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頁籤選單縮合
題名 | A Retrospective Analysis of Unfavorable Fracture during Sagittal Split Ramus Osteotomy and the Proposal of a Risk Reduction Protocol=降低下顎骨矢狀劈開術發生不當骨裂之建議流程 |
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作者 | 陳彥綦; 陳癸菁; 吳禕凡; 羅文甫; 張佩穎; 簡杏宜; 陳遠謙; Chen, Yan-chi; Chen, Kwei-jing; Wu, I-fan; Lo, Wen-fu; Chang, Pei-ying; Surianti, Hani; Chen, Michael Yuanchien; |
期刊 | 臺灣口腔顎面外科學會雜誌 |
出版日期 | 20190600 |
卷期 | 30:2 2019.06[民108.06] |
頁次 | 頁73-86 |
分類號 | 416.97 |
語文 | eng |
關鍵詞 | 正顎手術; 矢狀骨劈開術; 不良骨裂; Orthognathic surgery; Sagittal split ramus osteotomy; Bad split; |
中文摘要 | 下顎骨矢狀骨劈開術是正顎手術中一種具有高度實用性及多重適應性之方式;然而,術中所產生之非預期性不良骨裂應是每位術者都需儘量避免的。根據過去的文獻記載,非預期性不良骨裂可歸咎於兩大主因:一為病患下顎解剖構造之變異性所致;另一則為醫源性問題。即使現今的手術方式和使用器械都已多經改良,但非預期性不良骨裂有時仍是無法避免其發生的。在西元2010至2016年期間,本中心有220位病人,合計進行437處之矢狀骨劈開術;其中發生非預期性不良骨裂一共有10處(發生比率為2.28%);但迄今沒有因不良骨裂進而引起其他併發症。這10處之不良骨裂中,有9處是發生在截骨段近心端,唯有一例是發生在截骨段遠心端。在所有手術中,有143處是使用傳統的手術鋸及手術鑽,其中發生4例之不良性骨裂,發生率為2.80%;另外之294處手術則是以超音波骨刀進行,其中發生6例不良性骨裂,發生率為2.04%。根據過去之文獻記載與綜合本院過去之臨床經驗,我們歸納出五項避免不良性骨裂之步驟流程:(1)在術前需有與下顎咬合平面平行之X光斷層掃描以明瞭病患下顎骨之解剖構造;(2)根據杭薩克氏手術原則,進行低位且短距之舌側處截骨切線;(3)使用超音波骨刀以改善安仝性並提高手術效率;(4)在分離截骨段之近心端與遠心端時必需使用專用之分離器,並施於穩定且均勻之力量以行分開;(5)避免進行下顎骨矢狀骨劈開術之同時拔除下顎第三大臼齒。當進行下顎矢狀骨劈開術時,吾人應盡力避免非預期之不良性骨裂產生,因其可能造成之不良影響遠比下齒槽神經裸露來得嚴重;在我們過去的經驗中,若遭遇下齒槽神經裸露時,適當的使用超音波骨刀及對應之手術技巧即可減少術後之神經感覺異常之嚴重程度。 |
英文摘要 | Bad splits, or unfavorable fractures, could be an offensive complication during sagittal split ramus osteotomy (SSRO) in orthognathic surgery. Even with improvement of operative instruments and surgical techniques, sometimes it is still inevitable. According to literatures, iatrogenic problem and anatomic variation were acknowledged to be the two major contributing factors of bad splits. In this article, a case series of 220 patients underwent bilateral or unilateral SSRO by the same surgeon from 2010 to 2016 was reviewed. Bad splits occurred in 10 out of 437 sites (2.28%) and none of these led to compromised bone healing. These data were further divided according to the location of bad splits and surgical instruments for initial corticotomy. 9 out of 10 bad splits were observed at proximal segment while only one at distal segment. 4 bad splits occurred during 143 procedures carried out by traditional saw/bur (2.80%) and 6 out of 294 sites by Piezo corticotomy (2.04%). In light of the encouraging results from both groups using different instruments, we would like to introduce a protocol during SSRO to reduce incidence of bad splits including (1) routine pre-operative axial computed tomography (CT) made parallel to the mandibular occlusal plane for evaluation of topographic ramus anatomy, (2) short and low lingual cut according to Hunsuck's modification, (3) safe and efficient Piezo corticotomy, (4) steady splitting force by proper engagement of Smith ramus separator, last but not the least, (5) avoid simultaneous 3^(rd) molar extraction. |
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