应用牵张成骨整复腭裂的动物实验研究

Distraction osteogenesis for repair of cleft palate: an experimental study

目的 应用研制的腭裂整复牵张装置行腭裂牵张成骨整复术 ,探索腭裂功能性整复治疗的新途径。方法 以家猫 14只为实验对象。用 12只猫建立人工腭裂的实验动物模型 ,其中 2只为实验对照组 ,另 10只作为实验组。在建立腭裂的同时每只动物均在上颌腭侧安置自行研制的腭裂牵张装置。 4周后 ,于裂侧腭部形成单骨运送盘。术后第 6日起 ,以每次 0 .4mm的速度 ,每日 2次向恒定的方向行牵张成骨术 ,直到腭部软硬组织裂隙完全封闭。于原位固定 2、4、6、8及 12周后各时段分别处死实验动物各 2只 ,按计划项目对标本测量、X线摄片 ,从大体到超微结构系列检测。结果 利用该腭裂口内牵张装置 ,成功地进行了腭裂牵张整复术。腭部裂隙软硬组织缺损在获得相同组织修复的基础上 ,裂隙封闭 ;骨牵张间隙完全为新生骨组织取代 ;腭裂整复后对牙颌颅面框架及其相互关系无明显影响。结论 自行研制的口内腭裂牵张装置设计合理 ,性能良好。牵张成骨腭裂整复术开拓了腭裂整复治疗的新途径 ,为临床应用提供了理论和实验根据。

Objective To observe the repair of cleft palate(CP) bone defect under the application of distraction osteogenesis(DO); to investigate the correction mechanism in thin bone of palatal shelf and to search a possible new treatment approach for repair of CP Methods 14 cats were assigned randomly to 3 groups: (1) Empty control, 2 cats unoperated with euthanasia at the end of 2 weeks; (2) Experimental control, 2 cats underwent 8 mm×18 mm palatal osteoectomy in saggital direction as the experimental model of CP with euthanasia in 6 weeks; (3) Experimental group, 10 cats were performed the same palatal osteoectomy as group (2), the newly designed and individual manufactured intraoral distractors were fixed to teeth by brackets and to bilateral palate bone across the defect with titanium miniscrews 4 weeks later the transport disc(TD) osteotomy were performed and gradual disctraction was started after 6 days latency period at the rate of 0 4 mm×2/day till the TD reached the opposite edge of the CP Roentgenographic, gross meterage and ultrastructural observation were performed 2, 4, 6, 8, 12 weeks after completion of distraction Results All the examinations revealed the TD recombination to the opposite bone edge of the CP, simultaneously, the proportional expansion of overlay mucoperiosteal flap was achieved The bone defect were filled with de move osteogenesis Roentgenographically, the new bone mineralization was along the DO vector, developed from the bone cut edges bilaterally to the central translucent zone until turned to thin fissure Comparison of the plaster casts showed no change in the occlusion or dentomaxillofacial framework Conclusions The intraoral distractor is able to get both effective distraction and steady fixation The examination results suggest that the CP bone and soft tissue defect could be repaired and achived functional reconstruction under DO, which could be a new treatment approach for repair of CP