鼻牙槽嵴塑形矫治器在单侧完全性唇腭裂腭部畸形矫治中的效果评价

Effective evaluation of presurgical nasoalveolar molding devices in the treatment of complete unilateral cleft lip and palate patients

目的评价鼻牙槽嵴塑形(PNAM)矫治器对单侧完全性唇腭裂患者腭部畸形的矫治效果。方法研究对象分为3组,每组19例。A、B组均为非综合征单侧完全性唇腭裂患者,A组在唇腭裂手术前先行PNAM矫治,B组术前未行PNAM矫治。C组为3月龄左右鼻唇部及腭部发育正常婴儿。获取A组PNAM矫治前及PNAM矫治后唇裂术前、B组唇裂术前和C组的标准腭部模型正位照片,对模型照片进行测量。采用SPSS 21.0软件进行分析。结果 A组PNAM矫治后与矫治前相比,患者的牙弓宽度(AW)、牙弓周长(AC)、腭部面积(PA)明显增加(P<0.05),腭部裂隙宽度(CPW)、牙槽突裂隙宽度(CWA)、牙槽突裂隙矢状向距离(CWAS)与水平向距离(CWAH)、前颌突倾斜度(PMD)、裂隙面积(CA)明显减小(P<0.05);但与C组相比仍有差距(P<0.05);B组AW、CPW、CA及PA较A组矫治前均明显增加(P<0.05)。多元方差分析表明,3组上颌结节间距离(TW)均无统计学差异(P>0.05)。结论 PNAM矫治是早期有效改善患者腭部原发畸形的非手术治疗手段之一。

Objective To evaluate the orthopedic effect of presurgical nasoalveolar molding （PNAM） devices on the palatal deformities in unilateral complete cleft lip and palate （UCCLP） patients. Methods Three groups with 19 patients each were studied. All samples in groups A and B were non-syndromic UCCLP children. Group A was treated with PNAM prior to operation. Group B was untreated prior to operation. Samples in group C were normally developed nose and lip palate infants aged three months. The orthotopic palate photos before and after PNAM treatment for group A, as well as pre-operative photos of groups B and group C, were taken and measured. All statistics were analyzed using SPSS 21.0. Results PNAM treatment significantly increased the AW, AC, and PA of UCCLP patients （P〈0.05）, whereas CPW, CWA, CWAS, CWAH, PMD, and CA significantly decreased （P〈0.05）. However, no significant difference was observed with the cases in group C （P〈0.05）. The AW, CPW, CA, and PA of the patients in group B significantly increased compared with the cases in group A before PNAM treatment （P〈0.05）. Multivariate analysis of variance indicated that TW had no statistically significant diffe- rence among the three groups （P〉0.05）. Conclusion PNAM treatment is a non-surgical early treatment for the effective improvement of palatal primary deformities in UCCLP patients.