前段截骨牵引治疗唇腭裂继发上颌骨发育不足  

Clinical Evaluation on the Anterior Maxillary Segmental Distraction with Rigid External Distraction in the Treatment of Severe Maxillary Hypoplasia Secondary to CLP

作　　者：刘庆成[1] 王敏娇[1] 司家文[1] 王旭东[1] 于洪波[1] LIU Qing-cheng;WANG Min-jiao;SI Jiarwen;WANG Xu-dong;YU Hong-bo(Department of Oral and Craniomaxillofacial Surgery,Ninth People's Hospital,College of Stomatology,Shanghai Jiaotong University School of Medicine;Shanghai Key Laboratory of Stomatology,Shanghai 200011,China)

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：《口腔颌面外科杂志》2017年第3期179-184,共6页Journal of Oral and Maxillofacial Surgery

基　　金：国家自然科学基金(81571022);上海市浦江人才计划(15PJD023);上海交通大学"医工"交叉项目(YG2013MS56)

摘　　要：目的 :利用颅外支架外固定牵引技术,采用上颌骨前段截骨牵引的方式治疗唇腭裂继发上颌骨重度发育不足患者,探讨手术效果并进行术后稳定性的评价。方法:选取唇腭裂术后继发上颌骨重度发育不足患者15例,采用上颌骨前段截骨,颅外支架外固定式牵引器进行术后牵引,通过头影测量分析,评价其术后效果及长期稳定性。利用SPSS 13.0软件包对数据进行方差分析。结果 :所有患者均顺利完成上颌骨前段截骨及颅外支架的固定,术后进行牵引,无明显并发症发生,面型及咬合关系显著改善,牵引成骨后上颌骨凸度、前牙覆盖、上颌骨长度和高度等显著增加(P<0.05),术后无明显复发(P>0.05)。而腭咽腔的深度、软腭长度无明显改变,语音功能未受明显影响。结论:上颌骨前段截骨配合颅骨外支架牵引能够显著增加上颌骨长度,同时避免了对腭咽闭合功能的损伤,降低了术后复发的风险,是一种理想的矫治唇腭裂继发上颌骨发育不足的方法。Anterior maxillary segmental distractions(AMSD)were used recently in the treatment of severe maxillary hypoplasia secondary to cleft lip and palate(CLP).The aim of this study was to assess the effect and long-term outcome of AMSD.Methods:Fifteen patients with severe maxillary hypoplasia secondary to CLP were enrolled in this study.They were treated with AMSD using rigid external distraction(RED).Cephalometric analysis was performed at three time points:before surgery(T1),after distraction(T2),and 2 years after surgery(T3).The data was analyzed by one-way analysis of variance with SPSS 13.0 software package.Results:All surgeries completed smoothly,and midfacial deformities were corrected efficiently.The SNA,overjet,U1-PP and PP(ANS-PNS)improved significantly after AMSD(P<0.05),mean overjet increased by 14.28 mm.Comparison of data between T2 and T3 showed no significant difference.No obvious changes of palatopharyngeal depth and soft palatal length were found.Conclusions:With the ability of increasing maxillary length,avoiding damage on palatopharyngeal closure function,and reducing risk of relapse,AMSD has become a promising procedure in the treatment of severe maxillary hypoplasia secondary to CLP.

关 键 词：唇腭裂 上颌骨发育不足 牵引成骨 前段截骨 腭咽闭合 稳定性 

分 类 号：R782.2[医药卫生—口腔医学]