骨性Ⅲ类错颌患者正颌手术先行1年后上气道变化的流体力学研究

发布时间：2018-06-02 05:55

本文选题：骨性Ⅲ类错颌畸形 + 手术先行　；参考：《山东大学》2017年硕士论文

【摘要】：研究背景和目的骨性Ⅲ类错牙合畸形是一类由于颌骨生长发育异常而导致上下颌骨间大小、形态、位置不调的错牙合畸形,是正畸临床治疗中常见的主动就诊原因。对于已无生长发育潜力的严重骨性Ⅲ类错颌成人患者往往需要通过正畸—正颌联合矫治来重建颔骨的三维空间关系。近年来,手术先行的治疗模式(Surgery-First Approach,SFA)逐渐兴起,相对于传统的正颌手术模式,SFA具有早期改善容貌、治疗周期短、降低正畸治疗难度的优点。正颌手术中上下颌骨需要大范围的移动,其位置的改变会对上气道形态和功能产生影响,临床中易发生术后阻塞性睡眠呼吸暂停综合征(0SAHS)。而以往学者对正颌治疗前后患者上气道变化的研究多基于传统正畸-正颌联合治疗患者的数据,手术先行患者的数据没有得到足够的重视。该术式对于上气道通气功能影响的研究还比较少。本实验通过CBCT对成人骨性Ⅲ类错颌患者正颌手术前后上气道及其周围组织变化进行观察,建立上气道流体力学(Computional Fluid Dynamics,CFD)模型,模拟上气道内的气流流动,研究分析正颌手术(SFA)术前术后上气道气流流场变化,为骨性Ⅲ类错牙合患者在术后的正畸治疗阶段的矫治方案制定提供参考。材料和方法本研究随机选取台湾风华整形联合医院就诊的骨性Ⅲ类错牙合畸形患者11例,其中男性4例,女7例,年龄20~28岁。患者均接受正畸-正颌手术先行(SFA)治疗。正颌术式:上颌Le Fort Ⅰ型骨切开术+下颌升支矢状骨劈开术(SSRO)+颏成形术。所有患者均于术前一周(TO)及术后12个月(T1)拍摄CBCT。将获取的CBCT Dicom格式数据导入Mimics 17.0中进行三维重建,导出STL数据文件并导入到ANSYS 16.0软件中,修整上气道三维模型后进行网格划分,建立流体力学分析的三维模型,并对其行数值模拟。使用SPSS 19.0软件进行统计学分析,使用配对样本t检验比较T0、T1组测量数据。咽部压降与上气道各形态学参数变化的相关关系采用皮尔森相关性检验(Pearson correlation analyze)方法分析。结果1、接受正颌手术(SFA)的骨性Ⅲ类患者术后上气道形态学变化:①鼻咽段和腭咽段的容积及横截面积增加(P0.05),且该部分气道的LR/AP值增大,相对于治疗前气道形态更加趋近于圆形;②舌咽段和喉咽段的容积及横截面积减小,其中舌咽段的变化最为显著(P0.01),该部分气道的LR/AP减小,其形态更加趋近于椭圆形。2、接受正颌手术(SFA)的骨性Ⅲ类患者术后上气道流场特征变化:①随着上气道内气流压力的变化,治疗后鼻咽部、腭咽部的气体流速较治疗前分别降低5.04±1.51%和11.48±1.91%(P0.05);而舌咽部及喉咽部的气体流速较治疗前分别升高 29.16±3.57%和 13.26±2.56%(P0.05)。②上气道的压降在鼻咽和腭咽段降低,舌咽和喉咽段升高,其中舌咽段变化最显著。上气道整体压降较治疗前上升了 7.71±1.98%(P0.05)。同时对舌咽段的压降变化量与形态学参数行相关性检验,可见舌咽段的压降与它的最小横截面积、体积和舌咽形态一致性呈现负相关(P0.05)。结论骨性Ⅲ类患者接受正颌手术(SFA)一年后,鼻咽及颚咽部气道变大,而舌咽及喉咽气道减小。上气道形态整体仍呈现窄缩的趋势,气流阻力有所增大,其中以舌咽段阻力增大最为显著,上气道的通气功能较术前有所下降。
[Abstract]:Background and objective orthodontic malocclusion is a kind of malocclusion which is caused by the abnormal growth and development of the jaw, which leads to the malocclusion of the size, shape and position of the maxilla. It is a common cause of active treatment in orthodontic clinical treatment. Orthodontic orthodontic orthodontic treatment is used to reconstruct the three-dimensional spatial relationship of maxillary bone. In recent years, the Surgery-First Approach (SFA) is gradually rising. Compared with the traditional orthognathic mode, SFA has the advantages of early improvement, short period of treatment, and reduction of the difficulty of orthodontic treatment. The maxilla needs a large range of maxillary operations in orthognathic surgery. The changes in position will affect the morphology and function of the upper airway, and the postoperative obstructive sleep apnea syndrome (0SAHS) is easy to occur in the clinic. The previous scholars' study on the upper airway changes in the patients before and after the orthognathic treatment is based on the data of the traditional orthodontic orthodontic combined treatment of the patients, and the data of the patients who were first operated were not obtained. Sufficient attention is given. The study on the effect of the operation on the upper airway ventilation is still less. In this experiment, CBCT was used to observe the changes in the upper airway and surrounding tissues of the adult type III malocclusion patients before and after the orthognathic operation. The upper airway fluid mechanics (Computional Fluid Dynamics, CFD) model was established to simulate the flow of airflow in the upper airway. The changes in the airflow flow field of the upper airway before and after the operation of the orthognathic operation (SFA) were analyzed, and the reference was provided for the orthodontic treatment of