单纯BSSRO-术后快速正畸治疗下额前突的可行性研究

发布时间：2018-06-10 00:37

本文选题：下颌前突 + 颞下颌关节　；参考：《北京协和医学院》2015年博士论文

【摘要】：目的：探讨采用坚强内固定的单纯双侧下颌升支矢状劈开截骨成形术(bilateral sagittal split ramus osteotomy, BSSRO)-术后快速正畸治疗下颌前突(mandibular prognathism, MP)的术后复发率情况及影响复发的相关因素,以及治疗后颞下颌关节(temporomandibular joint, TMJ)位置的变化及与传统治疗方法的差别,为临床应用及改进提供理论依据。方法：本研究纳入了2012年01月至2014年10月在中国医学科学院整形外科医院颅颌面中心2接受治疗的18位MP患者(男性9位,女性9位),术前未正畸,直接行BSSRO-术后快速正畸治疗,术前(TO)、术后5天(T1)及术后1年及以上(T2)拍摄头颅侧位X片。应用计算机软件MedCeph4.0.1.x进行标志点测量。其次对24位MP患者(男性8位,女性16位)在术前及术后1年进行头颅计算机断层(computed tomography, CT)扫描并三维重建。面部对称及不对称组12位,根据中线角设为偏颌侧和非偏颌侧。应用医学成像软件Proplan 14对术前术后TMJ位置进行测量,并与传统治疗方法进行比较(参照2012年日本学者Ueki发表的文献)。应用统计学软件SPSS17.0进行数据分析。结果：18位患者经单纯行BSSRO-术后快速正畸治疗,术后效果满意,无术后并发症。在水平向上,B点在T1较TO平均后退7.5mm,在T2较T1平均前移21mm(28.0%)。Pog点在T1较TO平均后退6.6mam,在T2较T1平均前移29mm(43.9%)。在垂直向上,B点(1.3mm)和Pog点(1.0mm)在T1较TO向下移,在T2较T]向上移(分别为0.1mm和0.3mm)。Ramus angle在T1较TO平均增加4.3。,在T2较T1平均减小1.1。(25.6%)。在水平向和垂直向,B点和Pog点的后退距离(T1-TO)与术后长期改变的距离(T2-T1)无显著相关性(P0.05)。Ramus angle的改变(T1-TO)与Pog点的改变(T2-T1)无显著相关性(P0.05)。对24位患者头颅CT进行分析,结果显示在面部对称组,术前偏颌侧与非偏颌侧对比各参数无显著性差异(P0.05)；在面部不对称组,术前矢状位升支角偏颌侧明显小于非偏颌侧(P=0.023)；术前偏颌侧面部对称组与面部不对称组相比各参数统计学无显著性差异(P0.05),非偏颌侧面部对称组冠状位升支角明显大于面部不对称组(P=0.0161)。在面部对称组,偏颌侧术前术后各参数无显著性差异,非偏颌侧冠状位髁突角(P=0.0355)及前间隙(P=0.0412)术后明显大于术前；偏颌侧与非偏颌侧对比术前术后各参数变化值无显著性差异(P0.05)。在面部不对称组,偏颌侧术前术后各参数无显著性差异(P0.05),非偏颌侧冠状位升支角(P=0.0175)及矢状位升支角(P=0.0398)术后明显大于术前；上间隙术后明显小于术前(P=0.0319)。在面部对称组及面部不对称组,偏颌侧与非偏颌侧对比术前术后各间隙变化幅度无明显差异(P0.05)。经单纯BSSRO-术后快速正畸治疗MP患者,其TMJ位置各参数的变化值与传统治疗方法相比,在面部对称组,偏颌侧及非偏颌侧关节后间隙的变化存在显著性差异(P值分别为0.007和0.037),变化幅度均小于传统治疗方法：在面部不对称组,偏颌侧各参数变化值无显著性差异,非偏颌侧关节上间隙的变化存在显著性差异(P=0.020),变化幅度大于传统治疗方法。结论：单纯行BSSRO-术后快速正畸治疗MP存在一定的复发率,但是复发程度与B点和Pog点及ramus angle术中改变程度无显著线性相关性。在面部对称组,术前偏颌侧与非偏颌侧TMJ位置相近；在面部不对称组,术前矢状位升支角偏颌侧较非偏颌侧小；术前非偏颌侧面部对称组冠状位升支角较面部不对称组大。经单纯BSSRO-术后快速正畸治疗MP,面部对称组的非偏颌侧术后冠状位髁突角及前间隙出现了扩张,面部不对称组的非偏颌侧术后冠状位升支角及矢状位升支角增加,上间隙缩小,而偏颌侧无明显改变。在面部对称组及面部不对称组,偏颌侧与非偏颌侧对比术前术后各间隙变化幅度相近。与传统的MP矫正方法比较,单纯BSSRO-术后正畸治疗在面部对称组偏颌侧及非偏颌侧髁突关节后间隙位置变化小于传统治疗方法,而在面部不对称组非偏颌侧上间隙位置变化大于传统治疗方法。
[Abstract]:Objective: To investigate the recurrence rate of bilateral sagittal split ramus osteotomy (BSSRO) and postoperative rapid orthodontic treatment of the mandibular protrusion (mandibular prognathism, MP) and the related factors affecting the recurrence, and the temporomandibular joint (temporoma) after treatment (temporoma). The changes in the position of NDIBULAR joint, TMJ) and the difference from the traditional treatment methods provide a theoretical basis for clinical application and improvement. Methods: This study included 18 MP patients (9 men, 9 women) who were treated in the Craniofacial Center of Plastic Surgery Hospital, CAMS, PUMC from 01 to October 2014 2012. Rapid orthodontic treatment after BSSRO-, preoperative (TO), 5 days after operation (T1) and 1 years and above (T2) were taken to photograph the lateral head of the head. Use the computer software MedCeph4.0.1.x to measure the mark point. Secondly, 24 MP patients (8 men, 16 women) were scanned by the skull computed tomography (computed tomography, CT) before and 1 years after the operation and three. Reconstruction. 12 positions of facial symmetry and asymmetry group were set at the midline angle to the mandibular and non mandibular sides. Proplan 14 was used to measure the position of TMJ before and after operation with the medical imaging software, and compared with the traditional method of treatment (referring to the literature published by Japanese scholar Ueki in 2012). The data should be analyzed with statistical software SPSS17.0. 18 patients were treated with rapid orthodontic treatment after simple BSSRO- operation. The postoperative effect was satisfactory without postoperative complications. At the level of level, the B point was 7.5mm in T1 compared with the TO average, and 21mm (28%).Pog at T2 compared to T1 averaging (43.9%). Move up and move up in T2 than T] (0.1mm and 0.3mm).Ramus angle increase 4.3. at T1 compared with TO, and T2 is less than T1 average 1.1. (25.6%). 