CAJ | 학술논문

目的：研究上颌Le FortⅠ型截骨术后鼻翼宽度的变化规律，并比较3种控制鼻翼宽度缝合方法的效果。方法：选取2011年至2014年在北京大学口腔医院行正颌外科手术的79名患者（男性22名，女性57名，平均年龄23．2±3．4岁），随机分为3组，组1为传统口内入路鼻翼基底缩窄缝合；组2为口外入路鼻翼基底缩窄缝合；组3为在组1方法基础上于鼻翼最外点对应部位增加一针口内缝合。使用3dMD相机分别在术前、术后3个月及6个月拍摄患者面部三维照片，由两名医师独立在三维照片上测量鼻翼宽度，重复3次，各间隔1周，取平均值进行统计分析。测量两侧鼻翼基底点距离（Sbal-Sbal）、鼻翼基底最外点距离（Al-Al）、鼻翼最外点距离（G．lat-G．lat），使用SPSS13．0进行数据分析。结果：术后6个月较术后3个月鼻翼宽度缩窄；3种缝合方法的中长期效果差异无统计学意义；上颌矢状向移动方向对术后鼻翼宽度的变化有影响，前移者鼻翼增宽更多；术后鼻翼增宽的程度与术中鼻翼增宽量呈正相关，与术前鼻翼宽度及较术前缩窄量呈负相关。结论：3种缝合方法控制鼻翼宽度的效果无差别，均不能完全避免术后鼻翼增宽，且这种宽度的变化至少持续至术后半年。对术前鼻翼较窄，术中需要前移上颌骨的患者，应于术中进行更大程度的过矫正，以利于控制术后鼻翼增宽的幅度。
목적：연구상합Le FortⅠ형절골술후비익관도적변화규률，병비교3충공제비익관도봉합방법적효과。방법：선취2011년지2014년재북경대학구강의원행정합외과수술적79명환자（남성22명，녀성57명，평균년령23．2±3．4세），수궤분위3조，조1위전통구내입로비익기저축착봉합；조2위구외입로비익기저축착봉합；조3위재조1방법기출상우비익최외점대응부위증가일침구내봉합。사용3dMD상궤분별재술전、술후3개월급6개월박섭환자면부삼유조편，유량명의사독립재삼유조편상측량비익관도，중복3차，각간격1주，취평균치진행통계분석。측량량측비익기저점거리（Sbal-Sbal）、비익기저최외점거리（Al-Al）、비익최외점거리（G．lat-G．lat），사용SPSS13．0진행수거분석。결과：술후6개월교술후3개월비익관도축착；3충봉합방법적중장기효과차이무통계학의의；상합시상향이동방향대술후비익관도적변화유영향，전이자비익증관경다；술후비익증관적정도여술중비익증관량정정상관，여술전비익관도급교술전축착량정부상관。결론：3충봉합방법공제비익관도적효과무차별，균불능완전피면술후비익증관，차저충관도적변화지소지속지술후반년。대술전비익교착，술중수요전이상합골적환자，응우술중진행경대정도적과교정，이리우공제술후비익증관적폭도。
Objective: To identify nasal width changes occurring after Le Fort Ⅰosteotomy and to compare prospectively the effect of three surgical techniques for controlling postoperative nasal width . Methods:In the study, 79 patients (22 male and 57 female, mean age 23.2 ±3.4 years), who re-ceived Le Fort Ⅰosteotomy at Peking University Hospital of Stomatology from 2011 to 2014, were ran-domly divided into three groups .Group 1 was treated with traditional intraoral alar base cinch suture ( ABCS);Group 2 with extraoral ABCS, and Group 3 with traditional ABCS plus an extra intraoral suture at points G.lat.All the patients had taken 3D photos using 3dMD camera before operation , and 3, and 6 months after operation.The nasal widths, which were indicated as distances between Sbal-Sbal, G.lat-G.lat and Al-Al, were measured by two examiners in the 3D photos three times with a time-interval of one week .SPSS 13 .0 was used to do the statistic analysis .Results: At the end of the postoperative 6 months, the nasal widths lessened as compared with the postoperative 3 months.No significant diffe-rences were found between the three groups 6 months after the operation .The degree of the postoperative nasal width widening had positive correlation with that of the intraoperative nasal width widening , and had negative correlation with the initial nasal width and the amount of post-suture narrowing .Conclusion:There is no difference between three suturing techniques for controlling nasal width widening after Le FortⅠosteotomy.The postoperative nasal width-widening can’t be totally avoided, and the alteration might last at least 6 months after the operation .For patients with narrow nasal width and need to move maxilla forward , more overcorrection of ABCS is needed to control the postoperative nasal base widening .