下颌双侧体部牵引成骨联合上颌手术辅助快速扩弓治疗双侧髁突自溶性吸收继发重度骨性Ⅱ类错畸形伴上牙弓狭窄的效果  

Combined mandibular distraction osteogenesis and surgical-assisted maxillary rapid expansion to treat patients with severe skeletal Class Ⅱ malocclusion and narrow maxillary dental arch secondary to bilateral idiopathic condylar resorption

作　　者：薛晓晨 李彪[1] 孙昊[1] 柳稚旭[1] 朱敏[1] 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：《中国口腔颌面外科杂志》2017年第2期165-170,共6页China Journal of Oral and Maxillofacial Surgery

摘　　要：目的 :介绍一种治疗双侧髁突自溶性吸收(ICR)继发重度骨性Ⅱ类错畸形伴上牙弓狭窄的方法。方法 :纳入6例双侧ICR继发重度骨性Ⅱ类错畸形伴上牙弓狭窄的病例,进行下颌双侧体部牵引成骨(DO)联合上颌手术辅助快速扩弓(SARME)。依照计算机辅助手术模拟(CASS)技术标准流程进行下颌体部DO术模拟,根据临床检查及影像学检查,设计牵引方向及距离。在T0、T1、T2及T3分别进行头颅CT、颞下颌关节(TMJ)问卷、TMJ磁共振、多导睡眠监测(PSG)等检查,从面型、咬合关系、颞下颌关节情况及睡眠呼吸功能4个方面评估手术效果、二期手术必要性及关节稳定性等。结果:纳入病例中,3例已完成全部治疗。下颌体部分别牵引13.0 mm、6.7 mm和8.1 mm,二期颏成形分别前移7.2 mm、0(未做)和11 mm,上颌分别扩弓5.3 mm、7.3 mm和4.9 mm,PSG数据显示重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)痊愈。最终面型及咬合关系均达到预期,改建期无复发,TMJ亦无明显变化。结论:下颌体部DO联合SARME,可有效纠正双侧ICR继发重度骨性Ⅱ类错畸形伴上牙弓狭窄。运用CASS技术进行手术设计及模拟,可有效预计牵引方向及距离,使治疗效果及稳定性更加可靠。PURPOSE ： To introduce a treatment approach for severe skeletal Class Ⅱ malocclusion and narrow maxillary dental arch secondary to bilateral idiopathic condylar resorption. METHODS ： Six cases with severe skeletal Class Ⅱ malocclusion and narrow maxillary dental arch secondary to bilateral ICR were included in this study, and they were treated with mandibular distraction osteogenesis and surgery-assisted rapid maxillary expansion. The path and magnitude of distraction were simulated using computer-aided surgical simulation technique. The outcome of distraction, the necessity of secondary surgery and stability were evaluated through 4 aspects： profile, occlusion, temporomandibular joint （TMJ） condition and sleep respiratory function at T0, T1, T2 and T3. CT, TMJ questionnaire, MRI of TMJ and PSG were acquired at this 4 time points. RESULTS ： Three cases finished all treatments. The distraction magnitudes were 13.0mm, 6.7mm and 8.1mm, respectively. Chin advanced in genioplasity for 7.2 mm, 0 and 11 mm, respectively. Maxillary dental arch widened 5.3mm, 7.3 mm and 4.9 mm, respectively. Polysomnography data revealed that severe obstructive sleep apnea hypopnea syndrome was cured. Skeletal malocclusion was effectively corrected in all 3 cases and there was no obvious relapse during remodeling phase. TMJ condition remained stable. CONCLUSION S： Mandibular DO and SARME approach can effectively correct severe skeletal Class II malocclusion and narrow maxillary dental arch secondary to bilateral ICR. Using CASS technology to simulate the magnitude and path of distraction, the outcomes are more stable and predictable.

关 键 词：髁突自溶性吸收 下颌体部牵引成骨 上颌手术辅助快速扩弓 计算机辅助手术模拟技术 

分 类 号：R783.5[医药卫生—口腔医学]