口内入路改良下颌升支矢状劈开截骨术矫治下颌前突

Modified intraoral sagittal split ramus osteotomy for correction of mandibular prognathism

目的:探讨改良下颌升支矢状劈开截骨术(SSRO)和经典SSRO何种术式是矫治下颌前突的更为合适的手术方式。方法:采用改良SSRO或经典SSRO矫正真性下颌前突及下颌前突合并其他部位畸形患者95例,采用改良术式矫正43例,经典术式矫正52例。结果:经典术式组术后单侧或双侧下唇麻木9例,劈骨时单侧下颌升支意外骨折1例,严重出血1例,术后切口感染1例,术后复发3例。改良术式组术后感觉障碍2例,术后复发1例,无颌骨意外骨折、严重出血、术后感染等并发症发生。随访3月～7年,所有患者术后面型及咬合关系均得到明显改善。结论:改良术式具有经典术式无法比拟的优点:操作方便,手术时间短,术后恢复快;手术风险小;增加了下颌体的后退量;术中术后并发症少。因而是下颌前突尤其是严重前突和伴有偏颌畸形患者升支矢状劈开旋转、后退的首选术式,配合正规及时的术前、术后口腔正畸治疗,具有更为广阔的应用前景。

Objective To explore which of the two methods of modified or classical technique of intraoral Sagittal Split Ramus Osteotomy （SSRO） is the more appropriate and effective method for correction of mandibular prognathism. Methods 95 patients suffering from mandibular prognathism or accompanied by other deformities have been operated on by modified or classical technique of intraoral SSRO. 43 by modified SSRO and 52 by classical SSRO. Results In team treated by classical SSRO, 9 cases disorder of local sensibility, 1 case mandibular fracture during the cleavage of the ascending ramus, 1 case of significant bleeding, 1 case postoperative infection, 3 cases postoperative relapse. 2 cases disorder of local sensibility, 1 case postoperative relapse, no mandibular fracture, significance bleeding, postoperative infection, and other complications occurred to the team treated by modified SSRO. With routinely follow-up ranging from 3 months to 7 years. The face type and dental articulation of all the patients improved greatly. Conclusion Since modified technique of SSRO has more advantages that conventional classical technique can＇t compare with： such as more convenient manipulation, shorter-time operation, sooner postoperative recovery, less risk of operation, enough backward space and fewer complications, et al; it is the preferred method for the correction of mandibular prognathism, especially for those severer patients accompanied by mandible deviation. Accompanied by regularity and in time pre- and post- operational orthodontic therapy, it will be more widely used and has a glorious future.