两种骨支抗牵引方法对唇腭裂术后上颌后缩患者疗效的对比研究  

Comparative study on two bone-anchored maxillary protraction protocols for maxillary hypolasia in post-surgery cleft patients

作　　者：李新桂 叶金梅 崔颖秋 毛喆 王洪涛 Li Xingui;Ye Jinmei;Cui Yingqiu;Mao Zhe;Wang Hongtao(Department of Orthodontic,Guangzhou Women and Children's Medical Center,Guangzhou 510120,China;Department of Oral and Maxillofacial Surgery,Guangzhou Women and Children's Medical Center,Guangzhou 510120,China)

机构地区：[1]广州市妇女儿童医疗中心口腔正畸科,510120 [2]广州市妇女儿童医疗中心口腔颌面外科,510120

出　　处：《中华口腔正畸学杂志》2020年第4期197-204,共8页Chinese Journal of Orthodontics

基　　金：广州市卫生和计划生育委员会西医类一般引导项目(20151A010041)。

摘　　要：目的比较两种骨支抗前牵引方法治疗唇腭裂术后上颌后缩患者的疗效。方法 12例替牙晚期或恒牙早期唇腭裂上颌后缩患者,随机分为两组:A组上颌颧牙槽嵴处钛板配合面具前牵引;B组上、下颌钛板,配合颌间Ⅲ类牵引。牵引前后拍摄头颅侧位片进行比较。结果 A、B组牵引时间分别为12.1个月和12.5个月。A、B组上颌骨均发生明显前移,分别前移3.12及3.83 mm;颌骨间关系变得协调,ANB角分别增加3.69°及3.14°、Wit’s值分别增加4.30及4.52 mm,软组织侧貌明显改善。然而,A组下颌骨发生了后下旋转及下切牙的舌倾。B组下颌骨发生了少量逆旋及下切牙轻度的唇倾。结论上颌钛板面具牵引与上、下颌钛板颌间Ⅲ类牵引治疗替牙晚期及恒牙早期的唇腭裂上颌后缩患者均非常有效,但上、下颌钛板Ⅲ类牵引对垂直向控制更好,更有利于对高角病例的控制,受病例数量限制,还需要更大样本量的研究支持。Objective To compare the effects of 2 protocols of bone-anchored maxillary protraction for maxillary hypoplasia in post-surgery cleft patients.Methods Twelve growing post-surgery cleft patients with maxillary deficiency in the late mixed or early permanent dentition were included in the study,and they were randomly divided into two groups.In group A(n=6),skeletal-anchored facemasks were used with miniplates placed at the zygomatic buttress.In group B(n=6),the patients were treated with ClassⅢelastics extending from infrazygomatic miniplates in the maxilla to symphyseal miniplates in the mandible.Cephalometric radiographs were analyzed before and after the protraction treatment.Results The protraction treatment periods were 12.1 and 12.5 months in groups A and B,respectively.The maxilla moved forward significantly in both groups(3.12 mm in group A,3.83 mm in group B);The intermaxillary relationship variables(ANB,Wits appraisal)demonstrated highly significant improvements in two groups(3.69°and 4.30 mm in group A,3.14°and 4.52 mm in group B).Soft tissue harmony demonstrated great improvement.The mandible showed clockwise rotation with a downward and backward position and the mandibular incisors showed a significant retroclination in group A.However,group B showed a reduction of the mandibular plane angle and a slight proclination of the mandibular incisors.Conclusions The two skeletal anchorage protocols for maxillary protraction effectively resolved the severe maxillary deficiently in growing cleft patients.However,ClassⅢelastics between miniplates can provide greater vertical closing of the mandibular plane than facemasks anchored with miniplates,which makes it a better choice in high angle patients.Due to the limited number of cases,a larger sample size is needed to support the study.

关 键 词：唇腭裂 上颌后缩 前方牵引 钛板种植体 

分 类 号：R782.21[医药卫生—口腔医学]