双侧人工颞下颌关节置换与双颌手术治疗特发性髁突吸收伴前牙开患者的上气道改变对比研究  

A comparative study of the upper airway changes of idiopathic condylar resorption and anterior open bite patients after bilateral temporomandibular joint prostheses surgery and bimaxillary orthognathic surgery

作　　者：李昊翰 刘华泽 李倩琍 毕瑞野[1] 祝颂松[1] Li Haohan;Liu Huaze;Li Qianli;Bi Ruiye;Zhu Songsong(Department of Orthognathic and Temporomandibular Joint Surgery,West China Hospital of Stomatology,Sichuan University&State Key Laboratory of Oral Diseases&National Clinical Research Center for Oral Diseases,Chengdu 610041,China)

机构地区：[1]四川大学华西口腔医院正颌及关节外科,口腔疾病研究国家重点实验室,国家口腔疾病临床医学研究中心,成都610041

出　　处：《中华口腔医学杂志》2022年第7期708-715,共8页Chinese Journal of Stomatology

基　　金：国家自然科学基金(82071139,81801003)。

摘　　要：目的研究对比特发性髁突吸收伴前牙开患者行双侧人工颞下颌关节置换术或双颌手术后上气道的二维及三维变化。方法本研究属于回顾性研究,筛选2018年1月至2021年12月就诊于四川大学华西口腔医院正颌及关节外科的特发性髁突吸收伴前牙开患者,选择行双侧人工颞下颌关节置换治疗病例8例(R组),行双颌手术治疗病例9例(O组)。收集患者术前1个月(T1)及术后1年(T2)内的螺旋CT影像学资料,进行上气道总体积(total volume of airway,VT)、上气道矢状面最大面积(maximum sagittal area,MSA)、上气道横截面最大面积(maximum cross-sectional area,MACA)、上气道横截面最小面积(minimum cross-sectional area,MICA)、腭平面气道横截面面积(the area of the most posterior plane,PPA)、软腭平面气道横截面面积(the area of soft-palate plane,SPA)、舌根平面气道横截面面积(the area of the most posterior point of tongue base plane,PTA)、会厌根平面气道横截面面积(the area of the root of epiglottis plane,EA)、口咽部气道体积(oropharyngeal airway volume,VO)、舌咽部气道体积(glossopharyngeal airway volume,VG)、喉咽部气道体积(laryngeal airway volume,VL)测量,对测量结果统计分析(除R组术后VO、术后SPA、术前术后VO差值、术前术后MACA差值,O组术前PTA、术后EA应用Wilcoxon符号秩检验分析外,其余项目均使用t检验),比较同组患者术前与术后上气道不同维度与不同分段的改变情况以及不同术式对上气道改变情况的差异。结果与术前相比,R组患者术后1年内VT、VO、VG、VL、MSA、MACA、MICA、PPA、PTA、EA均显著增加(P<0.05),O组患者术后VT、VO、VG、MSA、MACA、MICA、PPA、SPA均显著增加(P<0.05)。R组与O组治疗前后上气道改变量对比显示,R组VT增加的绝对值[(6854.80±3197.82)mm^(3)]显著大于O组[(3367.91±3124.62)mm^(3)](t=2.27,P=0.038);R组VL增加绝对值[(2252.85±1527.96)mm^(3)]显著大于O组[(413.21±1244.44)mm^(3)]Objective To evaluate the 2-dimension and 3-dimension changes of upper airway of patients who were diagnosed with idiopathic condylar resorption(ICR)and anterior open bite as well as received bilateral temporomandibular joint(TMJ)prostheses replacement or bimaxillary orthognathic surgery.Methods This study is a retrospective study.Seventeen patients diagnosed as ICR and anterior open bite in Department of Orthognathic and TMJ surgery,West China Hospital of Sichuan University were selected(January 2018 to December 2021)and divided into bilateral TMJ protheses replacement group(group R,n=8)and orthognathic group(group O,n=9),according to which surgery they have performed.In order to compare variation of upper airway before and after surgery in different dimensions and sections within the same group or between groups,Spiral computed tomography data were obtained before(1 month)and after operation(10 to 12 months)to measure the total volume of airway(VT),the maximum sagittal area(MSA),the maximum cross-sectional area(MACA),the minimum cross-sectional area(MICA),the area of the most posterior plane(PPA),the area of soft-palate plane(SPA),the area of the most posterior point of tongue base plane(PTA),the area of the root of epiglottis plane(EA),the oropharyngeal airway volume(VO),the glossopharyngeal airway volume(VG)and the laryngeal airway volume(VL).Wilcoxon signed-rank test were used to complete statistical analyses for VO(T2),SPA(T2),ΔMSA,ΔMACA in group R as well as PTA(T1),EA(T2)in group O.Statistical analyses of other items were performed with student's t test.Results VT,VO,VG,VL,MSA,MACA,MIC,PPA,PTA and EA of group R(T2)were significantly increased after TMJ prosthesis with LefortⅠosteotomy(P<0.05).Meanwhile the VT,VO,VG,MSA,MACA,MICA,PPA and SPA of group O(T2)were significantly increased(P<0.05).There were significant difference in ΔVT and ΔVL between group R[(6854.80±3197.82)mm^(3),(2252.85±1527.96)mm^(3)]and group O[(3367.91±3124.62)mm^(3),(413.21±1244.44)mm^(3)](t=2.27,P=0.038;t=2.74,P=0.015).Conc

关 键 词：颞下颌关节 开 气道 全关节置换 正颌手术 

分 类 号：R782.6[医药卫生—口腔医学]