口内入路下颌升支矢状劈开术的改良及应用

The modification of intraoral sagittal split ramus osteotomy

目的:为便于术中行骨间坚固内固定和增强术后的稳定性,设计改良的口内入路下颌升支矢状劈开术方法并进行应用。方法:66例牙颌面畸形患者均行改良的口内入路下颌升支矢状劈开术。切口设计要点:①软组织切口宜延至第二前磨牙;②骨组织垂直切口应从第一磨牙近中面始垂直向下颌缘;宜在每侧下颌升支骨间斜形线近远骨端两侧用三块小型钛板钛钉行坚固内固定,间隔10mm。术后辅以1～2周颌间牵引固定。结果:无论下颌骨前徙、后退或旋转,下颌骨均较稳定地在设计的位置愈合,获得满意的颜面外形和稳定的咬合关系。结论:该手术改良便于术中骨断端间行坚固内固定,同时钛板钛钉坚固内固定的方法与位置可减少损伤下齿槽神经血管束,增加了术后骨段间的接触面与稳定性并预防了复发。另外,术前与术后正畸治疗的配合是必需的。

Objective To design the modification of intraoral sagittal split ramus osteotomy in order to perform easily rigid internal fixation in orthognathic surgery and reinforce the stability of bone segments in postoperative cases. Methods Sixty-six cases with dento-mxillofacial deformities were performed via The modification of intraoral Sagittal Split Ramus Osteotomy. The key points of preoperative design were following as： ①The incisions of soft tissue were prolonged to the second premolar; ②The vertical incisions of hard tissue were undergone from the internal of the first molar to the mandibular edge. Rigid internal fixation should be performed in ramus every 10 mm using one piece of three Titanium palates. Results All patients had gained satisfactiory maxillofacial appearance and firm occlusion relationship no matter what the mandibular body moved forward and backward and rotated. Conclusion the modification of sagittal split ramus osteotomy can do easily rigid internal fixation in optimal both sides of segments and protect effectively the mandibular never blood boundle and enhance the interfaces of segments and their stability and prevent relapse. It is necessary to combine preoperative and postoperative orthodontics.