单侧完全性唇腭裂术后患者上腭裂隙内骨再生情况的研究
发布时间：2018-09-06 15:00
【摘要】：目的:观察单侧完全性唇腭裂术后(Unilateral cleft lip and palate,UCLP)患者上腭裂隙内骨再生情况,探究其对牙弓形态发育的影响。资料与方法:随机选取2015年6月~2017年1月在蚌埠医学院第一附属医院整形外科就诊的单侧完全性唇腭裂术后患者共计35例作为观察组,年龄9岁~18岁,平均年龄12.34±2.85岁,其中男性22例,女性13例;随机选取20例正常牙鄈作为对照组,男性10例,女性10例,年龄9岁~18岁,平均年龄12±2.69岁,所有研究对象均行CT高分辨平扫。在观察组中,经冠状面骨窗图像查看上腭裂隙内是否有再生骨桥形成,根据是否有再生骨桥的形成,将所有研究对象分为两组:有再生骨桥形成组,无再生骨桥形成组;测量有再生骨桥形成组内再生骨的长度及分布情况;分别测量两组间牙弓前段、中段、后段宽度,对测量结果行统计学分析比较两组间是否有差异;测量对照组牙弓前段、中段、后段宽度,再分别将有再生骨桥形成组与正常对照组比较,无再生骨桥形成组与正常对照组比较。结果:(1)观察组35例单侧完全性腭裂患者中,共计25例上颌骨腭突有不同程度的骨再生并相互连接形成骨桥,再生骨桥阳性率为71.4%,其中男性16例,女性9例,再生骨桥长度介于5mm~21mm,平均长度11.59±4.74mm,宽度介于6mm~14mm,再生骨的厚度、密度不均一;再生骨主要分布于尖牙至第一磨牙段,冠状位骨窗示健侧各牙位再生骨桥阳性率分别为:中切牙(0例),侧切牙(0例),尖牙(0例),第一前磨牙(11例、44%),第二前磨牙(23例、92%),第一磨牙(21例、84%),第二磨牙(5例、20%),所有患者共计60个牙位阳性,不同牙位所占比例分别为:第一前磨牙18.3%,第二前磨牙38.3%,第一磨牙35%,第二磨牙8.3%;余下10例上腭裂隙内可见不同程度的再生骨质形成,但未连接形成骨桥。(2)切牙孔至前方牙槽骨裂隙段无再生骨,腭骨横板处未见明显再生骨。(3)观察组中有再生骨桥形成组牙弓前段宽度平均值为30.45±1.63mm,牙弓中段宽度平均值为40.96±1.92mm,牙弓后段宽度平均值50.84±1.81mm,无再生骨桥形成组牙弓前段宽度平均值为30.55±1.89mm,牙弓中段宽度平均值为37.76±1.51mm,牙弓后段宽度平均值50.52±1.94mm;对照组牙弓前段宽度平均值为37.27±1.66mm,牙弓中段宽度平均值为44.37±1.57mm,牙弓后段宽度平均值54.26±1.57mm;观察组中有再生骨桥形成组牙弓中段宽度大于无再生骨桥形成组(P0.05),牙弓前段、后段宽度未见明显差异(P0.05),见表1;有再生骨桥形成组与正常对照组相比,牙弓前段宽度、中段宽度、后段宽度均小于对照组(P0.05),见表2;无再生骨桥形成组与正常对照组相比,牙弓前段、中段宽度、后段宽度均小于对照组(P0.05),见表3。结论:(1)高分辨螺旋CT可以用于上颌骨三维重建并进行精确的观察、测量,能较直观的反映上颌骨三维形态。(2)部分单侧完全性腭裂患者术后上颌骨双侧腭突有不同程度的再生骨相互连接形成骨桥封闭裂隙,主要分布于第一前磨牙至第二磨牙间,尤以第二前磨牙近点至第一磨牙远点之间显著,可能与局部软组织张力大、瘢痕挛缩牵拉有关。(3)观察组牙弓各段宽度均明显小于对照组;观察组内有骨桥再生组牙弓中段宽度值较无骨桥再生组大,牙弓前段及牙弓后段未见显著差异,这与骨桥分布位置相对应,再生骨桥有利于牙弓形态更好的发育。(4)单侧完全性唇腭裂患者术后牙槽嵴裂、牙槽嵴至切牙孔段、腭骨横突段裂隙仍然存在,未见明显再生骨,可能与局部解剖结构有关,具体原因有待于进一步探讨。(5)再生骨桥形成有利于牙弓及上颌骨形态的发育,在以后的研究中可以进一步探究如何诱导腭突的再生,指导并应用于临床,必将改善患者颌面部的发育状况。
[Abstract]:Objective: To observe the bone regeneration in the upper palate cleft of patients with unilateral complete cleft lip and palate (UCLP) and to explore its effect on dental arch morphology and development. A total of 35 cases were selected as the observation group, aged 9-18 years, with an average age of 12.34 (+ 2.85), including 22 males and 13 females; 20 cases of normal dentin were randomly selected as the control group, 10 males and 10 females, aged 9-18 years, with an average age of 12 (+ 2.69). All subjects underwent high-resolution plain CT scanning. In the observation group, the images of coronal bone window were examined. All subjects were divided into two groups according to the formation of regenerated bone bridge: regenerated bone bridge formation group and non-regenerated bone bridge formation group; the length and distribution of regenerated bone in regenerated bone bridge formation group were measured; the width of anterior, middle and posterior segments of dental arch between the two groups were measured and compared. Results Statistical analysis was performed to compare the differences between the two groups. The width of anterior, middle and posterior segments of the dental arch in the control group was measured and compared with that in the normal control group. The positive rate of regenerated bone bridge was 71.4%. There were 16 males and 9 females. The length of regenerated bone bridge ranged from 5 mm to 21 mm, with an average length of 11.59 (+ 4.74 mm) and a width of 6 mm to 14 mm. The positive rates of regenerated bone bridge were central incisor (0 cases), lateral incisor (0 cases), canine (0 cases), first premolar (11 cases, 44%), second premolar (23 cases, 92%), first molar (21 cases, 84%) and second molar (5 cases, 20%) respectively. There were 60 positive teeth in all patients. The proportion of different tooth positions was 18.3% in the first premolar, 38.3% in the second premolar. There were 35% of the first molars and 8.3% of the second molars, and 10 cases of upper palate cleft showed different degrees of regenerated bone formation, but no bone bridge was formed. (2) There was no regenerated bone from incisor to anterior alveolar bone cleft, and no obvious regenerated bone was found at palatal bone transverse plate. (3) The average width of anterior segment of dental arch in regenerated bone bridge formation group was 30.45 [1.63 mm] and the average width of anterior segment of dental arch was 30.45 The average width of the middle segment of the arch was 40.96 (+ 1.92 