内置式下颌骨牵引成骨术及其常见并发症的处理

Analysis of the complications following mandibular distraction using internal distractors

目的探讨内置式下颌骨牵引成骨术的常见术后并发症发生的原因及防治措施。方法总结分析1997至2004年采用内置式下颌骨牵引成骨术治疗下颌骨畸形或缺损患者46例61侧,其中半侧颜面短小27例,下颌骨发育不足或小颌畸形双侧8例、单侧4例,电击伤或肿瘤术后缺损畸形3例,Treacher Colins综合征2例,睡眠呼吸暂停综合征2例。结果46例61侧发生并发症者9例,包括牵引机械装置故障3例,局部感染2例,前牙开2例,皮肤窦道2例。经积极处理后均达到预期治疗目的。结论减少下颌骨牵引成骨术并发症的关键在于充分理解下颌骨牵引成骨术的机理,熟悉掌握下颌骨及邻近解剖结构,操作规范熟练,充分的术前准备和术后处理尤为重要。

Objective To investigate the causes and the prophylactic for the complications following mandibular distraction osteogensis using internal distractors. Methods From 1997 to 2004, a total of 46 patients（61 sides） suffering from malformations or defects of mandible who underwent mandibular distraction osteogensis were analyzed. The diseases included hemifacial microsomia in 27 cases, congenital or acquired mandibular hypoplasia and micrognathia bilateral in 8 cases and unilateral in 4 cases, electronical injury or postoperative mandibular defects in 3 cases, Treacher Colins syndrome in 2 cases, obstructive sleep apnea syndrome in 2 cases. Results Of them, 9 patients had postoperative complications, which included 3 patients had complications associated with distractors, local infection occurred in 2 cases, apertognathia of anterior teeth in 2 case, 2 patients had sinus of the skin of the lower lip. 9 patients had been aggressivly managed and obtained satisfactory results. Conclusions The pivotal points to reduce complications are to understand the mechanism of mandibular distraction osteogensis completely, and to be familiar with the anatomy of mandible and adjacent tissues. It is necessary to treat with it preoperatively and postoperatively.