应用颌间牵引改善数字化下颌骨缺损重建术后咬合不良  

Application of intermaxillary traction improve the disordered occlusion after the reconstruction of mandibular defects assisted by digital technology

作　　者：宾志文 梁建锋 王成[2] 刘海潮[2] 胡静 侯劲松[2] Bin Zhiwen;Liang Jianfeng;Wang Cheng;Liu Haichao;Hu Jing;Hou Jinsong(Department of Stomatology,Guilin Second People′s Hospital,Guilin 541001,China;Hospital of Stomatology,Guanghua School of Stomatology,Sun Yat-sen University,Guangdong Provincial Key Laboratory of Stomatology,Guangzhou 510055,China)

机构地区：[1]桂林市第二人民医院口腔科,541001 [2]中山大学附属口腔医院,光华口腔医学院,广东省口腔医学重点实验室,广州510055

出　　处：《中华口腔医学研究杂志（电子版）》2021年第1期18-23,共6页Chinese Journal of Stomatological Research(Electronic Edition)

摘　　要：目的评价应用颌间牵引改善数字化技术联合自体骨移植修复下颌骨缺损后仍然存在的上、下颌咬合关系不良的临床效果。方法回顾分析中山大学附属口腔医院口腔颌面外科和桂林市第二人民医院口腔科2016年1月至2018年2月进行的18例利用数字化技术联合自体骨移植修复口腔下颌骨缺损的手术,术前均采用数字化辅助外科技术制作个体化树脂头模、设计腓骨或髂骨修复的位置及高度,其中17例为血管化游离腓骨肌皮瓣修复手术、1例游离髂骨修复下颌骨缺损手术。9例术中植入Ormco颌间牵引钉并术后早期颌间牵引,维持咬合关系稳定,另外9例术中未同期植入牵引钉,术后无颌间牵引。记录颌间牵引钉使用数目、位置、咬合关系情况。采用Fisher确切概率法(SPSS 25.0统计软件),分析采用早期颌间牵引与未采用早期颌间牵引这两种方法对数字化技术辅助修复下颌骨缺损后咬合关系的恢复效果。结果手术同期植入牵引钉并早期颌间牵引的9例患者中,2例(22.22%)出院时(术后12~14 d)咬合关系正常、7例(77.78%)出院时存在不同程度后牙早接触;9例未同期植入牵引钉患者中,3例(33.33%)出院时咬合关系正常、6例(66.67%)存在不同程度咬合早接触,两组患者出院时咬合关系不佳的比例无明显差异(P=1.00)。术后1、6和12个月复诊,手术同期植入牵引钉并早期颌间牵引的9例患者,咬合关系均正常且稳定;未同期植入牵引钉行颌间牵引患者,术后1个月仅2例(22.22%)咬合关系正常、7例(77.78%)患者均不同程度咬合关系不良,未同期植入颌间牵引钉组患者咬合关系不佳发生率明显高于同期植入颌间牵引钉并早期颌间牵引组的患者(P=0.002)。结论应用牵引钉早期颌间牵引明显有利于数字化技术修复下颌骨缺损后的咬合关系稳定。Objective To investigate the effect of intermaxillary traction on the disordered occlusion after the reconstruction of mandibular defects assisted by digital technology.Methods Retrospective analysis of 18 cases with mandible defect reconstruction utilized digital technology in the Department of Oral and Maxillofacial Surgery,Hospital of Stomatology,Sun Yat-sen University,between January 2016 and February 2018.The mandibular resection and reconstruction were simulated using individualized digital technology aided surgery,where the position and height of fibula or iliac crest were also shaped based on the model.Among the 18 selected cases,17 cases were reconstructed using the vascularized free fibular flap,and one case received free iliac bone flap.Nine patients subjected to ORMCO intermaxillary traction screws which were combined with the early intermaxillary traction to maintain the stability of occlusion relationship,while traction screws were not implanted in the rest cases.The intermaxillary traction screw number,position and occlusion were recorded.Fisher′s exact test was used to analyze the effect of these two methods on the postoperative occlusal relationship.Results Among the nine patients who used early intermaxillary traction,Two(2/9,22.22%)had normal occlusal relationship and seven had different degrees of occlusion deviation in 12 to 14 days after operation.There were three cases(33.33%)of normal occlusal relationship and six cases(66.67%)of abnormal occlusion among the other nine postoperative patients who did not have traction screws.There was no significant difference in the proportion of abnormal occlusal relationship between the two groups at discharge(P=1.00).The occlusal relationship was normal and stable in all the nine patients who used early intermaxillary traction in 1,6,12 m after surgery.Meanwhile,only two(22.22%)patients had normal occlusal relationship and seven cases(77.78%)had occlusion disharmony or deviation among the nine patients who did not use early intermaxillary traction.The

关 键 词：牵引 骨螺丝 数字化技术 下颌骨 

分 类 号：R782.4[医药卫生—口腔医学]