上颌牵张成骨术与Le Fort I型前徙术治疗复杂唇腭裂上颌发育不全的效果比较  

Comparative analysis of maxillary distraction osteogenesis and Le Fort Ⅰ osteotomy on maxillary hypoplasia in patients with complex cleft lip and palate

作　　者：张天赐 赵寰卓 蒋曼 王涛 周建萍[1,2,3] 曹礼[1,2,3] 郑雷蕾 Zhang Tianci;Zhao Huanzhuo;Jiang Man;Wang Tao;Zhou Jianping;Cao Li;Zheng Leilei(Department of Orthodontics,Stomatological Hospital of Chongqing Medical University,Chongqing 400016,China;Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences,Chongqing 400016,China;Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education,Chongqing 400016,China;Department of Orthognathic Surgery,Stomatological Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属口腔医院正畸科,重庆400016 [2]口腔疾病与生物医学重庆市重点实验室,重庆400016 [3]重庆市高校市级口腔生物医学工程重点实验室,重庆400016 [4]重庆医科大学附属口腔医院正颌外科,重庆400016

出　　处：《中华整形外科杂志》2024年第8期846-856,共11页Chinese Journal of Plastic Surgery

基　　金：重庆英才计划创新领军人才项目(CQYC20210303384);重庆市科卫联合医学科研重点项目(2018ZDXM020);重庆医科大学未来医学青年创新团队支持计划(W0033);重庆市渝北区科学技术局项目[2022(农社)32]。

摘　　要：目的比较上颌牵张成骨术与Le FortⅠ型前徙术治疗复杂唇腭裂上颌发育不全患者的效果。方法回顾性收集2015年1月至2022年12月就诊于重庆医科大学附属口腔医院需正畸-正颌联合治疗的唇腭裂骨性Ⅲ类错畸形患者的临床资料,根据上颌骨的手术方式分为3组,分别行全上颌截骨牵张术(TMD,A组)、上颌前部截骨牵张术(AMD,B组)和Le FortⅠ型前徙术(LFⅠ,C组)。搜集术前1个月和牵张器拆除时(若无牵张器则为术后3个月)患者头颅侧位X线片及锥形束CT(CBCT)影像资料,利用Mimics 21.0及Dolphin Imaging 11.9软件对患者治疗前后的CBCT进行三维重建,分别评估颅颌面以及气道的变化。采用SPSS 25.0进行数据分析,同组内手术前后比较采用Wilcoxon秩和检验,3组间比较采用Kruskal-Wallis H检验。结果共纳入15例患者,每组各5例,其中男8例,女7例,年龄15~21岁。3组性别、年龄分布及唇腭裂分类差异无统计学意义(P>0.05)。经过手术治疗,3组患者的上颌发育不全均得到一定程度改善。与术前比较,术后3组由上牙槽座点、鼻根点及下牙槽座点所构成的角(ANB角)增加(P均<0.05),A、B组上牙槽座点至鼻根点垂直距离(A-Nperp)增加(P均<0.05),C组差异无统计学意义(P>0.05),3组牙槽嵴缺隙面积均有增加趋势(P>0.05);下颌平面与眶耳平面的交角(FMA角)在B组术后减小,而其余2组均有增加趋势,但差异均无统计学意义(P>0.05);A、B组术后气道体积增加或有增加趋势(A组P<0.05,B组P>0.05),但C组气道体积有所减小(P>0.05)。组间比较显示,3组间术前后由蝶鞍中心、鼻根点及上牙槽座点所构成的角(SNA角)及前鼻棘点至冠状面的垂直距离(ANS-CP)的变化量差异有统计学意义(P<0.05),其中A组SNA角和ANS-CP的变化量显著大于B组,且ANS-CP的变化量显著大于C组,差异均有统计学意义(P<0.05),其他组间差异无统计学意义(P>0.05)。结论对复杂唇腭裂上颌发育严重不足�ObjectiveTo compare the efficacy of maxillary distraction osteogenesis(DO)and Le FortⅠosteotomy(LFⅠ)in patients with complex cleft lip and palate.MethodsA retrospective study was conducted,clinical data were collected involving patients with complex cleft lip and palate who required combined orthodontic and orthognathic treatment and were treated at the Stomatological Hospital of Chongqing Medical University from January 2015 to December 2022.Patients were divided into three groups based on the surgical method used for the maxilla:total maxillary distraction(TMD,group A),anterior maxillary distraction(AMD,group B),and Le FortⅠosteotomy(LFⅠ,group C).Cone-beam CT scans and lateral cephalograms were obtained preoperatively and at 3 months postoperatively.Three-dimensional reconstructions were performed using Mimics 21.0 and Dolphin Imaging 11.9 software to evaluate changes in craniofacial morphology and airway.Data analysis was conducted using SPSS 25.0.Intragroup comparisons before and after surgery were performed using the Wilcoxon rank sum test,and intergroup comparisons among the three groups were conducted using the Kruskal-Wallis H test.ResultsA total of 15 patients were included,with 5 patients in each group.The cohort comprised 8 males and 7 females,aged between 15 and 21 years.There were no statistically significant differences in the distribution of gender,age,or cleft lip and palate classification among the three groups(P>0.05).Postoperatively,all three groups showed improvement in maxillary hypoplasia.Compared to preoperative measurements,the angle formed by the points A(subspinale),N(nasion),and B(supramentale)(ANB angle)increased in all three groups(all P<0.05).The vertical distance from point A to the nasion perpendicular(A-Nperp)increased in groups A and B(P<0.05 for both)but not in group C(P>0.05).The area of the alveolar gap showed an increasing trend in all three groups(P>0.05).The mandibular plane angle(FMA)decreased postoperatively in group B but showed an increasing trend in the other t

关 键 词：外科 口腔 复杂唇腭裂 正畸-正颌联合治疗 牵张成骨 三维重建 锥形束CT 

分 类 号：R782.2[医药卫生—口腔医学]