摘要：
目的 探讨在婴幼儿下颌骨牵张成骨术中截骨线的选择方法及其意义.方法 回顾性分析2013年5月至2018年7月广州市妇女儿童医疗中心口腔颌面外科收治的208例婴幼儿下颌骨畸形患儿的临床资料,男131例,女77例,年龄8d至4岁,平均6个月.其中罗宾序列征162例,第一、二鳃弓发育不良37例,Treacher-Collins综合征2例,其他先天性畸形7例.在牵张成骨术中,根据患儿下颌骨畸形特征选择不同的截骨线:(1)对于下颌骨体部过短者,术中采用直线截骨线延长体部.(2)对于下颌骨升支过短者,术中采用折线截骨线延长升支.(3)对于下颌骨体部长轴与升支长轴夹角过大者,采用弧形截骨线改变下颌角角度.结果 208例中采用直线截骨38例、折线截骨129例、弧线截骨41例.其中4例直线截骨患者出现乳牙胚损伤,6例直线截骨患者和2例折线截骨患者出现前牙区开(牙合),弧线截骨患者未出现牙胚损伤和(牙合)关系紊乱.术后随访3个月至5年,平均6.2个月.所有患者截骨牵张区域愈合良好,未出现骨段坏死或者骨不连.结论 应根据婴幼儿下颌骨畸形特征设计下颌骨牵张成骨术截骨线,可减少牙胚损伤、(牙合)关系紊乱等并发症.%Objective To explore how to select osteotomy line and its significance in mandibular distraction osteogenesis in infants and young children.Methods From May 2013 to July 2018,208 infants and young children with mandibular deformity were admitted to the Department of Oral and Maxillofacial Surgery,Guangzhou Women and Children Medical Center,including 131 males and 77 females,with the age range of 8 days to 4 years,mean age of 6 months.Their clinical records were retrospectively analyzed.There were 162 cases of Robin sequence,37 cases of the first and branchial arch anomalies,2 cases of Treacher-Collins syndrome,and 7 cases of other congenital malformations.During the distraction osteogenesis,different osteotomy lines were selected according to the characteristics of the mandibular deformity:(1) For short mandibular body,the straight osteotomy line was used to extend the mandibular body.(2) For short mandibular ramus,a polygonal osteotomy line was used to extend the ramus.(3) For the increased mandibular angle,a curved osteotomy line was used to change the angulation.Results Linear osteotomy was used in 38 patients,polygonal line osteotomy were used in 129 patients,and curved osteotomy was performed in 41 patients.Among them,4 patients with linear osteotomy had deciduous embryo injury,6 patients with linear osteotomy and 2 patients with polygonal osteotomy had open occlusion,and patients with curved osteotomy did not have tooth and mandible damage,or malocclusion.All patients were followed up for 3 months to 5 years.The average follow-up time was 6.2 months.All osteotomy healed well,without osteonecrosis or nonunion.Conclusions For the mandibular distraction osteogenesis,osteotomy line could be individualized,according to the characteristics of mandibular deformity of infants and young children,which can reduce complications such as dental damage and open occlusion.
