腭裂牵张成骨整复术的新设计——动物实验结果与评价

A New Design and Evaluat ion of Distraction Osteogenesis for Repairing Cleft Palate in Cats

目的在建立腭裂实验动物(猫)模型的基础上,采用研制的口内腭裂牵张装置,用于新设计的腭裂牵张成骨整复术,并观察评价其效果。方法设立空白对照组(动物2只)及实验对照组(动物3只)。设计制备个体化的纯钛口内腭裂牵张整复装置;以20只家猫为实验对象,建立腭裂实验动物模型。在实验动物的上颌腭侧,通过磨牙带环及纯钛自攻螺钉固位,安置腭裂牵张装置。4周后,实施单骨运送盘形成术,术后第6天起,以0.4mm×2次/d的速度与频率,向裂隙健侧行牵张成骨术,至健侧骨运送盘与裂缘紧接,裂隙封闭。于原位固定的不同时期分别处死实验动物各3只,取标本行大体及组织学、荧光标记、免疫组化、超微结构以及激光共聚焦显微镜与生长因子的表达等系列检测,并对矫治前后的咬合模型进行对比测量。结果在建立腭裂实验动物模型的基础上,首次采用新设计的腭裂牵张装置及术式,通过骨牵张间隙的新骨形成及覆盖黏骨膜的伸展,直至骨运送盘与健侧裂缘衔接。各项检测结果表明,所设计的新术式,在修复腭部软硬组织缺损的基础上,牵张间隙以膜内成骨方式形成新骨,成功地整复了腭裂。结论新设计的腭裂牵张成骨整复术,是一种以局部新生软硬组织的增殖为基础,在保持功能与结构稳定的前提下,关闭裂隙的功能性腭裂整复术。

Objective To explore the new method of cleft palate( CP )repair on surgically established experimental CP animal(cats)model by individua lly manufactured intraoral distractor,and to observe and evaluate the effects.Me thods New designed titanium intraoral distractor was manufactured individually.1 5cats were underwent rectangular palatal os-teoectomy in sagittal direction to establish the CP experimental model,and then the intraoral distractors were fixe d with molar brackets onto molar teeth and titanium miniscrews into palate bone across the defect of CP at one time.4weeks lat-er the transport disc(TD)osteoto my were performed and gradual distraction were carried out6days later at the rat e and rhythm of0.4mm×2/day till the TD reached the opposite edge of the CP.Plas ter cast meterages,histological,tetrachloride fluorescent labeling,immunohistoch emistry and ultrastructural studies were performed at different time intervals o f fixation period after the completion of distraction.Empty control(2cats)and ex perimental control(3cats)groups were set up for comparison.Results CP bone and s oft tissue defects in animal model were successfully repaired by DO technique wi th new designed intraoral distractor for the first time.TD recombination to the opposite bone edge of the CP and proportional expansion of overlay mucoperiostea l flap were achieved.The bone defects were filled with de nove osteogenesis.Conc lu-sion The soft tissue integrity and bone continuity in hard palate of CP were reconstructed by DO with on-site tissue re-generation.Functional repair for CP was achieved under adoption of DO,which implied a potentially new approach to C P treatment.