锥形束CT研究上颌反复扩缩前方牵引后上颌骨缝的三维变化  

A cone-beam computed tomography evaluation of three-dimensional changes of circummaxillary sutures following maxillary protraction with alternate rapid palatal expansions and constrictions

作　　者：刘伟涛[1,2] 王怡然 王雪东 周彦恒[1] LIU Wei-tao;WANG Yi-ran;WANG Xue-dong;ZHOU Yan-heng(Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China)

机构地区：[1]北京大学口腔医学院·口腔医院正畸科,国家口腔医学中心,国家口腔疾病临床医学研究中心,口腔生物材料和数字诊疗装备国家工程研究中心,口腔数字医学北京市重点实验室,北京100081 [2]北京赛德阳光口腔临床研究院 [3]山东大学口腔医学院·口腔医院儿童口腔科,山东省口腔组织再生重点实验室,山东省口腔生物材料与组织再生工程实验室

出　　处：《北京大学学报（医学版）》2022年第2期346-355,共10页Journal of Peking University:Health Sciences

基　　金：国家重大疾病多学科合作诊疗能力建设项目(PKUSSNMP-202013)。

摘　　要：目的:使用锥形束CT(cone-beam computed tomography,CBCT)影像研究上颌反复快速扩缩前方牵引后上颌及周围骨缝的三维变化,探讨该变化与颧颌缝成熟度之间的关系,分析上颌前移的影响因素,为骨性Ⅲ类错[牙合]畸形的早期治疗提供参考。方法:选择36例上颌后缩患者,使用随机化区组设计分为单次扩弓组和反复扩缩组(临床试验注册号:ChiCTR2000034909),患者7~13岁,安氏Ⅲ类错[牙合],前牙反[牙合],头影测量显示ANB角<0°,Wits值<-2 mm,上齿槽座点(A点)至过鼻根点(N点)的眼耳平面垂线的距离(A-Np)<0 mm。单次扩弓组行上颌单次快速扩弓后面罩前方牵引,反复扩缩组行上颌反复快速扩缩后面罩前方牵引。使用Dolphin 11.7软件对每组治疗前后的CBCT影像进行头位校正,使用Mimics 10.01软件进行三维重建,测量上颌骨及其周围骨缝标志点,使用独立样本t检验、双因素方差分析、Pearson相关性分析和回归分析进行统计学分析。结果:除2例患者未完成复诊随访外,其余34例患者均完成治疗。与单次扩弓组相比,反复扩缩组患者治疗后上颌及周围骨缝标志点矢状前移量更大,颧颞缝、颧颌缝及颧额缝标志点矢状向分别前移1.21 mm、2.20 mm及1.43 mm,组间差异均有统计学意义(P<0.05)。除颧颞缝外,其余骨缝标志点矢状向前移量不受颧颌缝成熟度影响(P>0.05)。反复扩缩组治疗后,颧颌缝标志点和A点矢状向前移量之间相关性较强(P<0.01),回归分析R^(2)=42.5%。结论:与上颌单次快速扩弓相比,上颌反复快速扩缩前方牵引对于早期治疗上颌后缩可能效果更佳;上颌反复快速扩缩前方牵引后,颧颌缝作为上颌矫形力作用的主要骨缝之一,其矢状向前移量与上齿槽座点的前移量相关性较强。Objective:To assess three-dimensional(3D)changes of circummaxillary sutures following maxillary protraction with alternate rapid palatal expansions and constrictions(RPE/C)facemask protocol in maxillary retrusive children,and to investigate the relationship between the changes of circum-maxillary sutures and zygomaticomaxillary suture(ZMS)maturation,and to explore the factors of maxilla forward movement with RPE/C and facemask.Methods:In the study(clinical trial registration No:ChiCTR2000034909),36 maxillary retrusive patients were recruited and block randomized to either the rapid palatal expansion(RPE)group or the RPE/C group.Patients aged 7 to 13 years,ClassⅢmalocclusion,anterior crossbite,ANB less than 0°,Wits appraisal less than-2 mm,and A-Np less than 0 mm were included in the study.The RPE group received rapid palatal expansion,whereas the RPE/C group received alternate rapid palatal expansions and constrictions,and both with facemask protraction.Head orientations of cone-beam computed tomography(CBCT)images were implemented by Dolphin 11.7.3D measurements of circummaxillary sutures on CBCT images were evaluated using Mimics 10.01 before(T0)and after treatment(T1).The changes were analyzed with independent t test,two-way ANOVA,Pearson correlation and regression analysis.Results:Two subjects in the RPE/C group were lost to follow-up.A total of 34 patients reached the completion criteria and were analyzed.Compared with the RPE group,sagittal changes of circummaxillary sutures were significantly increased in the RPE/C group with 1.21 mm advancement of zygomaticotemporal suture,2.20 mm of ZMS,1.43 mm of zygoma-ticofrontal suture(P<0.05,respectively).Except for the zygomaticotemporal suture,the rest forward sagittal changes of other circummaxillary sutures showed no major difference in terms of the ZMS maturation.The Spearman’s correlation in RPE/C indicated a strong positive correlation of sagittal changes between ZMS and point A(P<0.01)with a regression analysis R^(2)=42.5%.Conclusion:RPE/C might be more

关 键 词：错[牙合] 安氏Ⅲ类 上颌骨 腭扩张术 颅缝 锥形束CT 

分 类 号：R783.5[医药卫生—口腔医学]