mm), the average width of the posterior segment of the arch was 50.84 (+ 1.81 mm), the average width of the anterior segment of the arch was 30.55 (+ 1.89 mm), the average width of the middle segment of the arch was 37.76 (+ 1.51 mm), the average width of the posterior segment of the arch was 50.52 (+ 1.94 mm) and the average width of the anterior segment of the dental arch was 37.27 (+ 1.66 mm) and that of the middle segment of the In the observation group, the width of the middle segment of the dental arch in the regenerated bone bridge formation group was larger than that in the non-regenerated bone bridge formation group (P 0.05), and there was no significant difference in the width of the anterior segment and the posterior segment of the dental arch (P 0.05), as shown in Table 1. Compared with the normal control group, the width of the anterior segment of the dental arch in the regenerated bone bridge formation group was larger than that in the non-regenerated bone bridge formation group (P 0.05). The width of the anterior, middle and posterior segments of the dental arch were smaller than those of the control group (P 0.05), and the width of the posterior segments was smaller than that of the control group (P 0.05). 3-D morphology. (2) After partial unilateral complete cleft palate surgery, bilateral palatal processes of maxilla had different degrees of regenerated bone interconnected to form a bone bridge to seal the cleft, mainly distributed between the first premolar and the second molar, especially between the proximal point of the second premolar and the distal point of the first molar, which may be associated with local soft tissue tension, scar contracture and distraction. (3) The width of each segment of the dental arch in the observation group was significantly smaller than that in the control group; the width of the middle segment of the dental arch in the group with bone bridge regeneration was larger than that in the group without bone bridge regeneration, and there was no significant difference between the anterior segment and the posterior segment of the dental arch, which corresponded to the distribution of the bone bridge. The regenerated bone bridge was conducive to the better development of the dental arch morphology. (4) Unilateral complete cleft lip and PAL Postoperative alveolar ridge cleft, alveolar ridge to incisor foramen, palatal transverse process cleft still exist, no obvious regenerated bone, may be related to local anatomical structure, the specific reasons need to be further explored. (5) Regenerated bone bridge formation is conducive to the development of dental arch and maxillary bone morphology, in future research can be further explored how to induce the palate. Sudden regeneration, guided and applied to clinical practice, will improve the development of the maxillofacial region.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R782
本文编号：2226710
[Abstract]:Objective: To observe the bone regeneration in the upper palate cleft of patients with unilateral complete cleft lip and palate (UCLP) and to explore its effect on dental arch morphology and development. A total of 35 cases were selected as the observation group, aged 9-18 years, with an average age of 12.34 (+ 2.85), including 22 males and 13 females; 20 cases of normal dentin were randomly selected as the control group, 10 males and 10 females, aged 9-18 years, with an average age of 12 (+ 2.69). All subjects underwent high-resolution plain CT scanning. In the observation group, the images of coronal bone window were examined. All subjects were divided into two groups according to the formation of regenerated bone bridge: regenerated bone bridge formation group and non-regenerated bone bridge formation group; the length and distribution of regenerated bone in regenerated bone bridge formation group were measured; the width of anterior, middle and posterior segments of dental arch between the two groups were measured and compared. Results Statistical analysis was performed to compare the differences between the two groups. The width of anterior, middle and posterior segments of the dental arch in the control group was measured and compared with that in the normal control