L形颧骨颧弓缩窄术不同固定方式稳定性的对比研究  

The stability of different fixation methods in L-shaped reduction malarplasty: a comparative retrospective study

作　　者：吴一凡 何映酉 高鹤友 葛涵 周子航 李继华[1] Wu Yifan;He Yingyou;Gao Heyou;Ge Han;Zhou Zihang;Li Jihua(State Key Laboratory of Oral Diseases&National Clinical Research Center for Oral Diseases&Department of Orthognathic and Temporomandibular Joint Surgery,West China Hospital of Stomatology,Sichuan University,Chengdu 610041,China)

机构地区：[1]口腔疾病国家重点实验室、口腔疾病国家临床研究中心、四川大学华西口腔医院正颌及关节外科,成都610041

出　　处：《中华整形外科杂志》2024年第10期1065-1072,共8页Chinese Journal of Plastic Surgery

基　　金：四川省科技厅重点研发项目(24ZDYF0402)。

摘　　要：目的评估颧骨颧弓缩窄术(RM)中采用不同方式固定颧骨颧弓复合体的术后稳定性。方法回顾性分析2018年1月至2021年1月四川大学华西口腔医院正颌及关节外科收治的颧骨颧弓突出患者资料。所有患者均接受L形RM,按照固定部位分为颧骨体固定(ZBF)和颧弓固定(ZAF)2部分。根据ZBF方式不同分为4组:2枚双皮质钛钉(2LS)组、1块L形钛板+1枚双皮质钛钉(LPLS)组、1块短翼在颧骨体上的L形钛板(LPwZ)组、1块短翼在上颌骨上的L形钛板(LPwM)组;根据ZAF方式不同分为3组:榫卯结构(MT)组、3孔钛板(3HP)组、短钛钉(SS)组。分别采集术后1周和术后6个月患者CT影像数据,采用ITK-SNAP和3D Slicer软件构建颧骨颧弓复合体模型,评估相关标志点移位距离的差异,以此比较不同固定方式下颧骨颧弓复合体的术后稳定性。采用SPSS 25.0软件对数据进行统计分析,用Kruskal-Wallis法对不同固定方式下相关标志点的移位值进行比较,P<0.05为差异有统计学意义。结果共纳入60例患者(120侧颧骨颧弓),男21例,女39例,年龄(27.1±4.9)岁。按ZBF方式分组每组纳入30侧样本;按ZAF方式分组每组纳入40侧样本。2LS组和LPLS组与单一L形钛板(LPwZ、LPwM)组相比,颧骨颧弓复合体的移位距离均较短(P<0.05),而3种颧弓固定方式(MT、3HP、SS)对颧骨颧弓复合体移位的影响相近(P>0.05)。结论RM术后,在ZBF中,采用2LS和LPLS这种"双重"固定方式比单一L形钛板固定的稳定性更好,而所有ZAF方式分别与2LS或LPLS组合后,稳定性均相似。ObjectiveTo evaluate the stability of the zygomatic complex in reduction malarplasty(RM)with different fixation method.MethodsThe clinical data of patients with zygomatic arch protrusion at the Department of Orthognathic and Temporomandibular Joint Surgery,West China Hospital of Stomatology,Sichuan University from January 2018 to January 2021 were analyzed retrospectively.All patients underwent L-shaped osteotomy reduction malarplasty which were divided into zygomatic body fixation(ZBF)and zygomatic arch fixation(ZAF)according to fixation technique.As for ZBF,there were 4 different groups including two bicortical screws(2LS),an L-shaped plate with one bicortical screw(LPLS),an L-shaped plate with short-wing on the zygoma(LPwZ)and an L-shaped plate with short-wing on the maxilla(LPwM).As for ZAF,there were 3 different groups including mortice-tenon(MT),3-hole plate(3HP)and short screw(SS).CT imaging data of two postoperative periods(1 week later;6 months later)were collected.ITK-SNAP and 3D Slicer software were applied to evaluate the difference in the displacement distance of relevant landmarks of the zygomatic complex,so as to compare the postoperative stability of RM under different fixation methods.Statistical analyses were performed using IBM SPSS Statistics,version 25.0,and Kruskal-Wallis method was used to compare the difference of relevant landmarks displacement distance between ZBF group and ZAF group.P<0.05 was considered statistically significant.Results60 patients(120 zygomatic arches)who were composed of 21 men and 39 women,aged(27.1±4.9)years were included.There were 30 samples in each group of ZBF and 40 samples in each group of ZAF.Compared with the single L-shaped plate(LPwZ,LPwM)group,the displacement distance of zygomatic complex in 2LS and LPLS groups was shorter(P<0.05).The three fixation method of zygomatic arch(MT,3HP,SS)had similar effects on the displacement of zygomatic complex(P>0.05).ConclusionAfter RM,the"two-bridge"fixation method(2LS and LPLS)provides better stability than the singl

关 键 词：正颌外科学 颧骨颧弓缩窄术 颧骨颧弓肥大 稳定性 固定方式 移位 

分 类 号：R782[医药卫生—口腔医学]