北京大学学报(医学版)
北京大學學報(醫學版)
북경대학학보(의학판)
Journal of Peking University (Health Sciences)
2015年
5期
829-833
,共5页
何伟%谢晓艳%王兴%王晓霞%傅开元%李自力
何偉%謝曉豔%王興%王曉霞%傅開元%李自力
하위%사효염%왕흥%왕효하%부개원%리자력
截骨术,Le Fort%下颌骨髁状突%错牙合,安氏Ⅲ类%锥束计算机体层摄影术
截骨術,Le Fort%下頜骨髁狀突%錯牙閤,安氏Ⅲ類%錐束計算機體層攝影術
절골술,Le Fort%하합골과상돌%착아합,안씨Ⅲ류%추속계산궤체층섭영술
Osteotomy,Le Fort%Mandibular condyle%Malocclusion,Angle class Ⅲ%Cone-beam com-puted tomography
目的:研究上颌Le FortⅠ型分块截骨术及双侧下颌升支矢状劈开术( bilateral sagittal split ramus osteoto-my, BSSRO)对骨性Ⅲ类错牙合畸形患者髁突位置的影响。方法:对符合纳入标准的19名骨性Ⅲ类错牙合畸形患者的颞下颌关节间隙及髁突位置进行回顾性研究。所有患者分别于上颌Le FortⅠ型截骨及BSSRO术前1周内( T1)、术后1周内(T2)、术后3个月(T3)及术后6~14个月(T4),行双侧颞下颌关节锥形束计算机断层(cone beam com-puted tomography ,CBCT)扫描。在经过轴位断面上髁突最大内外径中点并与髁突最大内外径垂直的斜矢状断面上,按照Kamelchuk法测量双侧颞下颌关节前间隙、后间隙及上间隙,计算髁突位置参数,计算髁突在关节窝中位于前位、中位及后位等3种不同相对位置的分布比例,并对不同时期的测量结果进行统计分析。结果:T2时期双侧颞下颌关节前间隙、后间隙及上间隙[右侧:(2.78±1.23) mm、(2.47±0.89) mm、(3.07±0.85) mm;左侧:(2.93±0.83)mm、(2.69±1.14)mm、(3.44±1.16)mm]分别与T1[右侧:(1.81±0.95)mm、(1.65±0.55)mm、(2.13±0.52)mm;左侧:(2.12±1.05)mm、(1.79±0.59)mm、(2.15±0.93)mm]、T3[右侧:(2.08±1.25)mm、(1.79±0.68)mm、(1.80±0.76)mm;左侧:(2.05±0.75)mm、(1.99±0.94)mm、(2.14±0.71)mm]及T4[右侧:(1.94±0.77)mm、(1.81±0.69)mm、(2.05±0.69)mm;左侧:(1.89±0.69)mm、(1.80±0.61)mm、(2.19±0.75)mm)]时期比较,均增大,差异具有统计学意义(P<0.05);T1、T3及T4期双侧关节各间隙差异均无统计学意义(P>0.05);髁突位置参数及髁突相对位置分布比例在各时期的差异均无统计学意义( P>0.05)。上述结果提示,T2时期髁突向下移动,但在T3时期髁突位置恢复至与术前一致的位置,并在T4时期保持稳定状态。结论:骨性Ⅲ类错牙合畸形患者在行上颌Le FortⅠ型分块截骨术及BSSRO术后,短期内髁突的位置可发生显著改变,但可逐渐恢复至术前髁突的位置并保持稳定。
目的:研究上頜Le FortⅠ型分塊截骨術及雙側下頜升支矢狀劈開術( bilateral sagittal split ramus osteoto-my, BSSRO)對骨性Ⅲ類錯牙閤畸形患者髁突位置的影響。方法:對符閤納入標準的19名骨性Ⅲ類錯牙閤畸形患者的顳下頜關節間隙及髁突位置進行迴顧性研究。所有患者分彆于上頜Le FortⅠ型截骨及BSSRO術前1週內( T1)、術後1週內(T2)、術後3箇月(T3)及術後6~14箇月(T4),行雙側顳下頜關節錐形束計算機斷層(cone beam com-puted tomography ,CBCT)掃描。在經過軸位斷麵上髁突最大內外徑中點併與髁突最大內外徑垂直的斜矢狀斷麵上,按照Kamelchuk法測量雙側顳下頜關節前間隙、後間隙及上間隙,計算髁突位置參數,計算髁突在關節窩中位于前位、中位及後位等3種不同相對位置的分佈比例,併對不同時期的測量結果進行統計分析。結果:T2時期雙側顳下頜關節前間隙、後間隙及上間隙[右側:(2.78±1.23) mm、(2.47±0.89) mm、(3.07±0.85) mm;左側:(2.93±0.83)mm、(2.69±1.14)mm、(3.44±1.16)mm]分彆與T1[右側:(1.81±0.95)mm、(1.65±0.55)mm、(2.13±0.52)mm;左側:(2.12±1.05)mm、(1.79±0.59)mm、(2.15±0.93)mm]、T3[右側:(2.08±1.25)mm、(1.79±0.68)mm、(1.80±0.76)mm;左側:(2.05±0.75)mm、(1.99±0.94)mm、(2.14±0.71)mm]及T4[右側:(1.94±0.77)mm、(1.81±0.69)mm、(2.05±0.69)mm;左側:(1.89±0.69)mm、(1.80±0.61)mm、(2.19±0.75)mm)]時期比較,均增大,差異具有統計學意義(P<0.05);T1、T3及T4期雙側關節各間隙差異均無統計學意義(P>0.05);髁突位置參數及髁突相對位置分佈比例在各時期的差異均無統計學意義( P>0.05)。上述結果提示,T2時期髁突嚮下移動,但在T3時期髁突位置恢複至與術前一緻的位置,併在T4時期保持穩定狀態。結論:骨性Ⅲ類錯牙閤畸形患者在行上頜Le FortⅠ型分塊截骨術及BSSRO術後,短期內髁突的位置可髮生顯著改變,但可逐漸恢複至術前髁突的位置併保持穩定。
목적:연구상합Le FortⅠ형분괴절골술급쌍측하합승지시상벽개술( bilateral sagittal split ramus osteoto-my, BSSRO)대골성Ⅲ류착아합기형환자과돌위치적영향。방법:대부합납입표준적19명골성Ⅲ류착아합기형환자적섭하합관절간극급과돌위치진행회고성연구。소유환자분별우상합Le FortⅠ형절골급BSSRO술전1주내( T1)、술후1주내(T2)、술후3개월(T3)급술후6~14개월(T4),행쌍측섭하합관절추형속계산궤단층(cone beam com-puted tomography ,CBCT)소묘。재경과축위단면상과돌최대내외경중점병여과돌최대내외경수직적사시상단면상,안조Kamelchuk법측량쌍측섭하합관절전간극、후간극급상간극,계산과돌위치삼수,계산과돌재관절와중위우전위、중위급후위등3충불동상대위치적분포비례,병대불동시기적측량결과진행통계분석。