orthodontic type III malocclusion patients. Materials and methods randomly selected 11 cases of orthodontic malocclusion in the Taiwan Fenghua Plastic joint hospital, including 4 males and 7 females. Age 20~28 years. Patients received orthodontic orthognathic surgery (SFA) treatment. Orthognathic surgery: maxillary Le Fort I osteotomy + mandibular ramus sagittal osteotomy (SSRO) + genioplasty. All patients took CBCT Dicom format data obtained by CBCT. before operation (TO) and 12 months after operation (T1) to carry out three dimensional weight in Mimics 17. The STL data file is derived and imported into the ANSYS 16 software, the three-dimensional model of the upper airway is trimmed, the three-dimensional model of the hydrodynamics analysis is set up, and the numerical simulation of the hydrodynamics analysis is established. The statistical analysis is carried out with the SPSS 19 software, the T0, the T1 group measurement data are compared with the paired sample t test. The pharyngeal pressure drop and the upper airway form are compared. The correlation of the changes of the parameters was analyzed by the Pearson correlation test (Pearson correlation analyze). Results 1, the morphological changes in the upper airway of the patients with orthopathic operation (SFA) after operation (SFA): (1) the volume and cross section of the nasopharyngeal and palatopharyngeal segments increased (P0.05), and the LR/AP value of this part of the airway was increased, relative to the treatment. The morphology of the anterior airway is closer to the circle, and the volume and cross section of the glossopharyngeal and hypopharynx segments decrease, and the changes in the glossopharyngeal segment are most significant (P0.01). The LR/AP of this part of the airway is reduced, and its morphology is closer to the oval.2. The characteristics of the upper airway flow field after the orthostic surgery (SFA) are characterized by the changes in the upper airway flow field: (1) with the upper airway The changes in internal flow pressure, the flow velocity of the nasopharynx and palatopharynx after treatment was 5.04 + 1.51% and 11.48 + 1.91% (P0.05), respectively, while the gas flow rate of the tongue pharynx and laryngopharynx increased by 29.16 + 3.57% and 13.26 + 2.56% (P0.05), respectively. The pressure drop of the upper airway was reduced in the nasopharynx and palatopharyngeal segment, and the hyossopharyngeal and laryngopharynx Duan Shenggao The overall pressure drop of the upper airway was 7.71 + 1.98% (P0.05) higher than that before the treatment. At the same time, the correlation between the pressure drop of the glossopharyngeal segment and the morphological parameters showed that the pressure drop of the glossopharyngeal segment was negatively correlated with the minimum cross section area, the volume and the conformation of the glossopharyngeal shape (P0.05). After one year of orthognathic surgery (SFA), the nasopharyngeal and maxillary pharynx airway became larger, and the glossopharyngeal and larynglopharynx airways decreased. The overall upper airway morphology remained narrow and the airflow resistance increased, among which the resistance of the glossopharyngeal segment was the most significant, and the ventilation function of the upper airway was lower than that before the operation.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R783.5

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