快速扩弓结合前方牵引治疗不同骨龄组骨性Ⅲ类错[牙合]的临床研究

Hard tissue changes produced with rapid maxillary expansion and maxillary protraction in skeletal Class Ⅲ patients of different bone ages

目的评价快速扩弓联合前牵引治疗不同骨龄组骨性安氏Ⅲ类错[牙合]患者的硬组织变化，并探讨骨龄与前牵引效果之间的关系。方法选取75例上颌发育不足或位置后缩的骨性安氏Ⅲ类错[牙合]患者，均采用前方牵引联合快速扩弓治疗。根据治疗前头颅侧位片上颈椎成熟程度将其分为三组：生长加速期组（颈椎成熟度Ⅰ期），生长高峰期组（颈椎成熟度Ⅱ期），生长减速期组（颈椎成熟度Ⅲ-Ⅴ期）。结果（1）生长加速期及高峰期患者的上颌前移量没有明显差异，但生长减速期患者的前移量较小；（2）生长减速期患者牙槽反应明显；（3）三组间下颌向下后旋转、面下1／3高增加、磨牙萌出量没有明显差异。结论骨性安氏Ⅲ类错[牙合]患者诊断和治疗设计时应重视骨龄的评价。

Objective To evaluate hard tissue changes produced by rapid maxillary expansion and maxillary protraction in different bone age groups exhibiting skeletal Class Ⅲ malocclusion, and to determine the relationship between the effect of maxillary protraction and bone age. Methods 75 skeletal Class Ⅲ patients with retruded maxilla were treated with rapid maxillary expansion and maxillary protraction. Cephalometric radiographs were taken before and after treatment. The bone age of individual patients was assessed according to cervical vertebrace maturation stage （CVMS） on eephalometrie radiographs before treatment. Patients were divided into three groups： prepubertal group （CVMS Ⅰ ）, pubertal group （ CVMS Ⅱ ）, and postpubertal group （CVMS Ⅲ -- Ⅴ ）. Results （ 1 ） There was no difference in the effects of maxillary advancement after maxillary protraction between the prepubertal and the pubertal group） （2） In the postpubertal group, there was a decrease in maxillary skeletal advancement, whereas the dentoalveolar effect was increased; （3） The posteroinferior rotation of mandible, the increase of lower facial height, and the eruption of maxillary molars showed no correlation with bone age. Conclusion The results indicated that the evaluation of bone age and pubertal growth peak in patients with skeletal Class Ⅲ maloeelusions, was important.