锥形束CT测量数据三维重建分析正畸牙槽嵴裂植骨修复单侧完全性唇腭裂的可行性

Orthodontic surgery with alveolar cleft grafting in patients with complete unilateral cleft lip and palate: a feasibility analysis based on cone-beam CT three-dimensional reconstruction

背景:部分唇腭裂患者在9-10岁(尖牙牙根发育1/2-2/3)接受植骨后,矫治效果不能保持;且7-10岁患者植骨前后的治疗程序目前尚不统一。锥形束CT可在不破坏正常组织结构的前提下精确反映组织的微细结构,并通过相配套的计算机软件获得相关测量数据。目的:利用锥形束CT测量结果,比较不同顺次的正畸联合牙槽嵴裂植骨治疗单侧完全性唇腭裂的疗效。方法:选择2012至2013年就诊于沧州市人民医院的单侧完全性唇腭裂患者60名,分为3组,各20例。A组患者自体髂骨移植修复牙槽嵴裂植骨治疗后佩戴保持器保持3个月行正畸治疗;B组患者正畸治疗后即刻行自体髂骨移植修复牙槽嵴裂植骨治疗并后期佩戴保持器3个月;C组患者正畸治疗后佩戴保持器3个月后行自体髂骨移植修复牙槽嵴裂植骨治疗,植骨治疗完成后保持器保持3个月。结果与结论:锥形束CT结果显示,C组患者蝶鞍点-鼻根点-上齿槽座点角(SNA)、蝶鞍点-鼻根点-下齿槽座点角(SNB)、上齿槽座点-鼻根点-下齿槽座点角(ANB)、上中切牙切缘与鼻根点-上齿槽座点连线的交角(U1/NA)和U1/NA(L1/NB)与A组差异有显著性意义(P<0.01);B组患者的SNB、L1/NB较A组明显增大(P<0.05);C组与B组比较,SNB、U1/NA明显减小,SNA、L1/NB明显增大(P<0.05)。提示单侧完全性唇腭裂患者牙槽嵴植骨治疗前、治疗后正畸治疗效果明显优于单纯治疗前或治疗后正畸治疗,并有利于上颌骨矫正后的稳定性。

BACKGROUND：Some cleft lip and palate patients at 9-10 years of age （the canine root development about 1/2-2/3） cannot achieve a good orthodontic outcome after bone grafting, and moreover, there is no unified therapeutic procedure for patients at 7-10 years of age before and after bone grafting. Cone-beam CT can reflect the fine structure accurately under the premise not to destroy normal tissue structure, and have access to the relevant measurement data by matched computer software. OBJECTIVE：To compare the therapeutic effect of orthodontic surgery combined with alveolar cleft bone grafting at different order for treatment of complete unilateral cleft lip and palate. METHODS： Sixty patients with complete unilateral cleft lip and palate admitted at Cangzhou People’s Hospital from 2012 to 2013 were enroled and divided into three groups with 20 in each group： group A, autologous iliac graft was done folowed by 3 months of wearing orthodontic retainer; Group B, autologous iliac graft was done immediately after orthodontic treatment and then, orthodontic retainer was used for 3 consecutive months; group C, orthodontic retainer was used for 3 consecutive months folowing orthodontic treatment, and then, autologous iliac graft was performed folowed by another 3 consecutive months of wearing orthodontic retainer. RESULTS AND CONCLUSION：There were significant differences between groups A and C in terms of SNA, SNB, ANB, U1-NA and L1-NB （P 〈 0.01）. Group B was significantly higher than the group A in SNB and L1/NB （P 〈 0.05）. Compared with the group B, the SNB and U1/NA were reduced, while the SNA and L1/NB were increased significantly in the group C （P 〈 0.05）. These findings indicate that for complete unilateral cleft lip and palate patients, the orthodontic treatment before and after bone grafting is better than simple pre- or post-grafting orthodontic treatment, which is conductive to the stability of corrected maxila.