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題 名 | 用牽開的骨發生口內裝置器治療下顎骨發育不足的效果=Efficacy of Using the Intraoral Distraction Osteogenesis Device to Treat Mandibular Hypoplasia |
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作 者 | 楊瑞賢; 丁淦; | 書刊名 | 中華牙醫學雜誌 |
卷 期 | 17:3 1998.09[民87.09] |
頁 次 | 頁148-156 |
分類號 | 416.97 |
關鍵詞 | 下顎骨發育不足; 口內裝置器; 牽開的骨發生; Mandibular hypoplasia; Intraoral device; Distraction osteogenesis; |
語 文 | 中文(Chinese) |
中文摘要 | 在治療下顎骨嚴重發育不足或是因患單側顏面矮小畸形病而造成的下 顎骨發育異常與不對稱中,以外科手術矯正是常被使用的方法;但手術的方式與 治療的時機卻常引起爭議。所以我們試著以1905年Dr. Codivilla所提出用在治療四 肢骨長短不均的"牽開的骨發生(distraction osteogenesis)"觀念,應用在患有發育異 常的下顎骨上,期能尋求一更理想的治療方法。 本研究是以7位患有嚴重下顎骨發育不足或不對稱的年輕患者(6至16歲),在其下 顎骨較嚴重發育不足的一例或雙側,作一骨皮質切開術,再放置一特別設計的口 內裝置器,並以旋轉撐開該裝置,使下顎骨中線達到一適當的位置。並分別在四 個不同階段:(T1)治療前、(T2)旋轉撐開完成固定一個月後、(T3)裝置去除後及(T4) 術後三個月,各照攝一組包含前後觀測顱分析X光片和兩張左右各45度傾斜角的 測顱X光片。並以測顱術,由X光片上測量下顎骨的長度及相關顱骨的變化。 實驗結果發現,在裝有口內裝置器的下顎骨長度,在治療前後T1和T2間有顯著的 增加(P<0.00023),而術後的穩定度也不錯(T2到T4間,P值不小於0.05,無顯著差 異)。而未治療側即沒有裝口內裝置器治療的下顎骨長度,皆呈無顯著差異。本 文雖只是初步的研究,但它已為嚴重的下顎骨畸形患者,提供一簡單、安全,又 可儘早在年少時就矯正的治療方法,值得再進一步研究。 |
英文摘要 | Mandibular hypoplasia and various degrees of asymmetry usually result from hemifacial microsomia and some forms of congenital diseases. Among all therapies, surgicalcorrection is the most often used method for treating mandibular hypoplasia. However,there are arguments concerning both the surgical approach and the timing for the operation. To seek a better treatment method and to improve the patients' esthetics, theconcept of " distraction osteogenesis " was applied, which was first reported in 1905 byCodivilla to correct limb length discrepancies. Our study focused on this new method fortreating mandibular hypoplasia. Seven young patients with severe mandibular hypoplasia or combined asymmetry(aged 6 to 16) were selected from the craniofacial clinic. From our analysis and diagnosis, of these seven patients, two patients were treated on both sides of the mandiblewith corticotomies, then the intraoral devices were installed into the surgical sites. Theother five patients were treated only on the more severely affected side. Therefore, thefive untreated sides were used as our control. We then screwed in the intraoral devicesfor all seven patients (9 mandibles) to lengthen the mandibles until the skeletal midlineswere corrected. We used a 45-lateral oblique cephalometric radiograph from both sides to measurethe change in mandibular length at four different stages: (T1) before treatment, (T2) onemonth after the end of device expansion, (T3) right after removal of the device and (T4)3 months after device removal. In addition, we took a PA cephalometric radiograph atthe four stages to measure the craniofacial bony change around the mandible. We found that the mandibular length increased significantly between T1 and T2(using a paired two tails T test, p<0.00023) in the treatment group, while no statisticalsignificance (p ≧ 0.05) was observed during the follow up from T2 to T4. In addition, nostatistical significance was found in the control group. We conclude that the length deficiency and asymmetry of the mandible could beimproved and corrected effectively by using this intraoral distraction device. This is onlya preliminary study which introduces this new treatment device. It provides a simple andsafe alternative to treating mandibular hypoplasia patients at an early stage. Furtherstudies, to explore and follow up the efficacy of this new treatment, should be encuoraged. |
本系統中英文摘要資訊取自各篇刊載內容。