CAJ | 학술논문

目的：探讨下颌支矢状骨劈开术（sagittal split ramus osteotomy，SSRO）后下唇及颏部感觉功能障碍（neurosensory dysfunction,NSD）的发生区域、恢复趋势及影响因素。方法：对20例接受SSRO的骨性Ⅲ类患者，术前1周采集数据，并和术后1周、1个月、3个月、6个月随访数据对比。具体将下唇及颏部皮肤分为4个区域，检查每个区域的针刺觉、痛觉、热觉、冷觉、锐觉、钝觉、轻触觉、两点辨别觉，采用5分法记录检查结果。根据年龄、性别、神经暴露情况等因素分组，采用SPSS20.0统计学软件对数据进行处理。结果：1、2、3区域术后感觉得分均低于术前，各区域两两之间差异无统计学意义（P>0.05），区域4手术前后得分无改变。术后1周至6个月感觉得分逐渐提高，各种感觉NSD的发生率术后1周最高（92.5%~97.5%），术后6个月最低（15%~40%）。在同一时间痛觉得分最高，热觉最低。年龄、性别差异对感觉的影响无统计学意义（P>0.05）。颏成形术、神经暴露情况、远心骨段移动幅度、术后使用神经营养药物情况对感觉的影响有统计学意义（P<0.05）。结论：SSRO后NSD易发生于下唇及口角内侧的皮肤；术后痛觉的恢复优于其他感觉，热觉恢复最差；颏成形术、术中神经暴露及远心骨段大幅度移动，是术后感觉障碍的危险因素；术后使用恩经复（nerve growth factor, NGF）可促进NSD的恢复。
목적：탐토하합지시상골벽개술（sagittal split ramus osteotomy，SSRO）후하진급해부감각공능장애（neurosensory dysfunction,NSD）적발생구역、회복추세급영향인소。방법：대20례접수SSRO적골성Ⅲ류환자，술전1주채집수거，병화술후1주、1개월、3개월、6개월수방수거대비。구체장하진급해부피부분위4개구역，검사매개구역적침자각、통각、열각、랭각、예각、둔각、경촉각、량점변별각，채용5분법기록검사결과。근거년령、성별、신경폭로정황등인소분조，채용SPSS20.0통계학연건대수거진행처리。결과：1、2、3구역술후감각득분균저우술전，각구역량량지간차이무통계학의의（P>0.05），구역4수술전후득분무개변。술후1주지6개월감각득분축점제고，각충감각NSD적발생솔술후1주최고（92.5%~97.5%），술후6개월최저（15%~40%）。재동일시간통각득분최고，열각최저。년령、성별차이대감각적영향무통계학의의（P>0.05）。해성형술、신경폭로정황、원심골단이동폭도、술후사용신경영양약물정황대감각적영향유통계학의의（P<0.05）。결론：SSRO후NSD역발생우하진급구각내측적피부；술후통각적회복우우기타감각，열각회복최차；해성형술、술중신경폭로급원심골단대폭도이동，시술후감각장애적위험인소；술후사용은경복（nerve growth factor, NGF）가촉진NSD적회복。
Objective: The aim of this study was to investigate the accurate location, recovery process, and influence factors of neurosensory dysfunction (NSD) in the lower lip and chin after sagittal split ramus osteotomy (SSRO). Methods:20 patients with skeletal Class Ⅲ malocclusion undergone SSRO were examined at 1-week before the surgery, and 1-week, 1-month, 3-month, 6-month after the surgery. The surface skin in the lower lip and chin was divided into 4 zones. Neurosensory function of each zone was measured by tests, consisting of pinprick discrimination, algesia discrimination, warm/cold discrimination, sharp/blunt discrimination, light touch test, 2-point discrimination. The results were recorded by 5-point method. Patients were divided into 2 groups in accordance with age, gender, and the exposure of inferior alveolar nerve (IAN) repectively. Statistical analysis was performed using the SPSS 20.0 software package. Results: The sensory score of zone 1, zone 2, and zone 3 postoperation was lower than the score before operation. There was no significant difference in each pair of zone 1, 2, 3 (P>0.05). The sensory score of zone 4 had no change after operation. The sensory score increased gradually from 1 week to 6 months after surgery. The incidence of NSD reached the highest level at 1-week after surgery (92.5%-97.5%), and it recovered to the lowest level at 6 months after surgery (15%~40%). At the same time the algesia score was the highest in all sensations, and the warm discrimination score was the lowest. There was no significant difference between age groups or gender groups. But, there was significant statistical differences manifested between different method of genioplasty, the time of exposure of IAN, the movement of distal bone fragment and the use of neurotrophic drugs. Conclusion: The accurate position of NSD after SSRO was the lower lip and the skin inside angulus oris. Algesia sensation recovered first, and warm discriminateon recovered at last. Genioplasty, exposure of IAN, large movement of distal bone fragment were risk factors of NSD after SSRO. Nerve growth factor ( NGF) can accelerate the recovery of NSD after SSRO.