临床口腔医学杂志
臨床口腔醫學雜誌
림상구강의학잡지
JOURNAL OF CLINICAL STOMATOLOGY
2014年
7期
433-436,437
,共5页
下颌神经管%锥状束CT%下颌升支矢状劈开截骨术%下颌前突%测量%感觉神经障碍
下頜神經管%錐狀束CT%下頜升支矢狀劈開截骨術%下頜前突%測量%感覺神經障礙
하합신경관%추상속CT%하합승지시상벽개절골술%하합전돌%측량%감각신경장애
mandibular canal%CBCT%sagittal split ramus osteotomy%mandibular prognathism%measurements%neu-rosensory disturbance
目的：用锥状束CT（CBCT）研究下颌前突患者下颌支的解剖结构，同时评价下颌管走行与术后感觉神经障碍（neurosensory disturbance，NSD）之间的关系。方法：双侧下颌支矢状骨劈开术的骨性Ⅲ类下颌前突患者28例，使用CBCT机拍摄下颌骨影像，从下颌孔至第一磨牙区域共分为5个平面测量，在每一个层面分别测量下颌管外侧壁至颊舌侧骨皮质及下颌骨下缘的距离。采用主观评价下颌管颊侧骨髓腔宽度和术后感觉神经障碍（neurosensory distur－bance，NSD）之间的关系。测量结果采用SPSS l7．0软件进行统计学分析。结果：①．下颌管与颊侧骨皮质的关系分为分开型、接触型和融合型。②．当下颌管与颊侧骨皮质为融合型时均发生NSD，而且有50％患者超过1年，认为NSD有长期持续性。在骨髓腔宽度小于0．8 mm时，术后15 d仍存在NSD可能性为75％，而在骨髓腔宽度为1．2 mm或更宽时，术后15 d感觉障碍可恢复。结论：下颌管的总体走行靠近舌侧，当其颊侧骨髓腔宽度≤0．8 mm，NSD更容易发生。术前通过CBCT精确测量下颌管的走行，尤其是发现融合型的患者，建议选用其它更安全的术式，减少下牙槽神经不必要的损伤。
目的：用錐狀束CT（CBCT）研究下頜前突患者下頜支的解剖結構，同時評價下頜管走行與術後感覺神經障礙（neurosensory disturbance，NSD）之間的關繫。方法：雙側下頜支矢狀骨劈開術的骨性Ⅲ類下頜前突患者28例，使用CBCT機拍攝下頜骨影像，從下頜孔至第一磨牙區域共分為5箇平麵測量，在每一箇層麵分彆測量下頜管外側壁至頰舌側骨皮質及下頜骨下緣的距離。採用主觀評價下頜管頰側骨髓腔寬度和術後感覺神經障礙（neurosensory distur－bance，NSD）之間的關繫。測量結果採用SPSS l7．0軟件進行統計學分析。結果：①．下頜管與頰側骨皮質的關繫分為分開型、接觸型和融閤型。②．噹下頜管與頰側骨皮質為融閤型時均髮生NSD，而且有50％患者超過1年，認為NSD有長期持續性。在骨髓腔寬度小于0．8 mm時，術後15 d仍存在NSD可能性為75％，而在骨髓腔寬度為1．2 mm或更寬時，術後15 d感覺障礙可恢複。結論：下頜管的總體走行靠近舌側，噹其頰側骨髓腔寬度≤0．8 mm，NSD更容易髮生。術前通過CBCT精確測量下頜管的走行，尤其是髮現融閤型的患者，建議選用其它更安全的術式，減少下牙槽神經不必要的損傷。
목적：용추상속CT（CBCT）연구하합전돌환자하합지적해부결구，동시평개하합관주행여술후감각신경장애（neurosensory disturbance，NSD）지간적관계。방법：쌍측하합지시상골벽개술적골성Ⅲ류하합전돌환자28례，사용CBCT궤박섭하합골영상，종하합공지제일마아구역공분위5개평면측량，재매일개층면분별측량하합관외측벽지협설측골피질급하합골하연적거리。채용주관평개하합관협측골수강관도화술후감각신경장애（neurosensory distur－bance，NSD）지간적관계。측량결과채용SPSS l7．0연건진행통계학분석。결과：①．하합관여협측골피질적관계분위분개형、접촉형화융합형。②．당하합관여협측골피질위융합형시균발생NSD，이차유50％환자초과1년，인위NSD유장기지속성。재골수강관도소우0．8 mm시，술후15 d잉존재NSD가능성위75％，이재골수강관도위1．2 mm혹경관시，술후15 d감각장애가회복。결론：하합관적총체주행고근설측，당기협측골수강관도≤0．8 mm，NSD경용역발생。술전통과CBCT정학측량하합관적주행，우기시발현융합형적환자，건의선용기타경안전적술식，감소하아조신경불필요적손상。
Objective:This study aimed at investigating the anatomic location of mandibular prognathism with Conebeamcomputerized tomography(CBCT),as well as evaluating the relationship between the course of the mandibular canalwith neurosensory disturbance(NSD) after the operation to assist in designing and performing sagittal split ramus osteotomy(SSRO). Patients and Method:The subjects included 28 skeletal Class III patients who underwent bilateral SSRO. Measurementswere made on five planes for each mandibles from mandibular foramen to mandibular body at the portion of thefirst molar with CBCT. Each plane was detected including width between the mandibular canal and medial and lateral corticalbone and distance from mandibular canal to inferior border of mandible. The subjective evaluation was performed to relatethe width of bone marrow space at the buccal side and neurosensory disturbance(NSD). Analyses were performed bySPSS 17.0 statistics software. Result:①.The width of bone marrow space at the buccal side could be classified into separatetype,contact type and fusion type. ②.NSD occurred in all cases of fusion type,50 % of which were considered long lastingNSD for presenting over one year. 75 % of cases continued NSD over 15 days in which the width of bone marrow space wasless than 0.8mm, while NSD regained in 15days where the bone marrow space was wider than 1.2 mm. Conclusion:Themandibular canal is situated lingually on average. A higher incidence of NSD occurred where the width of buccal side bonemarrow space was less than 0.8mm. Other safer orthognathic surgical procedure was recommended depending on the measurementsof mandibular canal with CBCT before SSRO to reduce the injury to the inferior alveolar nerve,especially in fusiontype cases.
