自攻型微螺钉支抗与正颌手术矫治成年骨性开患者的比较研究  

Comparative evaluation of miniscrew and orthognathic surgery in treatment of skeletal open bite in adults

作　　者：赵弘[1] 卜亚平[1] 马妍[1] 郑春秀[1] 顾晓明[1] 王晓坤[2] 

机构地区：[1]武警总医院口腔综合科,北京100039 [2]北京军区总医院京西医院口腔科,100041

出　　处：《武警医学》2012年第12期1026-1030,共5页Medical Journal of the Chinese People's Armed Police Force

基　　金：国家十一五攻关课题资助

摘　　要：目的比较自攻型微螺钉支抗与正颌外科手术矫治成年开畸形患者疗效的差异。方法将25例骨性开的成年患者分为微螺钉支抗组(n=14)、正颌手术组(n=11)两组。微螺钉支抗组将自攻型微螺钉分别植入在上下颌第一、第二磨牙之间颊侧齿槽骨,上下颌使用横腭杆和固定舌弓,每侧加力1.5 N以压低后部牙齿槽;正颌手术组对患者进行LeFortⅠ型截骨术+下颌升支矢状劈开截骨术(sagittal spilt ramus osteotomy,SSRO),或者单颌手术SSRO,两组患者在治疗前后分别拍摄头颅侧位定位片,并进行头影测量的分析比较。结果 25例骨性开畸形均得到有效治疗,微螺钉支抗组的前牙覆由治疗前的平均-4.6 mm增加至治疗后平均2.0 mm(P<0.05),正颌手术组的前牙覆由治疗前的平均-5.5 mm增加至治疗后平均1.7 mm(P<0.05)。微螺钉支抗组压低后牙的效果更为明显,U6-PP(1.8 mm,0.2 mm,P<0.01)、L6-MP(1.2 mm,0.3mm,P<0.05),差异有统计学意义,而正颌手术组对垂直向的控制更为有效,MP/SN(6.3°,3.3°,P<0.01)、N-Me(3.8 mm,1.8 mm,P<0.05)、ANS-Me(3.9 mm,1.6 mm,P<0.05)、Gn-TH(2.8 mm,0.9 mm,P<0.05)。结论自攻型微螺钉支抗能够实现后部牙齿槽高度的压低,是矫治骨性开畸形的一种损伤小、患者依从性好的治疗手段。Objective To compare the treatment results in patients with skeletal open bite treated with molar intrusion by using miniscrew anchorage and orthognathic surgery.Methods Twenty-five patients with skeletal open bite were treated either by miniscrew anchorage（n=14） or LeFortⅠosteotomy combined with sagittal split ramus osteotomy（SSRO）（n=11）.Self-drilling miniscrew implants were inserted into the buccal alveolar bone between maxillary molars and mandibular molars.Palatal and lingual arches were used respectively.150 g force each side was added to miniscrew to intrude posterior teeth.Pretreatment and posttreatment lateral cephalograms were measured and compared.Results Skeletal open bite malocclusion in 25 patients were corrected effectively.There was no significant difference between miniscrew anchorage and orthognathic surgery,with increased overbites of 6.6mm and 7.2 mm,respectively.Miniscrew was more effective than orthognathic surgery in intruding posterior teeth.U6-PP（1.8 mm,0.2 mm,P0.01） and L6-MP（1.2 mm,0.3 mm,P0.05） were intruded significantly.Orthognathic surgery was more effective than miniscrew anchorage in reducing vertical dimension.The MP/SN（6.3°,3.3°,P0.01）,N-Me（3.8 mm,1.8 mm,P0.05）,ANS-Me（3.9 mm,1.6 mm,P0.05） and Gn-TH（2.8 mm,0.9 mm,P0.05） were decreased significantly.Conclusion Self-drilling minisrcew implant can be used as an efficient method to control vertical anchorage and correct skeletal open bite malocclusion effectively through absolute intrusion of posterior dental alveoli.

关 键 词：骨性开畸形 微螺钉支抗 正颌手术 

分 类 号：R473.73[医药卫生—护理学]