本文選題：腭裂　切入點：牽張成骨　出處：《天津醫(yī)科大學(xué)》2008年碩士論文　論文類型：學(xué)位論文

【摘要】： 目的腭裂是最常見的先天性發(fā)育畸形之一,其發(fā)病率在我國高達新生兒的2‰左右。腭部骨與軟組織的缺損畸形,嚴重影響患兒口頜系統(tǒng)功能及精神心理健康。以往傳統(tǒng)的整復(fù)手術(shù)都是通過轉(zhuǎn)移鄰近組織瓣關(guān)閉裂隙、后延軟腭長度等途徑,以恢復(fù)腭部的解剖形態(tài)和生理功能,但均不能整復(fù)腭部的骨質(zhì)缺損,恢復(fù)錯位的肌肉附著。加之術(shù)后大量瘢痕形成影響患兒的顏面部生長發(fā)育,往往出現(xiàn)繼發(fā)性的上頜發(fā)育不足。給患者及其家庭帶來影響深遠的社會心理障礙。 近年來利用牽張成骨(Distraction Osteogenesis,DO)技術(shù)矯治骨骼畸形和缺損成為新的研究熱點。DO以其操作簡便、創(chuàng)傷小、形成瘢痕少、無需植骨,在形成新骨的同時,附著于其表面肌肉等軟組織也相應(yīng)得到伸展等獨特優(yōu)點逐漸得到青睞。本研究探索利用靈長類動物獼猴為研究對象,建立與人類解剖結(jié)構(gòu)非常接近的腭裂動物模型,觀察該模型的制作可行性及其效果,為今后的臨床治療研究建立實驗平臺,并且嘗試使用DO技術(shù)關(guān)閉裂隙,觀察牽張區(qū)域在不同時間點新骨生成的變化發(fā)展規(guī)律。同時自行開發(fā)設(shè)計具有專利知識產(chǎn)權(quán)的新型口內(nèi)純鈦腭裂口內(nèi)牽張矯治器,并觀察其在DO應(yīng)用過程中的效能、穩(wěn)定性及適用性。 方法 1、采用25只亞成體獼猴為實驗對象,性別隨機,3-4歲齡,體重4.7-6.4kg。利用外科手術(shù)在動物一側(cè)硬腭部切除一約25×6mm~2大小矩形軟硬組織,形成口鼻腔相通的洞穿性缺損,建立腭裂動物模型。術(shù)后6周安樂處死2只動物X-ray檢查及大體組織觀察裂隙形態(tài),從而驗證和判斷該模型是否建立成功。 2、在上述方法成功建立模型的基礎(chǔ)上,以骨切開術(shù)形成骨運送盤,安裝自行設(shè)計的牽張器,延遲期5天后開始以0.8mm×1次/天的牽張速率牽張5～7天結(jié)束,固定6周后拆除牽張器。分別在牽張結(jié)束后的第1、2、4、6、8、12、24周安樂處死動物3只,通過X-ray檢查、掃描電鏡觀察及組織學(xué)切片染色觀察等方面研究,觀察各時間點新骨的不同形態(tài)特征及其變化規(guī)律。 結(jié)果 1、所有動物安全度過手術(shù),患側(cè)鼻孔有食物溢出、偶爾嗆咳等表現(xiàn),與人類腭裂患者表現(xiàn)相似,裂隙未發(fā)生自發(fā)性愈合,成功建立獼猴腭裂動物模型。 2、自行研制的口內(nèi)純鈦牽張器順利完成牽引及固定過程,除一例1顆壓緊螺帽脫落仍保持穩(wěn)定外,均完好保存至拆除�？煽啃�、穩(wěn)定性及其牽張效能均高。 3、利用DO成功關(guān)閉模型動物的腭部裂隙。 4、X線影像學(xué)檢查可見不同時間點間隙新骨不斷形成鈣化至接近正常骨密度。 5、掃描電鏡下,可見新骨由類骨質(zhì)產(chǎn)生到逐漸鈣化成骨的超微結(jié)構(gòu)變化過程。 6、組織學(xué)觀察牽張區(qū)域由中央到邊緣呈現(xiàn)新生類骨質(zhì)逐漸礦化成骨小梁直至成熟改建,未見軟骨骨痂。 結(jié)論 1、利用外科手術(shù)建立的獼猴腭裂模型,能夠順利適應(yīng)手術(shù)及其牽張操作過程,是進行腭裂以及其他原因?qū)е碌碾癫揩@得性組織缺損牽張整復(fù)研究的良好實驗動物模型。 2、本實驗的純鈦腭裂口內(nèi)牽張器使用方便,固位良好,能夠順利完成牽張及固定操作過程,效果穩(wěn)定。 3、本研究0.8mm×1次/天的牽張速率及6周的固定期成骨效果良好。 4、大體組織學(xué)觀察、X-ray檢查及掃描電鏡的觀測的牽張區(qū)域的改變證實新骨的形成方式為膜內(nèi)成骨。
[Abstract]:The purpose of cleft palate is one of the most common congenital malformation, the incidence rate in our country up to around 2. The neonatal palatal defect of bone and soft tissue deformity, seriously affect the patients' function of the stomatognathic system and mental health. The traditional surgery is through the transfer of the adjacent flap closed fracture after. The extension of the length of the soft palate and other ways to restore the anatomical morphology and physiological function of palate, but can not repair the palatal bone and restore normal muscle attachments. In addition to a large number of postoperative scar formation in infants with facial growth, often appear secondary maxillary hypoplasia to patients and their families to bring social and psychological obstacles far-reaching.
