【作者】 应彬彬；

【导师】 胡静；

【作者基本信息】 四川大学 ， 口腔临床医学， 2006， 博士

【摘要】 颏部缺损多继发于外伤及肿瘤术后，它给患者带来非常严重的功能障碍和容貌损毁，是口腔颌面整复外科领域内最具挑战的难题之一。应用骨移植等传统疗法不仅手术复杂，增加了供区的创伤，术后还存在移植骨感染坏死的风险；而即使移植成活，也与真正意义上的形态和功能重建相去甚远。输送盘牵张成骨术(Transport distraction osteogenesis)是一种矫治骨骼缺损的新的的理论和技术，该技术为颅面骨骨缺损提供了一种新的效果良好的治疗途径。但是，由于下颌骨为形态较特殊的弓形不规则骨，加之颏部具有的独特外形，使得用DO技术整复颏部骨缺损仍相当困难，目前还处于探索阶段。Sawaki等通过弓形面具式牵张器应用带输送盘(transport disc)的三点(trifocal)DO术，进行颏部缺损重建的临床尝试；虽获成功，但存在牵张器体积庞大，不美观等缺点。Annino等选用犬类进行颏部缺损重建的实验研究，其下颌骨和颏部形态与人类相去甚远，难以模拟人类弓形下颌骨的缺损。 本实验采用自行设计和研制的可调式多平面牵张器，选用与人下颌骨及颏部形态最为接近的灵长类动物一恒河猴作为实验动物，建立猴颏部骨缺损的动物模型，并探究三焦点牵张成骨修复颏部骨缺损的形态学改变。同时，通过对正常下颌骨在受咀嚼力作用下应力分布情况进行三维立体的有限元更多还原

【Abstract】 Reconstruction of mandibular symphyseal defects caused by cancerablation surgery or trauma remains a challenge in oral and maxillofacial field. Traditionally bone transportation from the fibula, ilium, scapula or costa, and implants such as metal plates and ceramics has been used in clinic. However the weaknesses of bone graft still exist, it may result in secondary donor site morbidity, and artificial materials retain the characteristics of a foreign body for the host.Since distraction osteogenesis as a technique was firstly applied to lengthen canine mandible in 1973 and used clinically in 1992, it seemed to be a promising new method in craniofacial bone lengthening and reconstruction through the process of bone and soft tissue regeneration under stimulation of gradual tensile stress. However, there have been some problems in using this technique to repair the defects of the mandibular symphyseal, which are in the arched contour. In 1997, Sawaki et al used a distraction device to reconstruct anterior defect of mandible in a patient treated for an oral floor cancer. However, bone graft was inevitable because the bone gap still remained between two transported segments after the completion of distraction. Therefore, in craniofacial bones trifocal distraction osteogenesis needs further investigation.In this experiment, four adult rhesus monkeys were used in this study. The更多还原