骨性Ⅲ类牙颌面畸形患者下颌后退术后近心骨段的三维变化

doi:10.3760/cma.j.cn101202-20221012-00309

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摘要目的分析骨性Ⅲ类牙颌面畸形患者双侧下颌升支矢状劈开术（BSSRO）后近心骨段三维方向位移情况,评估远心骨段后退距离与近心骨段横向间距变化量的关联。方法横断面研究。纳入2019年6月—2021年6月于南京大学附属口腔医院就诊的30例骨性Ⅲ类牙颌面畸形患者,其中男16例、女14例,年龄18~27岁（平均21.3岁）,均接受BSSRO手术治疗。收集患者手术前1周（T0）、术后1周（T1）、术后6个月（T2）的多层螺旋CT数据进行三维重建和分析。观察项目：（1）测量手术前后不同时间近心骨段髁突顶点（Co）、髁突外极点（Cd_lat）、髁突内极点（Cd_med）、下颌角点（Go）、喙突点（Cor）、乙状切迹点（SN）在三维方向上的移动距离及横向间距变化;（2）评估远心骨段的后退距离与近心骨段术后横向间距变化量间的相关性。结果（1）与T0时比较,T1时双侧Co点向外、下方移位,双侧Cd_med点向外、后、下方移位,双侧Cd_lat点向外、前方移位,髁突间距均增加;与T1时比较,T2时双侧Co点向内、上方移位,双侧Cd_med点向内、前、上方移位,双侧Cd_lat点向内侧移位,髁突间距均减小;与T0时比较,T2时双侧Cd_med点向后方移位,双侧Cd_lat点向前方移位：差异均有统计学意义（P值均<0.05）。髁突间距与术前差异无统计学意义（P>0.05）。（2）与T0时比较,T1时双侧Go点向外、后、下方移位,双侧Cor点和SN点向内、后、下移位,Go-Go间距增加,Cor-Cor、SN-SN间距均减小;与T1时比较,T2时左侧Go点向内、前方移位,右侧Go点向前、下方移位,左侧Cor点向上移位,右侧Cor点向前、上方移位,左侧SN点向前、上移位,右侧SN点向上移位,Go-Go间距减小;与T0时比较,T2时双侧Go点向外、下方移位,双侧Cor点向内、后方移位,双侧SN点向内侧移位,Go-Go间距增加,Cor-Cor、SN-SN间距均减小：差异均有统计学意义（P值均<0.05）。（3）远心骨段的后退距离与T0-T1期间两侧Co-Co间距增宽量呈正相关（r=0.410,P=0.025）,与T1-T2期间的Go-Go间距缩窄量呈正相关（r=0.435,P=0.016）。结论骨性Ⅲ类牙颌面畸形患者BSSRO术后近心骨段发生明显移位,随远心骨段后退距离增加术后1周内髁突顶点间距明显增宽,而术后6个月内的下颌角标志点间距缩窄量亦随之增加。

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	孔庆梅
	蒲玉梅
	王育新
	邹维娜
	张昆
	胡小蓓
	孔德彬
	杨旭东

关键词 ：口颌系统畸形, 骨性&#x02162, 类牙颌面畸形, 双侧升支矢状劈开术, 近心骨段, 后退距离

Abstract：Objective This study aims to analyze three-dimensional displacement of the proximal segments after bilateral sagittal split ramus osteotomy (BSSRO) in patients with skeletal class Ⅲ dentofacial deformity and evaluate the correlation between back distance and transversal width of the proximal segments. Methods This retrospective cross-sectional study reviewed 30 patients with skeletal class Ⅲ malocclusion who underwent bimaxillary surgery in Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, from June 2019 to June 2021. The patients included 16 males and 14 females, aged 18-27 years, with an average age of 21.3 years. CT data at 1 week preoperative (T0), 1 week postoperative (T1), and 6 months postoperative (T2) were collected for 3D reconstruction and assessment. (1) The displacements and transverse widths of the condylar apex (Co), condylar medial (Cd_med) and lateral poles (Cd_lat), mandibular corner (Go), coracoid point (Cor), and sigmoid notch (SN) after bimaxillary surgery were measured in three-dimensional direction. (2) The correlation between the back distance and postoperative transverse spacing of the proximal segment was evaluated. Results (1) The comparison of T1 with T0 showed that bilateral Co points moved outward and downward, bilateral Cd_med points shifted outward, backward and downward, bilateral Cd_lat points were displaced outward and forward, and the transverse spacing of condyle increased. During the postoperative recovery period (T1-T2), bilateral Co points returned to inward and upward, bilateral Cd_med points returned to inward, forward and upward, bilateral Cd_lat points returned to inward, and condyle spacing decreased. Compared with T0, bilateral Cd_med points at T2 were displaced to backward and bilateral Cd_lat points were displaced to forward. The differences were statistically significant (all P values <0.05). However, no significant difference was found in the condylar distance before and after the operation (P>0.05). (2) The comparison of T1 with T0 showed that bilateral Go points moved outward, backward, and downward and bilateral Cor points and SN points shifted inward, backward, and downward. The distance of Go-Go increased, while the spacing of Cor-Cor and the distance of SN-SN decreased. During the postoperative recovery period (T1-T2), the left Go point moved inward and forward, the right Go point moved forward and below, the left Cor point shifted upward, the right Cor point shifted forward and above, the left SN point moved forward and upward, and the right SN point moved upward. The spacing of Go-Go decreased. Compared with T0, bilateral Go points at T2 were displaced outward and downward, bilateral Cor points were displaced inward and backward, and bilateral SN points were displaced inward. In addition, the spacing of Go-Go increased, while the spacing of Cor-Cor and SN-SN decreased. The above differences were statistically significant (all P values <0.05). (3) The back distance was positively correlated with the widening of Co-Co during T0-T1 and with the reduction of Go-Go spacing during T1-T2 (r=0.410, 0.435, and P=0.025, 0.016, respectively). Conclusion After BSSRO, the proximal segment of patients with skeletal class Ⅲ dentofacial deformities shifts significantly. As the back distance increases, the spacing between Co increases significantly within one week after the operation, and the width reduction between Go within half a year after the operation increases.

Key words： Stomatognathic system abnormalities Skeletal class &#x02162 dentofacial deformity Bilateral sagittal split ramus osteotomy Proximal segment Back distance

收稿日期: 2022-10-12

基金资助:江苏省重点研发计划（BE2021609）

通讯作者: 杨旭东,Email： yangxd66@163.com

引用本文:

孔庆梅, 蒲玉梅, 王育新, 邹维娜, 张昆, 胡小蓓, 孔德彬, 杨旭东. 骨性Ⅲ类牙颌面畸形患者下颌后退术后近心骨段的三维变化[J]. 中华解剖与临床杂志, 2023, 28(4): 238-244.
Kong Qingmei, Pu Yumei, Wang Yuxin, Zou Weina, Zhang Kun, Hu Xiaobei, Kong Debin, Yang Xudong. Three-dimensional changes of proximal segments in patients with skeletal class Ⅲ dentofacial deformity after mandibular retraction. Chinese Journal of Anatomy and Clinics, 2023, 28(4): 238-244.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20221012-00309 或 http://www.cjac.com.cn/CN/Y2023/V28/I4/238

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