正颌外科手术矫正唇腭裂继发颌骨畸形术后上颌稳定性的研究

Skeletal stability after maxillary advancement with orthognatic surgery in patients with cleft lip and palate

目的 探讨正颌外科手术矫正唇腭裂继发颌骨畸形患者术后上颌骨的稳定性及相关影响因素.方法 34例唇腭裂继发上颌骨发育不足的患者,均行改良LeFortⅠ型截骨术前徙上颌骨,其中29例患者同期行BSSRO和/或颏成形术,术后随访时间≥12月.分别在术前、术后即刻及术后随访时拍摄头颅定位侧位片.通过头影测量分析,测量上齿槽座（A）点、后鼻嵴（PNS）点、∠SNA的变化.结果 34例患者术后1年以上（平均19个月）水平向复发率为（20.10±18.09）％;垂直向复发率为（34.78±32.89）％.∠SNA术前平均为77.9°,术后即刻为82.3°,术后1年以上为81.4°.水平向复发率与上颌骨前徙量无相关性（P＞0.05）,但垂直向的复发率与上颌骨下移量呈正相关性（P＜0.05）.通过对15例连续随访患者资料的方差分析提示,上颌骨术后复发主要发生在术后3个月内.结论 唇腭裂患者上颌骨前徙术后具有一定程度的复发,其复发主要发生在术后3个月内.垂直向的复发率与颌骨下移量成正相关.

Objective To investigate the skeletal stability after maxillary advancement with orthognatic surgery in patients with cleft lip and palate and the factors related to relapse.Methods 34 cleft lip and palate patients underwent modifiedLeFort I maxillary advancement osteotomy,29 of them also had BSSRO and/or genioplasty.The clinical follow-ups were no shorter than 12 months.Lateral cephalograms were taken at presurgery,immediately postsurgery and at least 1 year postsurgery.The positional change of point A and PNS and angular change of SNA were measured by serial cephalometric analysis.Results Horizontal advancement averaged （4.38±1.88） mm,and the mean relapse was （20.10±18.39） 0％.Downward surgical movement averaged （3.46±2.15） mm,and the vertical relapse was （34.78±32.89）％.∠SNA was 77.9° presurgicaly,82.3° immediately after surgery and 81.4°at least 1 year postoperatively.There was no significant correlation between surgical movement and postoperative relapse in the horizontal plane（P＞0.05）,but had a significant positive correlation in the vertical plane （P＜0.05）.Variance analysis of continuous follow-ups of 15 patients showed most of the relapse occurred in the first 3 months after surgery.Conclusions Maxillary surgical advancement in patients with CLP showed relapse to a certain extent.Most of the relapse occurred in the first 3 months after surgery.The vertical relapse was positively correlated with inferior surgical movement of the mandible.