单侧完全性唇腭裂前方牵引治疗后的稳定性研究

Stability of reverse headgear treatment in unilateral cleft lip and palate patients with crossbite

目的 通过对唇腭裂术后反（牙合）患者前方牵引治疗患者的纵向研究,探讨唇腭裂患者前方牵引治疗的稳定性.方法 单侧完全性唇腭裂术后前牙反（牙合）患者,下颌不能后退至切牙对刃、凹面型;骨龄显示患者处于生长发育高峰前期的患者18例,平均年龄（9.63±1.24）岁.进行前方牵引治疗,建立前牙正常覆盖关系,治疗时间平均（1.07±0.23）年.12名患者于（2.71±0.77）年之内完成了随访,患者分别于治疗前、前方牵引治疗后及治疗完成2年后进行头颅侧位X线片检查,手工描图并进行9项角度和15项线距测量.不同时点的（牙合）颌面特征进行配对t检验,并对影响前牙覆盖的因素进行了逐步回归分析.结果 前方牵引治疗后,经过平均（2.71±0.77）年的随访,NA-PA减小了2.92°±3.52°（P＜0.05）、OJ减小了（2.83±3.83） mm（P＜0.05）;L1-TL、B-TL、Po-TL、分别增加了（1.38±4.22） mm,（1.29±4.85） mm,（1.79±5.18） mm差异均有显著性（P＜0.05）;随访期间前面高N-ME、前下面高ANS-Me及后面高S-Go分别增加了（5.33±3.11） mm（P＜0.01）、（5.42±2.61）mm（P＜0.01）和（5.25±3.79） mm（P＜0.01）;治疗结束两年后患者SNA、ANB、NA-PA、U1-Sn、Y轴角、下颌平面角仍较治疗前增加;L1-MP及OP-SN、UL-U1保持较治疗前减小水平;U1-TL、A-TL、OJ与治疗前相比分别增加了5.38±2.79（P＜0.01）、3.13±1.60（P＜0.01）、4.78±2.96（P＜0.01）;而L1-TL、B-TL、PO-TL、UL-EL在治疗后的随访期与治疗前无显著性差异.以随访时前牙覆盖的复发量（T2-T1）为因变量对前方牵引治疗前及治疗后变化量的（牙合）颌面形态测量值做自变量进行逐步回归分析,得出回归方程：OJ（T2-T1）＝20.43-1.172OJT1-T0—0.548 L1-T1T1-T0—0.229U6-PPT1-T0 （R2=0.969）.结论 唇腭裂术后反（牙合）患者前方牵引治疗后的复发主要来自下颌的继续生长,前方牵引产生的上颌变化基本稳定.

Objective To investigate the stability of unilateral cleft lip and palate patients with crossbite after reverse headgear treatment Methods 18 unilateral cleft lip and palate patients with anterior crossbite before growth spurt were treated with reverse headgear and followed after treatment for （2.71± 0.77） years.The average age of the patients was （9.63±1.24） years before treatment.All patients had positive overjet after treatment.12 patients remained in the study after two years＇ of follow-up.Cephalograms of before （T0）,after （T1） reverse headgear treatment and at least two years follow-up（T2） were taken for each patient.9 angular and 15 linear measurements were analyzed.Paired t test and stepwise regression were done to compare the differences in dentofacial structures.Results NA-PA decreased by 2.92°±3.52° （P〈0.05）、OJ decreased by （2.83±3.83） mm （P〈0.05）,and L1-TL,B-TL,Po-TL increased by （1.38±4.22） mm （P〈0.05）,（1.29±4.85） mm （P〈0.05）,（1.79±5.18） mm （P〈0.05） after two years＇ follow up.The measurement of facial height （N-ME,ANS-ME,S-GO） increased by （5.33±3.11） mm （P〈0.01）,（5.42±2.61） mm （P〈 0.01） and （5.25±3.79） mm （P〈0.01） during the follow up.After 2.71±0.77 years＇ follow up the SNA,ANB,NA-PA,U1-SN,Y-axis,MP-SN remained larger and the L1-MP,OP-SN,and UL-U1 were smaller than that of pretreatment.Compared to that of the pretreatment U1-TL,A-TL and overjet increased by （5.38±2.79） mm （P〈0.01）、（3.13±1.60） mm （P〈0.01）、（4.78±2.96） mm （P〈0.01） when recalled.While LT-TL,B-TL,PO-TL,UL-EL showed no significant difference compared to pretreatment.Overjet relapse amount （T2-T1） was chosen as the dependent factor,the predict equation was：20.43-1.172OJT1-T0-0.548 L1-T1-T0-0.229U6-PPT1-T0 （R2 =0.969）.Conclusions Relapse after reverse headgear treatment in UCLP patients was mainly due to the excessive growth of mandible during pubertal period,and the maxillary forward movement caused by treatment remained stable.