正畸—正颌联合治疗骨性Ⅲ类错（牙合）畸形软硬组织的变化及对其生活质量的影响
发布时间：2018-08-25 14:21
【摘要】：目的:1.分析比较成人骨性Ⅲ类错(牙合)畸形在正畸-正颌联合治疗前后头影测量软硬组织的改变,评价正畸-正颌联合治疗对成年人骨性Ⅲ类错(牙合)畸形的治疗效果。2.通过在治疗前、中、后的不同阶段对上述患者进行口腔健康影响程度量表(OHIP-14)和正颌患者生活质量调查问卷(OQLQ)的问卷调查,分析以上患者在治疗前、中、后口腔健康相关生活质量(OHRQOL)的变化,探讨正畸-正颌联合治疗对其的影响。3.探讨患者术后头影测量指标的改变与其生活质量之间的关系。材料与方法:1.选择2014年3月~2017年4月年广西医科大学附属口腔医院经正畸-正颌联合治疗完成的21例骨性Ⅲ类错(牙合)畸形患者(排除唇腭裂、Down综合征等先天遗传性疾病的患者),其中男性11例,女性10例,年龄范围为18~27岁(治疗开始时的年龄),平均年龄20.3岁。所有患者均经过术前正畸-正颌会诊讨论,制定正畸-正颌联合治疗方案,并行术前正畸、模型外科、正颌手术、术后正畸、保持等治疗步骤。每位患者分别在治疗前(术前正畸开始前)、治疗后(术后正畸结束后)拍摄X线头颅定位侧位片。所有患者进行治疗前和治疗后头颅侧位片的X线头影测量分析,并使用SPSS 20.0统计学软件分析测量数据,比较治疗前后颅颌面部及上下颌骨软硬组织X线头影测量值的变化。2.对上述每一例患者进行OHIP-14和OQLQ问卷调查,分别在术前正畸开始前(T0)、正颌手术前1周(T1)、正颌手术后3-6个月(T2)三个时间点进行问卷调查,同时随机选取平均年龄无统计学差异的普通人群(Tc)40例进行问卷调查作为对照组进行比较。OHIP-14的每份问卷均包含有14个项目,7个领域。各个项目的自我评价分为5个级别(0~4级),并依次计为0~4分,测得在上述不同时间点每位患者及对照组的生活质量影响分数,得分越高则说明在相应的时间点被测者的生活质量越差。问卷总分范围为0~56分,每个领域分值范围为0~8分。OQLQ则包括四个领域22个项目,分别为口腔功能、面部美学、牙颌面畸形的自我感知以及社会交往。该测量表格的评分标准为四点量表,0至3依次增加表示了该行为的影响逐渐增大(即数值越大说明影响越大)。使用SPSS 20.0统计学软件记录数据并进行分析,对量表的得分情况进行统计描述,并采用Wilcoxon秩检验分别对21位患者的治疗前、中、后以及治疗后与正常组比较进行统计学分析,探讨骨性Ⅲ类错牙合畸形患者正畸-正颌联合治疗过程中患者的心理状态、身体机能、社会交往等方面因口腔健康的影响而产生的变化,绘制患者治疗前、中、后及正常对照组问卷总分变化曲线,探讨其变化的原因以及应对措施,为后续的治疗方案提供理论依据。在患者术后头影测量指标的改变与其生活质量间关系的探讨中,将纳入SNA角,SNB角,ANB角,Go-Pg,ANS-Me,ANSMe/NMe,U1-L1角,UL-EP,LL-EP,Z角,N-Sn-Pg角,wits值(mm)等头影测量指标,应用SPSS 20.0来计算这些指标的改变与患者生活质量(OQLQ and OHIP 14)间的相关性。结果:1.经正畸-正颌联合治疗,骨性III类错(牙合)畸形患者的SNA角变大,SNB角变小(P0.05),ANB角与Wits值显著增大(P0.01),提示颅骨与颌骨、上颌骨与下颌骨之间的相对位置得到改善;Go-Pg明显减小(P0.01),提示下颌骨长度变短,Go-Co无明显变化,提示下颌升支无明显改变,Ptm-A,Ptm-s无明显变化,提示上颌骨长度及位置无明显改变;SN-MP,ANS-Me/N-Me减小(P0.05),ANS-Me明显减小(P0.01),提示面高变短,面高比例更协调;U1-SN角,U1-NA角变小,L1-MP角变大(P0.05),U1-NA距明显变小(P0.01),提示上前牙舌倾去代偿,下前牙唇倾去代偿;N-Sn-Pg,Z angle,UL-EP,LL-EP明显减小(P0.01),提示患者软组织发生改变,面型发生变化,由凹面型变为直面型,与治疗前相比得到显著改善。2.在OHIP-14中:心理疾病、心理障碍、社会障碍三个指标的T2显著低于T0和T1(P0.01),且T1大于T0,T1大于T2(P0.05),三者均有统计学意义,而T2与T3相比较无统计学意义;在OQLQ中:四个领域中的T2均小于T0与T1,T1大于T0,二者差异均有统计学意义(P0.01),T2与Tc无统计学意义。说明经过正畸-正颌联合治疗后,在OHIP-14中患者的心理疾病、心理障碍、社会障碍三个指标得到显著改善并与普通人群调查结果无统计学差异,在OQLQ中,患者的口腔功能、面部美学、自我感知以及社会交往四个领域均得到显著改善并与普通人群调查结果无统计学差异。在骨性III类错(牙合)畸形患者中,颌凸角、下唇突度以及上下颌骨之间的关系对其生活质量影响最大。结论:1.成人骨性Ⅲ类错(牙合)畸形患者经过系统的正畸-正颌联合治疗后,III类骨面型得到显著改善,治疗效果确切。2.骨性Ⅲ类错(牙合)正畸-正颌联合治疗对患者的口腔健康相关生活质量有一定的改善,虽然在术前正畸去代偿后,患者的生活质量(quality of life,QOL)在手术前一段时间内有暂时的降低,但在全部治疗完成后,OQLQ调查发现患者的生活质量在各个领域均得到提高,并显著高于治疗前,与普通人群无统计学差异。因此正畸-正颌联合治疗能够改善成人骨性Ⅲ类错(牙合)畸形患者的口腔健康及相关生活质量。治疗后患者软硬组织的改变与其生活质量的改善显著相关。
[Abstract]:Objective: 1. To analyze and compare the cephalometric soft and hard tissue changes in adult skeletal class III malocclusion before and after orthodontic-orthognathic treatment, and to evaluate the effect of orthodontic-orthognathic treatment on adult skeletal class III malocclusion. 2. To evaluate the oral health impact of the above patients at different stages before, during and after treatment. The changes of oral health-related quality of life (OHRQOL) before, during and after treatment were analyzed by OHIP-14 and OQLQ questionnaires. The effects of orthodontic-orthognathic treatment on the quality of life were discussed. 3. The relationship between the changes of cephalometric parameters and the quality of life was investigated. Methods: 1. Twenty-one patients with skeletal class III malocclusion (excluding cleft lip and palate, Down syndrome and other congenital inherited diseases) were selected from the Department of Stomatology Affiliated to Guangxi Medical University from March 2014 to April 2017. Among them, 11 were males and 10 were females, aged 18-27 years (the first year of treatment). The average age was 20.3 years. All patients underwent orthodontic-orthognathic consultation before operation and formulated a combined orthodontic-orthognathic treatment plan. Preoperative orthodontics, model surgery, orthognathic surgery, postoperative orthodontics, and maintenance were performed. Each patient was taken X-ray skulls before treatment (before the beginning of orthodontic surgery), after treatment (after the end of orthodontic surgery). The cephalometric data were analyzed by SPSS 20.0 statistical software. The cephalometric values of craniomaxillofacial and maxillofacial soft and hard tissues were compared before and after treatment. 