矫治上颌前突畸形的两种前份截骨术式对唇部软组织影响的对比  

Effect comparison of two maxillary segmental osteotomy methods to correct maxillary protrusion on the lip soft tissue

作　　者：李燕妮 林阳阳[2] 侯敏[2] 宋大立[2] Li Yanni;Lin Yangyang;Hou Min;Song Dali(Department of Stomatology in Binhai New Area Hospital of TCM,Tianjin 300451,China;Department of Orthognathic Surgery in Tianjin Stomatogical Hospital,Tianjin 300041,China)

机构地区：[1]天津市滨海新区中医医院口腔科,300451 [2]天津市口腔医院正颌外科,300041

出　　处：《中华整形外科杂志》2020年第4期415-422,共8页Chinese Journal of Plastic Surgery

摘　　要：目的采用二维和三维相结合的方法来评估2种前份截骨术对上颌前突患者唇组织形态的影响。方法根据入选标准选取2015年1月至2017年1月就诊于天津市口腔医院正颌外科的上颌或双颌前突患者30例,其中男8例,女22例,年龄(25.0±0.6)岁。根据入院治疗的顺序随机将30例上颌前突患者分为传统组(20例)与改良组(10例),传统组采用传统的上颌前份截骨术,改良组采用改良术式。三维模型、定位头颅侧位片和正面照片结合,于术前1周及术后1年,测量4个骨组织测量项目、8个软组织测量项目和7个唇部测量值。应用配对t检验分析2组患者术前术后唇组织变化的差异以及上颌切牙与上唇变化的比例关系。结果30例患者伤口均一期愈合,无感染及骨块坏死。术后随访1年,骨性颌骨前突无复发。所有患者治疗结束后,颌骨关系正常,牙弓形态及曲线正常,牙排列整齐,咬合关系良好,唇齿关系良好,面下1/3颜面外形明显改善,鼻唇颏关系协调。传统组及改良组上唇红前后向的位置变化与上切牙颈部位置变化相关性最明显,呈显著正相关,传统组R=0.768,改良组R=0.771。2组患者上齿槽座角均减小,鼻唇角均增大,术前、术后比较差异具有统计学意义(P<0.05)。上切牙颈点及切点后退量,上唇后退量明显缩小,手术前、后差异具有统计学意义(P<0.05)。2组患者均存在术后上唇厚度增加、上下唇缘距离值减小、上中切牙-上唇缘距离值减小,与术前比较差异均具有统计学意义(P<0.05)。改良组上唇高度的增加有统计学意义(P<0.05),而传统组无统计学意义。传统组的中切牙颈部后退量与上唇后退量的比值为1.19∶1,改良组为0.81∶1;正面观改良组越靠近中线上唇厚度变小趋势越明显,上唇线变化趋势为M形。结论2种前份截骨术式对改善前突畸形效果显著。上唇红前后向的位置变化与上切牙颈部位置变化呈显著相�Objective Using a combination of 2D and 3D methods to evaluate the difference of lip changes between two maxillary anterior segmental osteotomy methods.Methods 30 patients who visited the Department of Orthognathic Surgery of Tianjin Stomatological Hospital from January 2015 to January 2017 with maxillary protrusion[8 males and 22 females,aged(25.0±0.6)years old]were divided into two groups.One group was treated with cupar maxillary anterior segmental osteotomy.One group underwent modified method.4 osseous tissue measurements,8 soft tissue measurements and 7 lip measurements were collected in three-dimensional model,lateral cephalometric radiographs and frontal photos at one week before surgery and one year after surgery to observe the difference between the two groups in the lip area and calculate the retreat ratio of upper incisor to upper lip.Results The wounds of all 30 patients were healed in one stage without infection and bone necrosis.There was no recurrence of the bone protrusion at 1 year after the operation.After treatment,the bone relationship was normal and the dental arch and occlusal curve were normal.The occlusion relationship and the lip-tooth relationship were good.The shape of the lower third of the face was significantly improved,and the relationship between nose,lips and chin was coordinated.The change of the horizontal position of the lip and the position of the neck of upper incisor tooth(UJ)had a significant positive correlation.In traditional group R=0.768 and in modified group R=0.771.The sella-nasion-A point decreased and the nasolabial angle increased in both groups.The difference was statistically significant before and after surgery(P<0.05).The amount of retraction of the neck point and incision point of the upper incisor and the amount of retraction of the upper lip were significantly reduced.The difference before and after surgery was statistically significant(P<0.05).There was an increase in the thickness of the upper lip before and after surgery,a decrease in the distance betwee

关 键 词：上颌前突 前份截骨术 正颌手术 

分 类 号：R7[医药卫生—临床医学]