唇腭裂患者正颌术后上颌骨短期稳定性的三维分析  

Analysis of three dimensional stability of the hypoplastic maxilla after orthognathic surgery in cleft lip and palate patients

作　　者：应王君子 沈舜尧[1] 李彪[1] 孙昊[1] 张天嘉 王旭东[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院·口腔医学院口腔颅颌面科,上海市口腔医学重点实验室,上海200011

出　　处：《上海口腔医学》2016年第3期345-351,共7页Shanghai Journal of Stomatology

摘　　要：目的 :建立一种可同时反映上颌骨位置及姿势的三维测量方法 ,对唇腭裂患者上颌骨正颌术后的短期稳定性进行三维评估。方法:选取因唇腭裂继发上颌骨发育不足而行正颌手术的25例患者,按照患侧分为左侧唇腭裂组10例、右侧唇腭裂组8例、双侧唇腭裂组7例;收集术前6周(T0)、术后4天(T1)、术后3个月(T2)、6个月(T3)的全头颅螺旋CT资料,利用计算机辅助设计软件Pro Plan建立三维坐标系,设定22个描述上颌骨空间位置的指标,并定义3个姿势角∠PP-CP、∠RP-CP、∠YP-CP,分别表示上颌骨在空间内俯仰、侧滚、摆尾。利用SPSS16.0软件包对T2、T3时的测量结果进行配对t检验。结果 :成功建立了较为完整反映上颌骨空间位置及姿势的测量方法。在垂直向上,颌骨前部牙骨段向上的总体复发率为7.46%;在矢状向上,各组复发率分别为30.95%、8.01%和34.76%,无显著差异;在水平向上,单侧完全性唇腭裂组均出现整体向健侧平移,且前部偏向健侧、而后部偏向患侧偏转的复发趋势。结论:腭裂患者正颌术后上颌骨在三维方向内存在复发趋势,本研究建立的三维测量比二维研究能更有效地从平移和旋转的角度进行评估。PURPOSE： To establish a three dimensional spacial measurement method to analyze the short-term stability of maxilla after orthognathic surgery in cleft lip and palate patients. METHODS： Twenty-five patients with maxillary hypoplasia secondary to cleft lip and palate seeking for orthognathic surgery were included in this study between January 2008 and September 2012. The spiral CT scan for the skull were taken 6 weeks preoperatively（T0）, 4 days postoperatively（T1）,3 months postoperatively（T2）, and 6 months postoperatively（T3） and collected. A three dimensional analytic method for measuring maxilla was set up in Pro Plan CMF software, and good repeatability of identification of landmarks was confirmed. Twenty-two indicators to describe the maxillary position and three new angles to describe the maxillary orientation were measured and analyzed. Student＇s t test was used to analyze the difference between T2 and T3 using SPSS16.0 software package. RESULTS： In 25 patients with cleft palate there was a translational relapse upwards along vertical axis and a pitch-up relapse of maxilla with an average of 7.46% at the anterior part of the cleft maxilla. The relapse rate was 30.95% in LUCLP, 8.01% in RUCLP, and 34.76% in BCLP, but with no significant difference. Along the horizontal axis, there was a maxillary translational relapse toward noncleft side in both LUCLP and RUCLP group, while a yaw relapse was confirmed with the anterior part of maxilla toward noncleft side and the posterior part toward cleft side.CONCLUSIONS： There is a three-dimensional relapse tendency for the maxilla in the cleft patient postoperatively. The established three-dimensional analytic method well describes the special position of cleft maxilla especially in the translational and rotational movement of maxilla in three different axes comparing with that from lateral cephalometry, thus providing references for accurate measurements in study of the three dimensional maxillary stability after orthognathic surgery.

关 键 词：唇腭裂 正颌手术 上颌骨 三维稳定性分析 

分 类 号：R782.2[医药卫生—口腔医学]