经缝牵引成骨术后患儿颧骨、环颧骨周缝及颧弓的变化  

Changes in the zygoma, circumzygomatic sutures, and zygomatic arch in children after trans-sutural distraction osteogenesis

作　　者：金梦颖 毕洪森[1] 薛红宇[1] 赵振民 Jin Mengying;Bi Hongsen;Xue Hongyu;Zhao Zhenmin(Department of Plastic Surgery,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院成形科,北京100191

出　　处：《中华整形外科杂志》2023年第7期737-749,共13页Chinese Journal of Plastic Surgery

摘　　要：目的探讨经缝牵引成骨术(TSDO)后患儿颧骨、环颧骨周缝及颧弓的变化。方法回顾性分析2005至2019年北京大学第三医院成形科收治的使用TSDO矫正面中部发育不全的唇腭裂患儿临床资料。利用软件Mimics 20.0对其头颅CT资料进行三维重建,观察TSDO术后牵引周期结束时颧骨、环颧骨周缝及颧弓的形态学改变,测量并分析颧突点至三维参考平面距离、颧骨高度、颧骨宽度1、颧骨宽度2、颧骨厚度、颧骨体积、坏颧骨周缝(颧上颌缝宽度、颧颞缝宽度、颧额缝宽度)、颧弓长度、颧弓各标志点(颞颧根点、颧点、颧骨点)至三维参考平面距离,所有数据分为唇腭裂侧及非唇腭裂侧。采用GraphPad Prism 9.4.1软件统计分析术后较术前的变化情况,正态分布计量资料以±s表示,手术前后比较通过配对样本t检验进行分析,非正态分布计量资料以M(IQR)表示,手术前后比较通过配对样本Wilcoxon秩和检验进行分析,P<0.05为差异有统计学意义。结果共纳入27例患儿,男23例,女4例,年龄(11.19±2.35)岁(5~15岁),双侧唇腭裂患儿10例,单侧唇腭裂患儿17例(左侧9例,右侧8例),患儿牵引周期为(40.26±11.43)d。TSDO术后牵引周期结束时患儿面中部凹陷情况得到矫正,颧骨向前下及横向生长,颧上颌缝、颧颞缝及颧额缝位置前移,颧弓向前下方生长。颧骨测量结果显示,TSDO术后颧突点在唇腭裂侧比术前前移(7.82±3.95)mm,差异有统计学意义(P<0.05),在非唇腭裂侧比术前前移4.26(5.72)mm,差异有统计学意义(P<0.05);颧突点在垂直方向和横向上,相比术前分别出现少量下移和少量外移,差异均有统计学意义(P均<0.05)。TSDO术后颧骨高度、宽度、体积较术前均增加,差异均有统计学意义(P均<0.05),其中下段的颧骨宽度2变化明显,在唇腭裂侧增加了4.33(5.17)mm,差异有统计学意义(P<0.05),在非唇腭裂侧增加了(3.42±2.67)mm,差异有统计学意义(P<0.05)。�Objective To investigate the changes of the zygoma,circumzygomatic sutures,and zygomatic arch in children after trans-sutural distraction osteogenesis(TSDO).Methods A retrospective analysis was performed on skull CT data of cleft lip and palate patients who underwent TSDO to correct midfacial hypoplasia between 2005 and 2019 in Peking University Third Hospital.The Mimics 20.0 software was used for three-dimensional(3D)model reconstruction to observe the morphological changes of the zygoma,circumzygomatic sutures,and zygomatic arch at the end of the traction period after TSDO.Measurements were taken and analyzed for the distances from mp point to 3D reference planes,zygoma height,zygoma width 1,zygoma width 2,zygoma thickness,zygoma volume,zygomaticomaxillary suture width,zygomaticotemporal suture width,zygomaticofrontal suture width,zygomatic arch length,and distances from zygomatic arch landmarks(tp point,zy point,and ju point)to the 3D reference planes.All data were divided into cleft and non-cleft sides.GraphPad Prism 9.4.1 software was used to analyze the changes before and after TSDO.Measurement data of normal distribution was expressed by±s and the comparison between groups before and after traction was analyzed by paired t-test.Measurement data of non-normal distribution was expressed by M(IQR)and the comparison between groups before and after traction was analyzed by paired Wilcoxon test.If P<0.05,the difference was statistically significant.Results A total of 27 patients were included in the study,including 23 males and 4 females,with a mean age of(11.19±2.35)years(5-15 years).Of these patients,10 had bilateral cleft lip and palate,and 17 had unilateral cleft lip and palate(9 on the left side and 8 on the right side).The average traction period was(40.26±11.43)days.The midfacial depression of the patients was corrected after TSDO,and the zygoma grew forward,downward,and horizontally.The circumzygomatic sutures shifted forward.The zygomatic arch showed forward and downward growth.The measurements of zy

关 键 词：颌面畸形 颧骨 颅面骨发育不全 颧弓 牵引术 环颧骨周缝 

分 类 号：R782[医药卫生—口腔医学]