In recent years the use of distraction osteogenesis (Distraction Osteogenesis DO) technique for the treatment of skeletal deformities and defects become a hot research topic in the new.DO for its simple operation, small trauma, less scar formation, without bone graft in the formation of new bone at the same time, attached to the surface of muscle and soft tissue has the unique advantages of extension has been favored. This study explores the use of primate animal monkeys as the research object, the establishment of animal model of cleft palate structure is very close to the human anatomy, observe the production feasibility and effectiveness of the model, establish the experimental platform for the study of clinical treatment in the future, and try to use DO technology to close the cleft, observe the development of the traction law Zhang at the different time change the new bone formation. At the same time to develop new export with proprietary intellectual property in pure titanium palatal distraction appliance in the fissure, and observe the application effect in DO Yes, stability and applicability.
Method
1, the 25 sub adult rhesus monkeys as the experimental object, random sex, age 3-4, body weight 4.7-6.4kg. by surgery in the animal side of the hard palate resection of a 25 * 6mm~2 rectangular soft tissue, the formation of nasal cavity defects, the establishment of animal model of cleft palate. After 6 Zhou Anle killed 2 animal X-ray check and general observation of fracture morphology, thus verifying and judging whether the model was successfully established.
2, the model was successfully established based on the above method, the osteotomy was formed the carrier plate, installed distrator designed, delayed 5 days after the date of starting with 0.8mm * 1 / day stretch rate of stretch over 5~7 days, 6 weeks after fixation removed distractor in distraction respectively. After the end of the week 1,2,4,6,8,12,24 rats were euthanized by animal 3, X-ray examination, observation etc. histologic observation and scanning electron microscope observation of different forms of organization, characteristics and change rules of the new bone at each time point.
Result
1, all animals passed the operation safely. There were food spills and occasional choking cough on the affected nostrils. Similar to those of human cleft palate patients, there was no spontaneous healing of fissures. A rhesus monkey cleft palate animal model was successfully established.
2, the self-developed intraoral titanium distractor successfully completed the traction and fixation process. Except for one case of 1 compression nuts, the stability of the screw cap remained stable, and all of them were well preserved until the dismantling. The reliability, stability and distraction efficiency were all high.
3, the clefts of the palate of the model animals were successfully closed by DO.
4, X-ray imaging showed that the new bone formed in different time points formed calcification to close to the normal bone density.
5, under scanning electron microscope, the ultrastructural changes of the new bone from osteoid to gradual calcification and osteogenesis can be seen.
6, the histological observation of the distraction area from the central to the edge showed that the new bone like bone gradually mineralized into the bone trabecula straight to the mature reconstruction, and no cartilaginous callus was found.
conclusion
1, the rhesus monkey cleft palate model established by surgery can adapt to operation and stretching process smoothly. It is a good experimental animal model for palatine and other palatal acquired tissue defect distraction.
2, the pure titanium palate retainer in this experiment is easy to use and has good retention, and can successfully complete the process of traction and fixation, and the effect is stable.
3, the results of this study were good at 0.8mm x 1 / day and 6 weeks in the fixation period.
4, gross histological observation, X-ray examination and changes in the distraction area observed by scanning electron microscopy confirmed that the formation of the new bone was the osteogenesis in the membrane.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2008
【分類號】：R782.2;R-332

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