牙附着式牵张成骨装置的研制及在牙槽突裂整复中的应用

Distraction osteogenesis for repair of alveolar cleft by tooth - attached intraoral distractor

目的:研制牙附着式口内牵张成骨装置整复牙槽突裂,探索牙槽突裂手术治疗的新途径。方法:自行研制牙附着式牵张装置,建立人工牙槽突裂的动物模型,8只成年杂种犬为实验组,对照组2只。以牙骨复合体作为转运盘,牵张器通过牙带环固定,并安装上颌牙弓弓丝。术后第7 d起,以每次0.4 mm的速度,每日2次沿弓丝方向行三维牵张成骨,直到关闭硬组织裂隙。0、14、28、63 d各处死动物2只,对照组动物在建立牙槽突裂模型12周后处死。进行X线摄片、大体标本和组织学观察。结果:利用牙附着式牵张装置,成功地进行牙槽突裂牵张成骨整复术,牙槽突硬组织裂隙关闭;骨牵张间隙完全为新生骨组织取代。结论:自行研制的牙附着式口内牵张装置设计合理,应用良好,牵张成骨提供了牙槽突裂治疗的新途径。

Objective-.To observe the repair of alveolar cleft (AC) bone defect under the application of distraction os-teogenesis(DO) using tooth - attached intraoral distractor ; to search a new approach for repair of alveolar cleft. Method; 10 dogs were used in the study, underwent 12 - 15mm width alveolar bone resection as experimental model of AC. The maxilliary models were taken to design and manufacture intraoral tooth - attached distractor individually. 2 dogs were control group ; 8 were experimental group, 2 weeks after the alveolar bone resection, the tooth-bone complex transport disc (TD) osteotomy were performed by vertical interdental and horizontal subapical osteotomy, at the same time the distractor and the arch wire were fixed. The gradual distraction was started after 7 days latency period at the rate of 0.4 mm twice a day along the arch wire three - dimensionally, till the TD reached the opposite edge of the AC. X - ray, gross and histology observation were performed 0, 14, 28, 63 day after completion of distraction. Result: all the examinations revealed the TD recombination to the opposite edge of the AC; Radiographically and histologically, distraction gap was bridged and new alveolar bone was generated and remodeled. Conclusion: The intraoral tooth - attached distractor can get effective distraction and stable fixation. The study results suggest that the AC hard and soft tissue defect could be repaired and achieved functional reconstruction under DO, which could be a new treatment for AC.