1) there was no significant correlation (P0.05). 24 patients with cranium were analyzed. The results showed that there was no significant difference between the preoperative partial maxillary and the non mandibular side (P0.05) in the facial symmetry group (P0.05), and in the facial asymmetry group, the sagittal angle of the ascending branch was significantly smaller than the non lateral maxillary side (P=0.023) before the operation, and the symmetry group and the face in the lateral maxillary group before the operation. There was no significant difference between the asymmetric group and the parameters (P0.05). The angle of the coronal ascending branch in the asymmetric group of the non maxillary side was obviously greater than that of the facial asymmetry group (P=0.0161). In the facial symmetry group, there was no significant difference in the preoperative and postoperative parameters, and the non lateral coronal condyle angle (P=0.0355) and the anterior space (P=0.0412) were obviously greater than the operation. There was no significant difference between the preoperative and postoperative parameters (P0.05). In the asymmetric facial group, there was no significant difference in the parameters (P0.05), the unbiased coronal elevation (P=0.0175) and the sagittal angle of ascending branch (P= 0.0398) were significantly higher than those before the operation. Before (P=0.0319). There was no significant difference in the gap between the facial symmetry group and the facial asymmetry group. There was no significant difference in the gap between the partial maxillary and the non mandibular sides (P0.05). The changes of the parameters of the TMJ position of the MP patients after the simple BSSRO- operation were compared with the traditional treatment methods, in the facial symmetry group, the partial maxillary side and the unbiased side joint. There was a significant difference in the changes of the posterior space (P value was 0.007 and 0.037 respectively), and the change amplitude was less than the traditional treatment method: there was no significant difference in the change values of the parameters of the anomandibular side in the asymmetric facial group, and there was a significant difference in the changes of the upper intermaxillary joint space (P=0.020), and the change amplitude was greater than the traditional treatment method. Conclusion: simple There was a certain recurrence rate in the rapid orthodontic treatment of MP after BSSRO-, but there was no significant linear correlation between the degree of recurrence and the degree of change of B points and Pog points and ramus angle. In the facial symmetry group, the preoperative partial maxillary side was similar to the unbiased TMJ position; in the facial asymmetry group, the sagittal angle of the ascending branch of the maxillofacial side was smaller than the non maxillary side. The coronal ascending branch angle of the anterior non lateral maxillary side was larger than that in the asymmetric face group. After the simple BSSRO- treatment of MP, the coronal condyle and the anterior space of the facial symmetry group expanded. The ascending branch angle and the sagittal angle of the sagittal position increased and the upper space narrowed after the unbiased facial asymmetry group. There was no obvious change in the lateral maxillary side. In the facial symmetry group and the facial asymmetry group, the changes in the gap between the partial maxillary and the non mandibular sides were similar. Compared with the traditional MP correction method, the post BSSRO- orthodontic treatment in the facial symmetry group was less than the traditional treatment side in the facial symmetry group and the non partial maxillary condyle joint. However, in the facial asymmetry group, the position of the non maxillary side gap was larger than that of the traditional treatment.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R782.2

【参考文献】