正畸-正颌联合治疗骨性Ⅲ类错[牙合]伴下颌偏斜过程中寰枢关节间隙及咽气道变化的锥形束CT分析  

Atlantoaxial joint space and pharyngeal airway changes in skeletal classⅢpatients with mandibular deviation after combined orthodontic-orthognathic treatment:a cone-beam CT analysis

作　　者：王颖 王娅 杨丹 孙吉成[1] 郑雷蕾[1] Wang Ying;Wang Ya;Yang Dan;Sun Jicheng;Zheng Leilei(Department of Orthodontics,Stomatological Hospital of Chongqing Medical University&Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences&Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education,Chongqing 401147,China)

机构地区：[1]重庆医科大学附属口腔医院正畸科,口腔疾病与生物医学重庆市重点实验室,重庆市高校市级口腔生物医学工程重点实验室,重庆401147

出　　处：《中华口腔医学杂志》2025年第2期123-131,共9页Chinese Journal of Stomatology

基　　金：重庆英才计划(CQYC20210303384);重庆市自然科学基金(CSTB2023NSCQ-MSX0233);重庆医科大学未来医学青年创新团队发展支持计划(W0033)。

摘　　要：目的探讨骨性Ⅲ类错[牙合]伴下颌偏斜患者正畸-正颌联合治疗过程中寰枢关节间隙及咽气道的变化。方法回顾性选取2014年8月至2021年10月于重庆医科大学附属口腔医院正畸科和正颌外科进行正畸-正颌联合治疗的骨性Ⅲ类错[牙合]伴下颌偏斜成年患者34例(男性10例, 女性24例), 年龄22(5)岁(18~33岁)。收集患者治疗前、术前正畸后(术前)、正颌手术后6~12个月(术后)的锥形束CT, 对不同时间点寰枢关节间隙[寰齿前间隙(ADI)、双侧齿突侧块间距差值(VBLADI)], 各气道截面前后向长度(APL)、最大横向宽度(LTW)、横截比(L/W值)、截面积(CSA), 气道容积及颌骨标志点[上牙槽座点(A点)、下牙槽座点(B点)、后鼻棘点(PNS点)、舌骨最前上点(H点)]位置等指标进行测量分析, 并分析气道变化与上下颌骨移动量及寰枢关节间隙变化量的相关性。结果正畸-正颌联合治疗不同治疗时间点间, 患者ADI及VBLADI差异均无统计学意义(均P>0.05)。术前气道总容积由治疗前的20 868(6 669)mm^(3)增加至21 302(8 911)mm^(3)(P<0.05);术后后鼻棘平面APL、CSA, 悬雍垂平面L/W值, 鼻咽气道容积与术前差异均无统计学意义(均P>0.05), 术后后鼻棘平面L/W值较术前显著增加(P<0.05), 其余气道参数则均较术前显著减小(均P<0.05);与治疗前相比, 术后鼻咽气道容积[6 186(1 707)mm^(3)]显著增加(P<0.05), 腭咽气道容积[8 145(2 594)mm^(3)]及舌咽气道容积[5 605(4 395)mm^(3)]均显著减小(均P<0.05), 总气道容积术后与治疗前差异无统计学意义(P>0.05)。相关性分析显示, 术前B点矢状向移动量与气道总容积变化量呈中度正相关(r=0.40, P=0.022), 手术前后PNS点矢状向移动量与腭咽气道及总气道容积变化量呈中度正相关(r=0.43, P=0.015;r=0.46, P=0.008)。此外, 正颌手术前后VBLADI变化量与后鼻棘平面CSA、悬雍垂平面APL变化量呈弱正相关(r=0.35, P=0.029;r=0.38, P=0.016)。结论正畸-�ObjectiveTo explore the changes of atlantoaxial joint spaces and pharyngeal airway after combined orthodontic-orthognathic treatment in skeletal classⅢpatients with mandibular deviation.MethodsA total of 34 adult skeletal classⅢpatients(10 males and 24 females)with mandibular deviation who received combined orthodontic-orthognathic treatment at the Department of Orthodontics and the Department of Orthognathic Surgery in the Stomatological Hospital of Chongqing Medical University from August 2014 to October 2021 were retrospectively selected.The patients were 22(5)years old(18-33 years).Cone-beam CT data of patients taken before treatment(T0),after preoperative orthodontics(T1),and 6 to 12 months after orthognathic surgery(T2)were collected.The anterior atlanto-dental interval(ADI),variance of bilateral lateral atlanto-dental interval(VBLADI),the anterior posterior length(APL),maximum transverse width(LTW),aspect ratio(L/W),cross-sectional area(CSA)of each airway cross-section,the airway volumes,as well as the positions of the maxillofacial landmark points[subspinale(point A),supramental(point B),posterior nasal spine(point PNS),the most anterior and superior point of the hyoid bone(point H)]were measured at different time points.The correlations between airway changes,maxillofacial movements as well as the changes in the atlantoaxial joint spaces were also analyzed.ResultsDuring the combined orthodontic-orthognathic treatment,no statistically significant differences were found in the ADI and VBLADI among different treatment time points(all P>0.05).After preoperative orthodontics,the volume of total airway increased from 20868(6669)mm^(3) to 21302(8911)mm^(3)(P<0.05).After orthognathic surgery,there were no statistically significant differences in the APL,CSA of the PNS plane,the L/W of the uvula plane,and the nasopharyngeal airway volume compared with those after preoperative orthodontics(all P>0.05).The L/W of the PNS plane after surgery was significantly increased compared with that after preoperative ortho

关 键 词：错[牙合] 安氏Ⅲ类 锥束计算机体层摄影术 下颌偏斜 正畸-正颌联合治疗 寰枢关节间隙 咽气道 

分 类 号：R783.5[医药卫生—口腔医学]