“手术优先”模式治疗下颌前突前后软硬组织变化的测量分析研究

发布时间：2018-06-06 12:59

本文选题：骨性下颌前突 + 手术优先　；参考：《北京协和医学院》2017年硕士论文

【摘要】：研究目的基于手术优先治疗模式,探讨下颌前突畸形患者,首先采取单纯下颌升支矢状劈开术(BSSRO),术后快速正畸。对治疗前后颌面部软硬组织矢状方向的变化及硬软组织移位比例关系进行分析,以期能对该类患者术前术后的软硬组织侧貌变化进行客观评价,指导手术方案的制定,预测手术效果。研究方法收集2010年1月至2016年12月在中国医学科学院整形外科医院颌面整形外科中心采用手术优先模式完成治疗下颌前突畸形患者的X线头颅侧位片。将患者TO(术前)、T1(术后一周)以及T2(术后6个月及以上)的侧位片进行软硬组织相关标志点测量及分析,评价各阶段软硬组织变化情况及移位比例关系。结果手术优先模式治疗的下颌前突畸形患者,术后软硬组织发生如下变化:1)硬组织矢状方向变化:B,D,Pog,Me分别平均后退9.54mm,9.45mm,9.87mm,9.29mm(P0.001),下颌骨整体后退,下颌前突得到缓解;SNB角、ANB角、SND角趋于正常(P0.001)。2)软组织矢状方向变化:LL,Si,Pos,Mes分别平均后退8.12mm,9.96mm,10.62mm和10.12mm(P0.001),下颌软组织前突得到治疗;鼻唇角、颏唇角趋近正常水平,侧貌改善。3)各硬组织标志点的复发程度:LI、B、Pog、Me分别为22.8%、23.4%、26.1%、27.3%,但复发程度2mm。4)下颌各软组织标志点与硬组织标志点间存在较强的相关关系(r0.80),移位比例关系为 LL:LI=96.8%,SB:B=105.99%,Pos:Pog=100.2%,Mes:Me=80.8%。结论运用手术优先治疗模式治疗下颌前突畸形,能有效后退下颌骨,纠正下颌前突畸形,使上下颌骨相互位置趋于正常,侧貌外形得到显著改善。矢状方向上软硬组织变化存在较强的移位比例关系;术后6个月随访,下颌骨存在复发趋势,但移动幅度小于2mm,在可接受范围内,并且手术优先的治疗模式可以明显缩短治疗的总体时间,认为手术优先模式可以作为下颌前突畸形的一种治疗选择推广应用。
[Abstract]:Objective to investigate the patients with mandibular protruding deformity based on the mode of priority operation. Firstly, BSSRO was performed with simple sagittal splitting of the ramus of the mandible and rapid orthodontics was performed after operation. The sagittal changes of soft and hard tissues and the displacement ratio of hard and hard tissues in maxillofacial region before and after treatment were analyzed in order to objectively evaluate the changes of soft and hard tissues before and after treatment and to guide the formulation of surgical schemes. To predict the effect of operation. Methods from January 2010 to December 2016, X-ray radiographs of patients with mandibular protruding deformity were performed in the Center of Maxillofacial plastic surgery, Chinese Academy of Medical Sciences. The relative markers of soft and hard tissue were measured and analyzed by the lateral films of TOT _ 1 (one week after operation) and T _ 2 (6 months or more after operation) to evaluate the change of soft and hard tissue and the relationship between the displacement ratio and the change of soft and hard tissue in each stage. Results in the patients with mandibular protrusion malformation treated by the priority mode of surgery, the changes of soft and hard tissue were as follows: 1) the sagittal direction of the hard and soft tissue was changed as follows: the sagittal direction of the sagittal tissue of the two groups was 9.54 mm, 9.45 mm, 9.87 mm and 9.29 mm respectively, and the mandible was receding as a whole. The sagittal direction change of soft tissue of the mandibular protrusion was relieved. The sagittal direction change of the soft tissue was 8.12mm, 9.96mm, 10.62mm and 10.12mm, respectively. The mandibular soft tissue protrusion was treated, the nasolabial angle and the chin labial angle tended to the normal level. The degree of recurrence of the soft tissue markers of the mandible was 22.80.80, and the displacement ratio was the ratio of LLLII96.896.8BU 105.99 / Posto Pog100.99. The ratio of displacement was: the ratio of the soft tissue markers of the mandible to the hard tissue markers was 22.80.80, and the ratio of displacement was the ratio of the ratio between the soft tissue markers of the mandible and the hard tissue markers. The ratio of displacement was: LLWLLII96.SBBU 105.99 / P: Pog100.2P: Pog100.2A / M = 105.99. The ratio of displacement was as follows: the ratio of displacement to the soft tissue markers in the mandible was 0.80, and the displacement ratio was as follows: Conclusion the treatment of mandibular protrusion malformation by the mode of priority treatment can effectively recede the mandible, correct the mandibular protruding deformity, make the upper and lower bone position normal, and improve the appearance of the side. The changes of soft and hard tissues in sagittal direction had a strong displacement proportional relationship, and the mandible recurred at 6 months after operation, but the movement amplitude was less than 2 mm, which was within the acceptable range. The operative priority mode can significantly shorten the total time of treatment. It is considered that the surgical priority mode can be used as a treatment choice for mandibular protrusion malformation.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R783.5

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