手术优先模式根尖下截骨术联合正畸治疗双颌前突的效果评价  

Therapeutic effect of anterior subapical osteotomy combined with postoperative orthodontic treatment for bimaxillary protrusion based on surgery-first approach

作　　者：杨斌 王怀良 李秉航 倪健 丁榆德 孙晓梅 滕利 

机构地区：[1]中国医学科学院北京协和医学院整形外科医院颌面外科与数字化整形中心,北京100144 [2]中国医学科学院北京协和医学院整形外科医院口腔医学中心,北京100144 [3]中国医学科学院北京协和医学院整形外科医院颅颌面外科中心,北京100144

出　　处：《中华整形外科杂志》2017年第6期406-412,共7页Chinese Journal of Plastic Surgery

基　　金：北京市科技计划首都临床特色应用研究项目（Z151100004015056）

摘　　要：目的探讨在手术优先模式下，采用正颌根尖下截骨术联合术后正畸治疗成人骨性双颌前突的临床效果。方法2015年4月至2016年4月，对22例成人双颌前突患者，应用数字化技术进行手术模拟以及模型外科设计，制作咬合导板，术中对上、下颌分别行根尖下截骨术，为患者建立暂时性咬合关系；术后2周进行快速正畸。对所有病例治疗前和治疗后6个月以上的头颅定位侧位片19个软硬组织项目进行测量对比研究，对所得数据采用配对t检验。结果22例患者手术切口均一期愈合，无骨坏死、感染，术后咬合关系良好，未发现前牙变色和牙髓坏死等并发症。随访6-12个月，平均（7.8±3.4）个月，所有患者均取得了良好的矫正效果，对面部侧貌满意。硬组织和软组织测量值均发生明显变化，上切牙内收（－10.5±4.9） mm，下切牙内收（－8.0±6.9） mm，上、下唇显著后移；SNA角由（82.5±2.8）°减少到（77.9±2.3）°，SNB角由（79.1±5.4）°减少到（74.6±3.8）°，上、下唇突度明显减小；上、下唇突点到审美平面的距离分别由（2.7±2.7） mm和（5.2±4.0） mm减少到（0.5±3.2） mm和（1.4±2.7） mm，面部侧貌轮廓显著改善。结论手术优先模式的根尖下截骨联合术后正畸，可有效地矫治成人双颌前突，获得正常的咬合关系和满意的面部侧貌轮廓。Objective To invesigate the therapeutic effect of anterior subapical osteotomy combined with postoperative orthodontic treatment for bimaxillary protrusion based on surgery-first approach （SFA）. Methods From April 2015 to April 2016, 22 adult patients with bimaxillary protrusion were treated with bimaxillary anterior subapical osteotomy without peroperative orthodontic treatment. Digital computer-aided technology was used for preoperative design and dental model simulation surgery. Then the oeclusal guide plate was made for intraoperative built-up of temporary occlusion. Two weeks after orthognathic surgery, a short-term orthodontic treatment was carried out to improve the occlusion. Cephalometrie analysis was done to evaluate the treatment effects. 19 cephalometric parameters about hard and soft tissues were measured and compared in all cases before and after SFA combined treatments. All data were statistically analyzed by SPSS software package. Results Primary healing was achieved in all the 22 cases without any infection or necrosis of bone and dental pulp. During the follow-up period of 6 - 12 months, all the patients were satisfied with the profile contour. The cephalometric parameters of hard and soft tissues changed remarkably. U1E-McN and L1E-McN set back （ - 10. 5 ±4. 9） mm and （ -8.0 ± 6.9） mm respectively. Upper and lower lip set back obviously. SNA decreased from （82.5 ± 2.8） to （77.9±2.3） degrees on average. SNB decreased from （79. 1 ± 5.4） to （74.6 ± 3.8） degrees on average. Upper and lower lip protrusion decreased obviously. TUL-E line decreased from the mean value of （2.7 ± 2.7 ） mm to （0.5 ± 3.2 ） mm and TLL-E line from （ 5.2 ＋ 4.0 ）mm to （ 1.4 ± 2.7 ） mm. The aesthetic contours were remarkably improved. Conclusions Anterior subapical osteotomy combined with postoperative orthodontic treatment based on SFA could correct adult bimaxillary protrusion effectively with normal occlusion, satisfactory soft tissue aesthetic profile.

关 键 词：根尖下截骨术 外科口腔正畸学 双颌前突 头影测量分析 

分 类 号：R782.2[医药卫生—口腔医学]