下颌后退术对骨性下颌前突畸形患者上气道形态影响的研究

发布时间：2018-04-21 05:26

本文选题：下颌骨矢状劈开截骨术 + 上气道　；参考：《大连医科大学》2017年硕士论文

【摘要】：目的:本研究基于CBCT数据的MMCS三维重建技术和三维配准技术,对经单纯双侧下颌升支矢状劈开后退术前后患者上气道的变化进行三维形态学评价,为单纯下颌发育过度患者手术计划的制定及治疗效果的评价提供一定的指导。材料和方法:本研究纳入单纯骨性下颌前突畸形患者5例(男性2例,女性3例),年龄20.50± 1.87岁,对纳入研究的患者进行下颌骨矢状劈开后退术,分别于术前1周,术后6个月进行CBCT扫描,将CBCT扫描数据导入M M CS17.0软件进行三维重建并对同一患者的术前术后数据进行三维配准。患者治疗前后的上气道三维形态学参数使用t检验或秩和检验,对于下颌骨水平向位置和上气道形态学参数(舌骨水平向位移H-C3、上气道体积V、腭咽体积V2、舌咽体积V3、喉咽体积V4、上气道平均横截面积Smean、上气道最小横截面积Smin、最小横截面积处前后径、左右径之比Da/Dl)的相关性关系采用皮尔森相关性检验(Pearson correlation analyze)进行分析。结果:正颌手术后,舌骨的位置随之向后方移动,上气道腭咽体积、舌咽体积、喉咽体积、平均横截面积、上气道平均横截面积、最小横截面积及最小横截面积的前后径左右径之比均显著减小。结论:单纯骨性下颌前突的患者行下颌矢状劈开后退术后,舌骨在水平向发生显著后退,上气道总体积、几个部分体积均有减小、其中腭咽、舌咽及喉咽的变化较为显著,上气道平均横截面积和最小横截面积均有显著减小,且最小横截面积处的形态更倾向于椭圆形。由于颌骨位置和上气道内空气流动的关系极其复杂,8mm以上的下颌骨后退量并非手术禁忌。
[Abstract]:Objective: to evaluate the changes of upper airway in patients with unilateral bilateral mandibular ramus sagittal splitting surgery before and after simple bilateral mandibular ramus sagittal splitting, based on MMCS 3D reconstruction and registration techniques based on CBCT data. To provide some guidance for simple mandibular hyperplastic surgery plan formulation and evaluation of therapeutic effects. Materials and methods: five patients (male 2, female 3, age 20.50 卤1.87) with simple mandibular protrusion were enrolled in this study. CBCT scanning was performed 6 months after operation. CBCT scanning data were imported into M M CS17.0 software for 3D reconstruction and 3D registration was performed on the same patient before and after operation. The three dimensional morphological parameters of upper airway before and after treatment were measured by t test or rank sum test. For the horizontal position of mandible and the morphological parameters of upper airway (horizontal displacement of hyoid H-C3, volume of upper airway V, volume of palatopharynx V2, volume of tongue pharynx V3, volume of larynx V4, mean cross sectional area of upper airway Smean, minimum cross-sectional area of upper airway Smin. The front and rear diameter of the small cross-sectional area, The correlation of the ratio of left and right diameters was analyzed by Pearson correlation analysis. Results: after orthognathic surgery, the position of hyoid bone moved to the rear. The palatopharynx volume, tongue pharynx volume, larynx volume, mean cross sectional area, mean cross sectional area of upper airway, The ratio of the minimum cross-sectional area and the minimum cross-sectional area to the anteroposterior diameter and left-right diameter decreased significantly. Conclusion: after mandibular sagittal split recession in patients with simple osteomandibular protrusion, the hyoid bone was significantly retreated horizontally, and the total volume and several partial volumes of upper airway were decreased. The changes of palatopharynx, tongue pharynx and laryngopharynx were more significant than those of palatopharynx, tongue pharynx and laryngopharynx. The mean cross-sectional area and minimum cross-sectional area of upper airway were significantly decreased, and the shape of the minimum cross-sectional area was more elliptical. The relationship between the maxillary position and the air flow in the upper airway is extremely complicated, and the mandibular receding volume above 8 mm is not contraindicated.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R782.2

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