2种不同正颌术式对骨性Ⅲ类错畸形患者上气道形态的影响  

Evaluation of the effects of two different modes of orthognathic surgery on upper airway morphology in patients with skeletal Class Ⅲ malocclusion

作　　者：聂萍[1] 陶丽[1] 朱妍菲 孙蕙珺 朱敏[1] NIE Ping;TAO Li;ZHU Yan-fei;SUN Hui-jun;ZHU Min.(Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People ＇s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicin;National Clinical Research Center of Stomatolog;Shanghai Key Laboratory of Stomatology ＆ Shanghai Research Institute of Stomatology. Shanghai 200011, Chin)

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、国家口腔疾病临床研究中心、上海市口腔医学重点实验室,上海市口腔医学研究所,上海200011

出　　处：《上海口腔医学》2018年第3期280-284,共5页Shanghai Journal of Stomatology

基　　金：上海交通大学医工(理)交叉基金(YG2017QN12); 上海高校青年教师培养资助计划(shjdy029)

摘　　要：目的:建立骨性Ⅲ类错畸形患者正颌手术前、后上气道三维模型,比较不同正颌术式对骨性Ⅲ类错畸形患者上气道各截面积及容积的影响。方法:28例骨性Ⅲ类错畸形患者经正颌-正畸联合会诊,制定手术方案,分为2组,实验A组(12例)为单纯双侧下颌支矢状劈开术(BSSRO)后退,即单颌手术组,实验B组(16例)为下颌骨BSSRO后退+上颌骨Le Fort I型截骨术前移,即双颌手术组。所有患者于正颌手术前(T1)和术后3个月(T2)分别行CT扫描,基于CT图像,应用Dolphin Imaging 11.7软件建立包含腭咽、舌咽和喉咽腔在内的上气道三维模型,测量、比较2组患者在正颌手术前、后的上气道各截面、腔隙的矢状径、冠状径、横截面积和容积改变的差异。采用SPSS 16.0软件包进行统计学分析。结果:在腭咽段,实验A组手术后各项数值均较术前减小;实验B组手术后除冠状径外,其余数值均较术前增大,且2组变化有显著差异(P<0.05)。在舌咽段及喉咽段,2组手术后数值均减小。在横截面积和容积方面,实验A组较实验B组减小更加明显,2组的减小量有显著差异(P<0.05)。结论:与单颌手术相比,双颌手术对骨性Ⅲ类错畸形患者上气道形态的减小改变影响较小。PURPOSE：To establish three-dimensional models of upper airway pre-and post-orthognathic surgery in patients with skeletal Class Ⅲ malocclusion,and to compare the effects of different modes of orthognathic surgery on the cross-sectional areas and volumes of upper airway.METHODS：Twenty-eight patients with skeletal Class Ⅲmalocclusion were divided into 2 groups.Group A（12 patients） underwent bilateral sagittal split ramus osteotomy（BSSRO）for mandibular setback,named single jaw surgery group;group B（16 patients） underwent BSSRO ＋ Le Fort I osteotomy for mandibular setback and maxillary advancement,named bimaxillary surgery group.All patients received CT scanning before（T1） and 3 months after surgery（T2）.The three-dimensional models of the upper airway containing velopharynx,glossopharynx and laryngopharynx were established by using Dolphin Imaging 11.7 software.The changes of sagittal diameters,coronal diameters,cross-sectional areas and volumes of the upper airway were measured and compared between the two groups pre-and post-surgery（T1,T2） using SPSS 16.0 software package,respectively.RESULTS：In velopharynx,the values of group A were decreased after surgery,while the other values of group B were increased except the value of coronal diameter.There was a significant difference between the two groups（P 0.05）.In glossopharynx and laryngopharynx,the values of group A and group B were both decreased after surgery.The reduction of the cross-sectional areas and volumes in group A were more obvious than group B（P0.05）.CONCLUSIONS：The amount of narrowing of the upper airway is smaller in patients undergoing bimaxillary surgery than in patients undergoing mandibular setback surgery.

关 键 词：骨性Ⅲ类错[牙合]畸形 正颌手术 上气道 

分 类 号：R782.2[医药卫生—口腔医学]