2. OHIP-14 and OQLQ questionnaires were conducted in each of the patients. At the same time, 40 normal subjects (Tc) with no significant difference in average age were randomly selected as control group. Each questionnaire of OHIP-14 contained 14 items and 7 fields. Objective Self-evaluation was divided into five grades (0-4 grades) and scored 0-4 points in turn. The higher the score, the worse the quality of life. The total score of the questionnaire ranged from 0-56 points, and the score of each field ranged from 0-8 points. Twenty-two items in each field, namely, oral function, facial aesthetics, self-perception of dentofacial deformities, and social interaction, were scored on a four-point scale, with 0-3 increasing in turn indicating a gradual increase in the impact of the behavior (i.e., the greater the value, the greater the impact). Data were recorded and scored using SPSS 20.0 statistical software. The scores of the scale were statistically described. The Wilcoxon rank test was used to analyze the mental state, physical function and social interaction of 21 patients with skeletal class III malocclusion before, during, after and after treatment. In order to provide a theoretical basis for the follow-up treatment, the change curves of the total scores of the questionnaires before, during, after and in the normal control group were drawn, and the causes and countermeasures were discussed. Cephalometric parameters such as SNB angle, ANB angle, Go-Pg, ANS-Me, ANSMe/NMe, U1-L1 angle, UL-EP, LL-EP, Z angle, N-Sn-Pg angle, with value (mm) were measured. SPSS 20.0 was used to calculate the correlation between the changes of these parameters and the quality of life (OQLQ and OHIP 14). Results: 1. After orthodontic-orthognathic treatment, the SNA angle of the patients with skeletal class III malocclusion (occlusion) became larger and SNB angle was higher. Angle became smaller (P 0.05), ANB angle and Wits value increased significantly (P 0.01), suggesting that the relative position between skull and jaw, maxilla and mandible was improved; Go-Pg decreased significantly (P 0.01), suggesting that the length of mandible became shorter, Go-Co did not change significantly, suggesting that mandibular ramus did not change significantly, Ptm-A, Ptm-s did not change significantly, suggesting that the length and position of maxilla did not change. SN-MP, ANS-Me/N-Me decreased significantly (P 0.05), ANS-Me decreased significantly (P 0.01), suggesting shorter facial height, more coordinated proportion of facial height; U1-SN angle, smaller U1-NA angle, larger L1-MP angle (P 0.05), significantly smaller U1-NA distance (P 0.01), suggesting that the upper anterior lingual inclination compensation, lower anterior lip inclination compensation; N-Sn-Pg, Z, UL-EP, LL-EP significantly reduced (P 0.01), suggesting that the disease occurred. In OHIP-14, T2 of mental disorders, mental disorders and social disorders were significantly lower than T0 and T1 (P 0.01), and T1 was greater than T0, T1 was greater than T2 (P 0.05), all of them had statistical significance, while T2 had no statistical significance compared with T3. In OQLQ, T2 was lower than T0 and T1, T1 was higher than T0 in all four fields, and the difference was statistically significant (P 0.01). T2 and Tc were not statistically significant. In OQLQ, oral function, facial esthetics, self-perception and social interaction were significantly improved, and there was no significant difference between OQLQ and the general population. Conclusion: 1. After systematic orthodontic-orthognathic treatment, the class III facial shape of adult patients with skeletal class III malocclusion has been significantly improved, and the treatment effect is definite. 