浓缩生长因子辅助下颌骨牵张成骨术治疗Pierre Robin序列征的临床效果

Application of concentrated growth factor during mandible distraction osteogenesis in Pierre Robin sequence

目的探讨浓缩生长因子(CGF)辅助下颌骨牵张成骨术治疗Pierre Robin序列征(PRS)的临床效果。方法回顾性分析2018年1月至2019年12月南京医科大学附属儿童医院烧伤整形外科收治的PRS患儿的临床资料,根据牵张成骨术中截骨断端是否填充CGF凝胶分为CGF组和NO-CGF组。所有患儿下颌截骨后分别在双侧下颌骨各安装1个可延长2 cm的延长器,术中均予以延长5 mm,CGF组在截骨断端放置CGF凝胶,NO-CGF组在截骨断端不放置任何物质。均在术后5 d开始牵张延长,每天1次,每侧每天延长0.8~1.2 mm,延长期10~15 d,在3个月固定期后行二次手术拆除延长器。记录术后气管插管拔管时间和骨延迟愈合等并发症发生情况。结果共纳入100例PRS患儿,其中CGF组45例,男32例,女13例,出生后3~28 d,体质量2.5~3.2 kg;NO-CGF组55例,男40例,女15例,出生后3~28 d,体质量2.6~3.3 kg。术后随访3~6个月,平均4个月,所有患儿下颌体长度均增加了15~20 mm,无死亡、骨坏死等严重并发症。CGF组和NO-CGF组分别有30例和38例患儿术后立即拔除气管插管,15例和17例术后4~6 d后拔除气管插管。出院后1~3个月CGF组和NO-CGF组分别有1例和4例发生感染,0例和2例螺钉脱落,0例和8例骨愈合延迟,0例和4例下颌回缩。2组患儿在骨延迟愈合的并发症方面差异有统计学意义(P<0.05)。结论CGF辅助双侧下颌骨牵张成骨术治疗PRS,可以明显减少骨延迟愈合等并发症的发生,骨愈合良好。

Objective To investigate the clinical effect of mandible distraction combined with concentrated growth factor(CGF)for the treatment of Pierre Robin sequence(PRS).Methods This retrospective research recruited clinical data of PRS neonates from January 2018 to December 2019 in the Department of Burns and Plastic Surgery,Children’s Hospital of Nanjing Medical University.All cases were divided into CGF group(osteotomy gap filled with CGF gel during distraction osteotomy),and NO-CGF group(no CGF gel used during distraction osteotomy).Bilateral internal distractors,which could be extended by 2 cm,were fixed on mandible after mandible osteotomy.Immediate distraction for 5 mm was performed in all children during the operation.After a latency period of 5 days,the jaw was extended 0.8 to 1.2 mm once a day,and the extension period was 10 to 15 days.The distractors were surgically removed after 3 months of application.Both postoperative extubation time and complications were analyzed.Results CGF group:the male∶female ratio was 32∶13,with age ranged 3 to 28 days and weight ranged 2.5 to 3.2 kg.NO-CGF group:the male∶female ratio was 40∶15,with age ranged 3 to 28 days and weight ranged 2.6 to 3.3 kg.The total mandibular distraction length was 15 to 20 mm,and no serious complications(such as death or osteonecrosis)were observed during 3 to 6 months postoperative follow-up.68 cases(30 in CGF group and 38 in NO-CGF group)experienced immediate extubation after surgery,and 32 cases(15 in CGF group and 17 in NO-CGF group)were extubated 4 to 6 days after the operation.For postoperative complications,CGF group(1 case with infection)and NO-CGF group(4 cases with infection,2 cases of screw loss,8 cases of delayed bone union,and 4 cases of mandibular retraction)were compared respectively.Statistical significance in the complications of delayed bone union was found between two groups(P<0.05).Conclusions Mandible distraction combined with CGF is a promising technique for the management of PRS as evidenced by the low incidence of complications and improved bone union.