group. The positive rate of regenerated bone bridge was 71.4%. There were 16 males and 9 females. The length of regenerated bone bridge ranged from 5 mm to 21 mm, with an average length of 11.59 (+ 4.74 mm) and a width of 6 mm to 14 mm. The positive rates of regenerated bone bridge were central incisor (0 cases), lateral incisor (0 cases), canine (0 cases), first premolar (11 cases, 44%), second premolar (23 cases, 92%), first molar (21 cases, 84%) and second molar (5 cases, 20%) respectively. There were 60 positive teeth in all patients. The proportion of different tooth positions was 18.3% in the first premolar, 38.3% in the second premolar. There were 35% of the first molars and 8.3% of the second molars, and 10 cases of upper palate cleft showed different degrees of regenerated bone formation, but no bone bridge was formed. (2) There was no regenerated bone from incisor to anterior alveolar bone cleft, and no obvious regenerated bone was found at palatal bone transverse plate. (3) The average width of anterior segment of dental arch in regenerated bone bridge formation group was 30.45 [1.63 mm] and the average width of anterior segment of dental arch was 30.45 The average width of the middle segment of the arch was 40.96 (+ 1.92 mm), the average width of the posterior segment of the arch was 50.84 (+ 1.81 mm), the average width of the anterior segment of the arch was 30.55 (+ 1.89 mm), the average width of the middle segment of the arch was 37.76 (+ 1.51 mm), the average width of the posterior segment of the arch was 50.52 (+ 1.94 mm) and the average width of the anterior segment of the dental arch was 37.27 (+ 1.66 mm) and that of the middle segment of the In the observation group, the width of the middle segment of the dental arch in the regenerated bone bridge formation group was larger than that in the non-regenerated bone bridge formation group (P 0.05), and there was no significant difference in the width of the anterior segment and the posterior segment of the dental arch (P 0.05), as shown in Table 1. Compared with the normal control group, the width of the anterior segment of the dental arch in the regenerated bone bridge formation group was larger than that in the non-regenerated bone bridge formation group (P 0.05). The width of the anterior, middle and posterior segments of the dental arch were smaller than those of the control group (P 0.05), and the width of the posterior segments was smaller than that of the control group (P 0.05). 3-D morphology. (2) After partial unilateral complete cleft palate surgery, bilateral palatal processes of maxilla had different degrees of regenerated bone interconnected to form a bone bridge to seal the cleft, mainly distributed between the first premolar and the second molar, especially between the proximal point of the second premolar and the distal point of the first molar, which may be associated with local soft tissue tension, scar contracture and distraction. (3) The width of each segment of the dental arch in the observation group was significantly smaller than that in the control group; the width of the middle segment of the dental arch in the group with bone bridge regeneration was larger than that in the group without bone bridge regeneration, and there was no significant difference between the anterior segment and the posterior segment of the dental arch, which corresponded to the distribution of the bone bridge. The regenerated bone bridge was conducive to the better development of the dental arch morphology. (4) Unilateral complete cleft lip and PAL Postoperative alveolar ridge cleft, alveolar ridge to incisor foramen, palatal transverse process cleft still exist, no obvious regenerated bone, may be related to local anatomical structure, the specific reasons need to be further explored. (5) Regenerated bone bridge formation is conducive to the development of dental arch and maxillary bone morphology, in future research can be further explored how to induce the palate. Sudden regeneration, guided and applied to clinical practice, will improve the development of the maxillofacial region.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R782
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