2. The combined orthodontic-orthognathic treatment of skeletal class III malocclusion can improve the oral health-related quality of life of the patients to some extent, although after preoperative orthodontic decompensation, the patients suffer from the disease. The quality of life (QOL) of the patients had a temporary decrease during the preoperative period, but after the completion of all the treatments, the OQLQ survey found that the quality of life of the patients had been improved in all areas, and was significantly higher than that before treatment. There was no significant difference between the patients and the general population. Oral health and related quality of life in patients with malocclusion were significantly correlated with the improvement of quality of life.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R783.5
[Abstract]:Objective: 1. To analyze and compare the cephalometric soft and hard tissue changes in adult skeletal class III malocclusion before and after orthodontic-orthognathic treatment, and to evaluate the effect of orthodontic-orthognathic treatment on adult skeletal class III malocclusion. 2. To evaluate the oral health impact of the above patients at different stages before, during and after treatment. The changes of oral health-related quality of life (OHRQOL) before, during and after treatment were analyzed by OHIP-14 and OQLQ questionnaires. The effects of orthodontic-orthognathic treatment on the quality of life were discussed. 3. The relationship between the changes of cephalometric parameters and the quality of life was investigated. Methods: 1. Twenty-one patients with skeletal class III malocclusion (excluding cleft lip and palate, Down syndrome and other congenital inherited diseases) were selected from the Department of Stomatology Affiliated to Guangxi Medical University from March 2014 to April 2017. Among them, 11 were males and 10 were females, aged 18-27 years (the first year of treatment). The average age was 20.3 years. All patients underwent orthodontic-orthognathic consultation before operation and formulated a combined orthodontic-orthognathic treatment plan. Preoperative orthodontics, model surgery, orthognathic surgery, postoperative orthodontics, and maintenance were performed. Each patient was taken X-ray skulls before treatment (before the beginning of orthodontic surgery), after treatment (after the end of orthodontic surgery). The cephalometric data were analyzed by SPSS 20.0 statistical software. The cephalometric values of craniomaxillofacial and maxillofacial soft and hard tissues were compared before and after treatment. 2. OHIP-14 and OQLQ questionnaires were conducted in each of the patients. At the same time, 40 normal subjects (Tc) with no significant difference in average age were randomly selected as control group. Each questionnaire of OHIP-14 contained 14 items and 7 fields. Objective Self-evaluation was divided into five grades (0-4 grades) and scored 0-4 points in turn. The higher the score, the worse the quality of life. The total score of the questionnaire ranged from 0-56 points, and the score of each field ranged from 0-8 points. Twenty-two items in each field, namely, oral function, facial aesthetics, self-perception of dentofacial deformities, and social interaction, were scored on a four-point scale, with 0-3 increasing in turn indicating a gradual increase in the impact of the behavior (i.e., the greater the value, the greater the impact). Data