两种上颌前份截骨后退术对鼻部形态的影响  

Three-dimensional effect of two anterior maxillary segmental osteotomies on nasal morphology

作　　者：林阳阳[1] 李燕妮 皮纳 宋大立[1] 侯敏[1] Lin Yangyang;Li Yanni;Pi Na;Song Dali;Hou Min(Department of Orthognathic Surgery,Tianjin Stomatological Hospital,Tianjin 300041,China;Department of Stomatology,Chinese Medicine Hospital of Tianjin Binhaixin District,Tianjin 300457,China)

机构地区：[1]天津市口腔医院,南开大学口腔医院正颌外科,300041 [2]天津市滨海新区中医医院口腔科

出　　处：《中华整形外科杂志》2020年第2期134-139,共6页Chinese Journal of Plastic Surgery

基　　金：天津市临床医学重点学科(口腔医学-口腔颌面外科学)专项基金(HWZX007);天津市口腔医院博硕士青年项目(2019BSQN04)。

摘　　要：目的评估2种上颌前份截骨术式对患者鼻部形态的影响。方法2015年1月至2017年12月天津市口腔医院收治双颌前突患者30例,男8例,女22例,年龄19~32岁。根据入院的治疗顺序随机分为传统手术组与改良手术组,传统手术组20例,采用传统的上颌前份截骨术;改良手术组10例,采用改良上颌前份截骨术。于术前及术后1年对患者行头颅锥形束CT扫描,将获得的DICOM数据导入Proplan CMF 2.0软件,三维重建颅面部解剖结构,选取反映鼻部形态的软、硬组织标志点,同时建立3个定位平面及三维定点测量系统,测量手术前、后各标志点间的距离及角度,包括鼻唇角、上鼻唇角、下鼻唇角、鼻尖角、鼻尖倾斜度、鼻小柱倾斜度、鼻高、鼻尖深度、垂直鼻尖位置、鼻翼基底宽、内眦间距、鼻小柱高度、右侧鼻孔轴角、左侧鼻孔轴角、鼻孔面积,并采用配对样本t检验来评价2种术式对患者术后鼻部形态的影响。结果(1)传统手术组患者术后鼻唇角由术前的113.74°±9.42°增加至121.93°±4.05°,差异有统计学意义(P<0.05);鼻小柱倾斜度由术前的129.86°±7.63°减少到120.06°±7.73°,差异有统计学意义(P<0.05);鼻高及鼻翼基底宽度均较术前增加,差异有统计学意义(P<0.05);但鼻尖角、鼻尖倾斜度、垂直鼻尖位置、鼻小柱高度、双侧鼻孔轴角及鼻孔面积与术前相比,差异均无统计学意义(P>0.05)。(2)改良手术组患者术后鼻唇角由术前的110.75°±1.67°增至122.42°±6.95°,差异有统计学意义(P<0.05);垂直鼻尖位置由术前的(11.87±1.39)mm减少至(11.16±1.02)mm;但鼻翼基底宽、鼻尖角、鼻尖倾斜度、鼻小柱倾斜度、鼻高、鼻小柱高度、双侧鼻孔轴角以及鼻孔面积,手术前后比较差异均无统计学意义。结论与传统的上颌前份截骨术相比,改良术式可获得良好的手术效果,且对患者鼻部形态的影响非常小,掌握适应证,灵活应用才能获得最�Objective To evaluate the effect of two kinds of anterior maxillary segmental osteotomies on nasal morphology.Methods 30 patients with bimaxillary protrusion were included at from Tianjin Stomatological Hospital Between January 2015 and December 2017.There were 8 males and 22 females aged from 19 to 32 years old,the patients were randomly divided into the traditional operation group and modified operation group according to the order of treatment.20 patients underwent traditional anterior maxillary osteotomy while 10 patients underwent modified osteotomy.Pre-and post-operative 1-year CBCT data of 30 patients were imported in Proplan CMF software,to reconstruct the 3D model of the nose and select characteristic landmarks.Three locating planes and 3D point measurement system were established,Relevant indices consisted of nasolabial angle,upper and lower nasolabial angle,nasal tip angle,nasal tip inclination,nasal columella inclination,nasal height,depth of nasal tip,vertical nasal tip position,nasal alar base width,inner canthic diameter,nasal columella height,bilateral nasal axis angle,nostril area and the comparison between two groups were conducted using paired-samples t test,the effect of two surgical methods on nasal morphology were evaluated.Results There were statistically significant differences between the nasolabial angle,nasal columella inclination,nasal height,nasal alar base width between preoperative group(113.74°±9.42°,120.06°±7.73°)and postoperative group(121.93°±4.05°,129.86°±7.63°),whereas no significant difference among nasal tip angle,nasal tip inclination,vertical nasal tip position,nasal columella height,bilateral nasal axis angle and nostril area in traditional operative group.However,in the modified operation group,there were statistically significant differences in the nasolabial angle,vertical nasal tip position between preoperative group[110.75°±1.67°and(11.87±1.39)mm]and postoperative group[122.42°±6.95°and(11.16±1.02)mm],whereas no significant difference among other

关 键 词：双颌前突 上颌前份截骨术 三维测量分析 

分 类 号：R7[医药卫生—临床医学]