜升支后緣高度及咬肌體積。結果71例半側顏面短小畸形患兒平均隨訪34.4個月,所有不良事件的發(fā)生率是36.6%,輕微不良事件發(fā)生率18.3%,包括局部感染和神經損傷,中等不良事件發(fā)生率是12.7%,包括暫時性顳骨吸收、牽引器松動和嚴重瘢痕增生,嚴重不良事件發(fā)生率是5.6%,包括牙齒或牙胚損傷和重度張口受限。對25例患兒進行了頭顱CT三維重建并測量咬肌體積。下頜骨延長術后患側下頜升支后緣高度顯著增加(32.2±6.4mm vs 39.2±5.9mm,P0.001)。術后健側咬肌體積無顯著差異(9633±297mm3 vs 9821±362mmm3,P=0.37),而患側咬肌體積術后較術前明顯增加(5343±342mm3 vs 6580±413mm3,P=0.008)。ⅡA型和ⅡB型半側顏面短小畸形患兒牽引成骨術后咬肌增加量無顯著差異(740±830mm3 vs 1658±457mm3,P=0.33);下頜升支后緣高度增加量與咬肌體積增加量無顯著相關性(相關系數(shù)R2=0.025,P=0.45)。結論下頜骨牽引成骨手術是治療半側顏面短小畸形的一種相對安全的治療方式,重視牽引過程中以及牽引后所有不良事件的發(fā)生,并進行妥善處理、改善治療流程非常重要。同時,下頜骨牽引成骨一方面可以矯正下頜骨發(fā)育不良,延長患側下頜升支高度,改善顱頜骨不對稱程度;另一方面,下頜骨牽引成骨可能有助于促進患側咬肌生長,增加咬肌體積,改善半側顏面短小畸形肌肉軟組織缺損情況。
[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 鹵6.4mm vs 39.2 鹵5.9mm P0.001.The volume of contralateral masseter muscle was not significantly different after operation (9633 鹵297mm ~ 3 vs 9821 鹵362mm ~ (-3)), but the volume of affected masseter muscle increased significantly after operation (5343 鹵342mm ~ 3 vs 6580 鹵413mm ~ (3) P _ (0.008)). There was no significant increase in masseter muscle volume after distraction osteogenesis in children with type 鈪，

本文編號：1561801