边缘骨性Ⅲ类错手术与非手术效果的对比分析

Comparison of Treatment Effects of Surgery and Non-surgery in Borderline Skeletal Class Ⅲ Malocclusions

目的:比较边缘骨性Ⅲ类错正颌手术与正畸掩饰治疗(拔牙)后的效果差异。方法:对两组骨性Ⅲ类手术边缘病例治疗前后的X线头颅侧位片进行对比分析,其中手术治疗组12例,单纯正畸组13例,所有病例治疗前ANB角都>-5°。结果:手术组治疗的主要变化是下颌骨前齿槽区的后移及下切牙的直立,正畸组的主要变化是下切牙的后倾及后移。两组治疗后的X线头影测量值经Mann-Whitney U检验显示ANB角,上下颌骨长度比(M/M ratio),NAPog角,下切牙倾斜角(∠L1/ML),上下切牙交角(∠U1/L1)有显著性差异,而标志软组织凹陷度的Holdaway角和Z角没有差异。结论:对于骨性Ⅲ类手术边缘错而言,选择合适的病例,手术与正畸掩饰治疗都可以获得可接受的咬合和美观效果。

Objective： To compare the treatment effects of orthognathic surgery and orthodontic camouflage （extraction） on borderline skeletal Class Ⅲ malocclusions. Methods： The pre- and post-treatment cephalograms of 25 patients （13 orthodontic, 12 surgical） with borderline Class Ⅲ malocclusion were compared. The ANB angles of all the patients were greater than -5° before treatment. Results： The main changes of surgical group were setback of mandibular dentoalveouls and uprighting of the lower incisors. The retraction and retroclination of lower incisors were the main changes in orthodontic group. After treatment, significant differences were found in M/M ratio, NAPo angle, ∠L1/ML and ∠U1/L1 between two groups using Mann - Whitney U test, whereas no difference was found in two soft tissue measurements Holdaway angle and Z angle. Conclusion： Among correctly chosen borderline Class Ⅲ patients, both surgery and orthodontic camouflage treatment can acquire an acceptable occlusion and esthetic effect.