儿童腭裂修复术后颌面形态发育的观察研究

The impact of children’s cleft palate repair on maxillofacial morphological growth

目的探讨不同类型腭裂患儿在腭裂修复术后的颌面形态发育情况。方法回顾性分析2015年1月至2020年12月在复旦大学附属儿科医院整形外科行腭裂修复术的患儿及同期正常儿童的临床资料。纳入的腭裂患儿均由同一医师在8~18个月龄时应用松弛切口的兰氏腭裂修复术进行治疗。X线头影测量数据和面部三维扫描资料来源于该院整形外科颌面数据库。根据腭裂类型和年龄段,将腭裂患儿分为6组:组1,8个月~1岁Ⅰ度腭裂术前患儿;组2,8个月~1岁Ⅱ~Ⅲ度腭裂术前患儿;组3,2~3岁Ⅰ度腭裂术后患儿;组4,2~3岁Ⅱ~Ⅲ度腭裂术后患儿;组5,4~6岁Ⅰ度腭裂术后患儿;组6,4~6岁Ⅱ~Ⅲ度腭裂术后患儿。根据年龄段,将正常儿童分为3组:组7,8个月~1岁正常儿童;组8,2~3岁正常儿童;组9,4~6岁正常儿童。多组间正态分布计量资料的比较采用方差分析,Ⅰ度腭裂、Ⅱ~Ⅲ度腭裂患儿分别与同龄正常儿童颌面特征数据比较时采用Dunnett-t检验。结果共纳入腭裂患儿183例,女84例,男99例,年龄(3.6±2.1)岁;正常儿童302例,女114例,男188例,年龄(4.1±1.9)岁。组1~组9分别纳入23、46、19、37、23、35、83、105、114例儿童。分析结果显示,在Ⅰ度、Ⅱ~Ⅲ度腭裂患儿术前X线头影测量和面部三维扫描测量结果中,上颌和下颌水平长度、垂直高度和角度与同龄正常儿童相比无明显差异,而术后2~3岁、4~6岁时的上颌和下颌水平长度、垂直高度和角度与同龄正常儿童有明显差异,且Ⅱ~Ⅲ度腭裂患儿颌面特征数据与同龄正常儿童的差异比Ⅰ度腭裂患儿更显著。结论不同类型腭裂患儿在修复术后不同年龄段均出现颌面形态发育抑制,表现为上颌和下颌水平长度、垂直高度和角度的发育落后,且Ⅱ~Ⅲ度腭裂患儿术后颌面形态发育抑制较Ⅰ度腭裂患儿严重。

Objective To investigate the maxillofacial morphological development of children with different types of cleft palate after cleft palate repair.Methods The clinical data of children who underwent cleft palate repair in the Department of Plastic Surgery,Children’s Hospital of Fudan University from January 2015 to December 2020 and normal children during the same period were retrospectively analyzed.All the included children were treated by the same physician at 8 to 18 months of age with loose incision and Langenbeck repair for cleft palate.X-ray cephalometric data and facial three-dimensional scanning data were obtained from the maxillofacial database of the Plastic Surgery Department of the hospital.According to the type and age of cleft palate,the children with cleft palate were divided into 6 groups:Group 1,8 months to 1 years old children with gradeⅠcleft palate before operation;Group 2,8 months to 1 year old children with gradeⅡ-Ⅲcleft palate before operation;Group 3,2-3 years old children with gradeⅠcleft palate after operation;Group 4,2-3 years old children with gradeⅡ-Ⅲcleft palate after operation;Group 5,4-6 years old children with gradeⅠcleft palate after surgery;Group 6,4-6 years old children with gradeⅡ-Ⅲcleft palate after operation.According to age,normal children were divided into three groups:Group 7,8 months to 1 year old normal children;Group 8,2-3 years old normal children;Group 9,4-6 years old normal children.Analysis of variance was used to compare the measurement data of normal distribution between groups.Dunnett-t test was used to compare the maxillofacial features of children with gradeⅠcleft palate and gradeⅡ-Ⅲcleft palate with normal children of the same age.Results A total of 183 children with cleft palate were included,including 84 females and 99 males,aged(3.6±2.1)years.There were 302 normal children,including 114 females and 188 males,aged(4.1±1.9)years.Groups 1 to 9 included 23,46,19,37,23,35,83,105 and 114 children,respectively.The analysis result showed that the horizontal length,vertical height and angle of maxillary and mandibular were not significantly different from that of normal children of the same age in the preoperative cephalometric and three-dimensional scanning result of the children with gradeⅠandⅡ-Ⅲcleft palate.However,the horizontal length,vertical height and angle of maxillary and mandibular were significantly different from that of normal children of the same age at 2-3 years and 4-6 years after surgery.Moreover,the difference between maxillofacial characteristics of children with gradeⅡ-Ⅲcleft palate and normal children of the same age is more significant than that of children with gradeⅠcleft palate.Conclusion Maxillofacial morphological development is inhibited at different ages in children with different types of cleft palate after repair,which is manifested as the backward development of maxillofacial horizontal length,vertical height and angle of maxillary and mandible.Moreover,the maxillofacial morphological development inhibition was more serious in children with gradeⅡ-Ⅲcleft palate than in children with gradeⅠcleft palate.