HDPP在面部凹陷畸形整复中临床应用.docVIP

HDPP在面部凹陷畸形整复中临床应用 　 作者：沈剑 陈小平 林洁 杨甄宇 【摘要】 目的 对高密度多孔聚乙烯(HDPP )面部植入体进行了临床回顾，以评价其临床应用价值。 方法 对67例求术者（77枚植入体）进行了3～48个月的临床随访观察。所有求术者采用骨膜下植入，钛钉固定。其分布为：前额4例、颞部2例、颧部10例、鼻底23例、下颌6例、颏部22例。 结果 所有求术者面部轮廓改善满意，无植入体外露、移动或移位、无组织变形及挛缩。再次手术率为7.5%，其原因为：感染和植入外形不满意。 结论 HDPP是一种良好的面部轮廓植入支架材料。坚强内固定技术可使植入体精确定位，并可防止植入体移位。 【关键词】 高密度多孔聚乙烯 外科植入体 面部骨轮廓 　　【Abstract】 Objective A retrospective review of clinical outcomes was performed to determine the clinical utility and morbidity associated with the use of high-density porous polyethylene (HDPP) facial implants . Methods Seventy implants were placed in 67 patients. The distribution of implants according to location was as follows: 4 frontal; 2 temporal; 10 malar; 23 nasal bottom; 6 mandible, and 22 chin. All implants were placed in the subperiosteal plane and were fixed with titanium screws . Results The operative effects were satisfactory during 3-48 months of follow-up. No implants were extruded or migrated, no metaplasia or crispation, no symptoms attributable to bioincompatibility. The overall reoperation rate was 7.5 percent (n= 5), which included operations to remove implants because of a late infection (n=3), to remove implants causing displeasing contours (n= 2). Conclusions Porous polyethylene implants have biomaterial properties favorable for facial skeletal augmentation. Screw application of the implants to the skeleton allows precise predictable contouring, thus saving revisional surgical procedures. 　　【Key words】High-density porous polyethylene Surgery implant Facial skeletal contour 　　应用生物材料植入对存在缺陷的面部骨支架进行充填重塑，是面部凹陷畸形修复的主要方法之一［１］。作者自2003年7月至2006年5月采用高密度多孔聚乙烯(High-density porous polyethylene ,HDPP)对存在凹陷畸形的面部轮廓进行了重塑，获得了良好效果，现报告如下。 　　1 临床资料 　　1.1 一般资料 　　本组67例中男26例，女41例；年龄17～42岁。均为面部轮廓凹陷畸形者，其中额部4例、颞部2例、颧骨过小10例、唇裂术后鼻底塌陷23例、下颌体过小6例、小颏22例。所用植入体均为HDPP，共77枚，其分布为：额部4枚、颞部4枚、颧部18枚、上颌23枚、下颌6枚、颏部22枚。 　　1.2 手术方法 　　(1)麻醉：全麻或0.5%利多卡因加1:200000肾上腺素局部浸润麻醉。(2)切口：面部塑形采用口内切口，切开粘膜、肌层及骨膜，用骨膜分离器行骨膜下剥离，显露神经血管束（眶下神经或颏神经），将其松解并予以保护。额部及颞部则行冠状切口，骨膜下分离。(3)植入体置入：骨