下颌前突合并上颌后缩患者双颌手术对上气道三维变化影响的研究  

Research of upper airway three-dimensional changes in mandibular prognathism accompanied with maxillary retrognathism patients treated with bimaxillary orthognathic surgery

作　　者：胡小蓓 邹维娜 蒲玉梅[2] 张昆 王育新[2] Hu Xiaobei;Zou Weina;Pu Yumei;Zhang Kun;Wang Yuxin(Department of Orthodontics,Nanjing Stomatological Hospital,Medical School of Nanjing University,Nanjing 210008,China;Department of Oral and Maxillofacial Surgery,Nanjing Stomatological Hospital,Medical School of Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属口腔医院,南京市口腔医院口腔正畸科,南京210008 [2]南京大学医学院附属口腔医院,南京市口腔医院口腔颌面外科,南京210008

出　　处：《中华整形外科杂志》2022年第9期1005-1012,共8页Chinese Journal of Plastic Surgery

基　　金：南京市医学科技发展课题(YKK20150);南京市卫生青年人才(QRX17174);南京市口腔疾病临床医学研究中心(2019060009);江苏省重点研发计划(社会发展)项目(BE2021609)。

摘　　要：目的采用螺旋CT研究下颌前突合并上颌后缩患者双颌手术前后上气道的三维变化。方法回顾性分析2017年5月至2020年10月南京大学医学院附属口腔医院口腔颌面外科行双颌手术的下颌前突合并上颌后缩患者资料。手术方式为LeFortⅠ型截骨术+双侧下颌升支矢状劈开后退术。以下齿槽座点矢状向后退距离为依据,分为A组(>5 mm)和B组(≤5 mm)。收集2组患者术前1周、术后1个月、术后6~12个月的螺旋CT数据并进行三维模型重建,分别测量各时期上气道各平面的截面积、矢状径及各段容积等指标,定量评价双颌手术对2组患者上气道的影响。采用重复测量方差分析比较同组患者各时间点上气道测量指标的差异,差异有统计学意义者用Bonferroni法进行多重比较(检验标准α矫正为0.017);采用两因素重复测量方差分析比较A、B组间上气道变化趋势的差异。结果共纳入30例患者,其中A组15例,男5例,女10例,年龄(21.2±2.3)岁;B组15例,男7例,女8例,年龄(23.6±2.4)岁。(1)舌咽上界平面的截面积及矢状径、舌咽容积和上气道总容积:A组在术后1个月显著减小,术后6~12个月不能恢复至术前水平(均P<0.017);B组在术后1个月显著减小(均P<0.017),术后6~12个月恢复至术前水平(均P>0.017);2组间这些指标的变化趋势差异有统计学意义(均P<0.05)。(2)舌咽长度及上气道总长度:与术前相比,A组在术后1个月、6~12个月均显著增大(均P<0.017);B组在术后1个月、6~12个月均无显著改变(均P>0.017);2组间这2个指标的变化趋势差异有统计学意义(均P<0.05)。结论下颌前突合并上颌后缩患者双颌手术后会造成舌咽容积及上气道总容积减小,下颌骨后退≤5 mm者术后6~12个月有较大可能恢复至术前水平,下颌骨后退>5 mm者术后6~12个月不能恢复至术前水平。Objective To evaluate the upper airway dimension changes in mandibular prognathism accompanied with maxillary retrognathism patients treated with bimaxillary orthognathic surgery by spiral CT.Methods The data of patients with mandibular prognathism accompanied with maxillary retrognathism who underwent bimaxillary surgery in the Department of Oral and Maxillofacial Surgery of Nanjing Stomatological Hospital,Medical School of Nanjing University from May 2017 to October 2020 were retrospectively analyzed.The surgical method was LeFortⅠosteotomy and bilateral sagittal split mandibular osteotomy.The patients were divided into 2 groups based on the sagittal setback distance of the supramentale(in group A,the setback distance of the supramentale was more than 5 mm;in group B,the setback distance of the supramentale was less than or equal to 5 mm).Spiral CT data were collected 1 week before surgery(T0),1 month after surgery(T1),and 6-12 months after surgery(T2).Three-dimensional model reconstruction was performed.The airway cross-sectional measurements,length and volumes in T0,T1 and T2 were measured.The effect of bimaxillary orthognathic surgery on upper airway of the patients was evaluated quantitatively.We performed repeated measures analysis of variance to compare the differences of upper airway among T0,T1 and T2 in the same group.The Bonferroni method was used for multiple comparisons if the difference was statistically significant(α=0.017).We used two-factor repeated measures analysis of variance to compare the differences of the upper airway change trend between the two groups.Results A total of 30 patients were included,including 15 patients in group A,5 males and 10 females[aged:(21.2±2.3)years];and 15 patients in group B,7 males and 8 females[aged:(23.6±2.4)years].The cross-section area and sagittal diameter of lower velopharyngeal plane(Lvp),the glossopharynx airway volume and total upper airway volume:group A decreased significantly at T1,and did not return to T0 level at T2(all P<0.017);group B decrea

关 键 词：颌面畸形 正颌外科学 下颌前突 上颌后缩 上气道 螺旋CT 

分 类 号：R783.5[医药卫生—口腔医学]