骨性Ⅲ类患者双颌正颌手术后上气道形态变化与颌骨移动量的相关性研究  

Correlation between upper airway morphological changes and jaw movement after bimaxillary orthognathic surgery in patients with skeletal Class Ⅲ malocclusion

作　　者：李根 郭松松[1,3] 蔡观慧 孙莲[1,2] 孙雯[1,2] 王华[1,2,4] LI Gen;GUO Songsong;CAI Guanhui;SUN Lian;SUN Wen;WANG Hua(Jiangsu Key Laboratory of Oral Diseases,Nanjing Medicine University,Nanjing 210029,China)

机构地区：[1]南京医科大学江苏省口腔疾病研究重点实验室,江苏南京210029 [2]南京医科大学江苏省口腔转化医学工程研究中心,江苏南京210029 [3]南京医科大学附属口腔医院口腔颌面外科,江苏南京210029 [4]南京医科大学附属口腔医院正畸科,江苏南京210029

出　　处：《口腔医学》2024年第7期515-521,共7页Stomatology

基　　金：国家自然科学基金(81970961)。

摘　　要：目的通过锥形束计算机断层扫描(cone beam computer tomography,CBCT)探究骨性Ⅲ类错(牙合)畸形患者双颌手术后上气道形态变化,以及颌骨移动与气道变化的关系。方法本研究纳入44例Ⅲ类双颌手术患者(男性21例,女性23例)。采集患者术前及术后3~6个月内CBCT数据,使用Dophin3D 11.95软件行测量分析。采用配对t检验、非参数Wilcoxon秩和检验分析上气道手术前后变化。采用Pearson相关系数分析气道变化与颌骨移动量的相关性。结果术后患者的上气道容积、正中矢状面纵截面积、最小横截面积明显减少(P<0.01)。口咽区容积变化量与B点的变化量相关(P<0.05)。随B点后退量的增加,上气道容积降低的显著性增加,当B点后退量>7 mm时,上气道各区域容积均显著降低(P<0.01),同时患者气道最小横截面积的危险程度显著升高(P<0.01)。结论骨性Ⅲ类双颌手术可降低患者的上气道容积。术后上气道容积减少量与B点后退量相关。当行大量下颌后退(>7 mm)时,可造成上气道容积的显著减低,增加OSAHS患病风险。对上气道有狭窄倾向的患者,应适当调整方案以减少气道风险。Objective To investigate the morphological changes in the upper airway after bimaxillary surgery in patients with skeletal Class Ⅲ malocclusion and the relationship between jaw movement and airway changes using CBCT. Methods This study involved 44 individuals(21 males and 23 females)receiving Class Ⅲ bimaxillary surgery. Preoperative and 3-6-month postoperative CBCT data were examined using Dophin3D 11.95 software. The alterations before and after upper airway surgery were analysed using paired t-test and non-parametric Wilcoxon rank sum test. The association between airway alterations and jaw movement was examined using Pearson's correlation coefficient. Results Patients who underwent Class Ⅲ bimaxillary surgery had significantly reduced upper airway volume, sagittal cross-sectional area, and minimum cross-sectional area(P<0.01). A correlation exists between oropharyngeal volume change and point B change(P<0.05). When B point recession was >7 mm, the decrease in upper airway volume increased significantly(P<0.01), as did the risk of minimum cross-sectional area of the patient's airway(P<0.01). Conclusion Class Ⅲ bimaxillary surgery reduces upper airway capacity. Postoperative reduction in upper airway capacity coincides with mandibular recession. Mandibular recession(>7 mm)may reduce postoperative upper airway capacity and increase the risk of OSAHS. Patients at risk of upper airway stenosis should have their protocol modified to reduce airway risk.

关 键 词：骨性Ⅲ类错(牙合)畸形 双颌手术 上气道 CBCT 

分 类 号：R782.23[医药卫生—口腔医学]