결과:T2시기쌍측섭하합관절전간극、후간극급상간극[우측:(2.78±1.23) mm、(2.47±0.89) mm、(3.07±0.85) mm;좌측:(2.93±0.83)mm、(2.69±1.14)mm、(3.44±1.16)mm]분별여T1[우측:(1.81±0.95)mm、(1.65±0.55)mm、(2.13±0.52)mm;좌측:(2.12±1.05)mm、(1.79±0.59)mm、(2.15±0.93)mm]、T3[우측:(2.08±1.25)mm、(1.79±0.68)mm、(1.80±0.76)mm;좌측:(2.05±0.75)mm、(1.99±0.94)mm、(2.14±0.71)mm]급T4[우측:(1.94±0.77)mm、(1.81±0.69)mm、(2.05±0.69)mm;좌측:(1.89±0.69)mm、(1.80±0.61)mm、(2.19±0.75)mm)]시기비교,균증대,차이구유통계학의의(P<0.05);T1、T3급T4기쌍측관절각간극차이균무통계학의의(P>0.05);과돌위치삼수급과돌상대위치분포비례재각시기적차이균무통계학의의( P>0.05)。상술결과제시,T2시기과돌향하이동,단재T3시기과돌위치회복지여술전일치적위치,병재T4시기보지은정상태。결론:골성Ⅲ류착아합기형환자재행상합Le FortⅠ형분괴절골술급BSSRO술후,단기내과돌적위치가발생현저개변,단가축점회복지술전과돌적위치병보지은정。
Objective:To investigate the effect of segmental Le FortⅠosteotomy and bilateral sagittal split ramus osteotomy ( BSSRO ) on the condyle position in skeletal class Ⅲ malocclusion patients . Methods:In this retrospective study , 19 patients with skeletal class Ⅲmalocclusion who met the inclu-sion criteria were enrolled .All the patients underwent the segmental Le FortⅠ osteotomy and BSSRO . Cone beam computed tomography ( CBCT) scans were performed in the following phases:T1:within one week before the surgeries;T2:within one week post-surgery;T3:three months post-surgery;T4:6 to 14 months post-surgery .The posterior spaces , anterior spaces and the superior spaces of the bilateral tem-poromandibular joints were measured according to the Kamelchuk method respectively .The fossa ratios of the condyle and the distribution of the condyle positions related to the glenoid fossa ( anterior , concentric and posterior position ) were calculated .The results were analyzed statistically .Results:The posterior space , the anterior space and the superior space of bilateral temporomandibular joints in T 2 phase [ right:(2.78 ±1.23) mm, (2.47 ±0.89) mm, (3.07 ±0.85) mm; left: (2.93 ±0.83) mm, (2.69 ± 1.14) mm, (3.44 ±1.16) mm] showed significantly larger spaces than those in T 1 phase [right:(1.81 ±0.95) mm, (1.65 ±0.55) mm, (2.13 ±0.52) mm;left:(2.12 ±1.05) mm, (1.79 ±0.59) mm, (2.15 ±0.93) mm],in T3 phase [right:(2.08 ±1.25) mm, (1.79 ±0.68) mm, (1.80 ±0.76) mm;left: (2.05 ±0.75) mm, (1.99 ±0.94) mm, (2.14 ±0.71) mm] and in T4 phase [right:(1.94 ±0.77) mm, (1.81 ±0.69) mm, (2.05 ±0.69) mm;left:(1.89 ±0.69) mm, (1.80 ±0.61) mm, (2.19 ±0.75) mm], P<0.05.No significant differences were observed among T 1,T3 and T4 pha-ses in the terms of the joint spaces of both sides ( P >0.05).The fossa ratio and the condyle position related to the glenoid fossa had no significant difference in all the four phases (P>0.05).The results suggested that the condyle moved downward in T 2 phase and changed to the original pre-surgery position in T3 phase, then keot stable in T4 phase.Conclusion:Segmental Le FortⅠ osteotomy and BSSRO caused significant and transient changes of the condyle position in skeletal class Ⅲmalocclusion patients . However , the condyle tended to move back to the original pre-surgery position and might keep stable .