口内入路改良牵引成骨与口外入路牵引成骨矫治儿童期半侧颜面短小畸形的临床效果探讨

Clinical efficacy of modified distraction osteogenesis via intraoral approach and distraction osteogenesis via extraoral approach in the treatment of hemifacial microsomia in childhood

目的比较口内入路改良牵引成骨与口外入路牵引成骨两种方法治疗儿童期半侧颜面短小畸形(hemifacial microsomia,HFM)的临床效果。方法收集自2015年1月至2021年1月就诊于中国医学科学院北京协和医学院整形外科医院数字化颌面整形中心符合入组要求的52例HFM患者术前、术后三维头颅CT资料,其中口内入路改良牵引成骨者22例(口内组),口外入路牵引成骨者30例(口外组)。通过数字化软件Proplan 3.0对下颌骨长度、宽度、厚度及颏偏距进行三维测量,并对各项三维测量指标进行统计分析,随访6~24个月。结果两组患者面部对称性均获得明显改善。在下颌骨长度延长上,口外组较口内组改善明显,差异具有统计学意义(P<0.05);在下颌骨厚度增加上,口内组与口外组差异无统计学意义(P>0.05);在下颌骨宽度维持上,口内组较口外组改善明显,差异具有统计学意义(P<0.05);口内组的术后瘢痕评分(2.0分)明显低于口外组(8.1分)。结论两种牵引成骨方法各有优势,临床上需要根据患者HFM严重程度选择合适的牵引成骨方法,才能获得最佳效果。

Objective To compare the clinical efficacy of modified distraction osteogenesis via intraoral approach and distraction osteogenesis via extraoral approach in the treatment of hemifacial microsomia(HFM)in childhood.Methods From January 2015 to January 2021,52 children with HFM were selected according to the inclusion criterion.The data of preoperative and postoperative head CT in all children were collected.In these children,22 cases underwent modified distraction osteogenesis via intraoral approach(intraoral group)and 30 cases underwent distraction osteogenesis via extraoral approach(extraoral group).The three-dimensional measurement of length,width and thickness of mandibular ramus was performed by Proplan 3.0 software.Statistical analysis of the three-dimensional measurement index was also conducted.All children were followed-up for 6 to 24 months.Results The facial asymmetry was significantly improved in both groups.The extension of mandibular ramus length in the extraoral group was significantly improved compared with the intraoral group(P<0.05).There was no statistical significance between intraoral group and extraoral group in terms of thickness of mandibular ramus(P>0.05).In the maintenance of width of mandibular ramus,the intraoral group was significantly improved compared with extraoral group(P<0.05).The scar scores in the intraoral group was significantly lower than that in the extraoral group(2.0∶8.1).Conclusion Two methods of distraction osteogenesis have their own advantages.Therefore,to acquire the best clinical efficacy,surgeons should select the suitable method according to the actual situation of children with HFM.