were recorded and scored using SPSS 20.0 statistical software. The scores of the scale were statistically described. The Wilcoxon rank test was used to analyze the mental state, physical function and social interaction of 21 patients with skeletal class III malocclusion before, during, after and after treatment. In order to provide a theoretical basis for the follow-up treatment, the change curves of the total scores of the questionnaires before, during, after and in the normal control group were drawn, and the causes and countermeasures were discussed. Cephalometric parameters such as SNB angle, ANB angle, Go-Pg, ANS-Me, ANSMe/NMe, U1-L1 angle, UL-EP, LL-EP, Z angle, N-Sn-Pg angle, with value (mm) were measured. SPSS 20.0 was used to calculate the correlation between the changes of these parameters and the quality of life (OQLQ and OHIP 14). Results: 1. After orthodontic-orthognathic treatment, the SNA angle of the patients with skeletal class III malocclusion (occlusion) became larger and SNB angle was higher. Angle became smaller (P 0.05), ANB angle and Wits value increased significantly (P 0.01), suggesting that the relative position between skull and jaw, maxilla and mandible was improved; Go-Pg decreased significantly (P 0.01), suggesting that the length of mandible became shorter, Go-Co did not change significantly, suggesting that mandibular ramus did not change significantly, Ptm-A, Ptm-s did not change significantly, suggesting that the length and position of maxilla did not change. SN-MP, ANS-Me/N-Me decreased significantly (P 0.05), ANS-Me decreased significantly (P 0.01), suggesting shorter facial height, more coordinated proportion of facial height; U1-SN angle, smaller U1-NA angle, larger L1-MP angle (P 0.05), significantly smaller U1-NA distance (P 0.01), suggesting that the upper anterior lingual inclination compensation, lower anterior lip inclination compensation; N-Sn-Pg, Z, UL-EP, LL-EP significantly reduced (P 0.01), suggesting that the disease occurred. In OHIP-14, T2 of mental disorders, mental disorders and social disorders were significantly lower than T0 and T1 (P 0.01), and T1 was greater than T0, T1 was greater than T2 (P 0.05), all of them had statistical significance, while T2 had no statistical significance compared with T3. In OQLQ, T2 was lower than T0 and T1, T1 was higher than T0 in all four fields, and the difference was statistically significant (P 0.01). T2 and Tc were not statistically significant. In OQLQ, oral function, facial esthetics, self-perception and social interaction were significantly improved, and there was no significant difference between OQLQ and the general population. Conclusion: 1. After systematic orthodontic-orthognathic treatment, the class III facial shape of adult patients with skeletal class III malocclusion has been significantly improved, and the treatment effect is definite. 2. The combined orthodontic-orthognathic treatment of skeletal class III malocclusion can improve the oral health-related quality of life of the patients to some extent, although after preoperative orthodontic decompensation, the patients suffer from the disease. The quality of life (QOL) of the patients had a temporary decrease during the preoperative period, but after the completion of all the treatments, the OQLQ survey found that the quality of life of the patients had been improved in all areas, and was significantly higher than that before treatment. There was no significant difference between the patients and the general population. Oral health and related quality of life in patients with malocclusion were significantly correlated with the improvement of quality of life.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R783.5
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