Herbst配合口外弓及上颌快速扩弓结合直丝弓种植支抗矫正骨性Ⅱ类错的效果评价

Treatment of Class Ⅱ malocclusion using Herbst appliance with headgear and rapid palatal expansion and straight wire appliance with implant anchorage

目的：研究Herbst矫正器配合口外弓及上颌快速扩弓结合直丝弓矫正器配合种植体作为支抗早期矫正骨性Ⅱ类错的临床疗效。方法：选择骨性Ⅱ类错患者25例,其中,男14例,女11例,年龄10~12岁（平均年龄10.5岁）,双期矫正,一期矫正时间约6个月,使用改良Herbst矫正器配合口外弓中位牵引和上颌快速扩弓;二期采用非拔牙矫正,使用直丝弓结合上颌种植体作为支抗,内收上颌牙列。通过治疗前、后X线头颅侧位片头影测量分析,研究患者治疗后牙及颌骨的变化。采用SPSS13.0软件包对数据进行统计学分析。结果：治疗后比治疗前∠SNB增大（4.2800±1.4000）°,∠NP-FH增大（3.5600±1.0440）°,∠SNA减小（0.5600±0.8206）°,∠ANB减小（4.7600±1.2000）°,∠U1-NA减小（11.9200±1.4411）°,∠U1-SN减小（13.1600±1.7720）°,差异均具有显著性（P〈0.05）。结论：Herbst矫正器配合口外弓和上颌快速扩弓抑制上颌骨发育,导下颌向前,临床疗效明显。固定矫正时使用种植体作为支抗,能最大限度地内收上颌牙列,患者骨面型得到明显改善。

PURPOSE： To investigate the effects of early treatment of Class II malocclusion with Herbst appliance with headgear and rapid palatal expansion and straight wire appliance with implant anchorage. METHODS： Twenty-five Chinese children （14 males, 11 females, aged from 10-12 years with an average age of 10.5 years） were treated with Herbst appliance with headgear and rapid palatal expansion for 6 months. Then they were further treated with straight wire appliance with implant anchorage. Cephalometric data pre- and post-treatment were measured and analysed. Multiple correlation analysis was performed with SPSS13.0 software package. RESULTS： Compared with pretreatment, LSNB （4.2800±1.4000）° and LNP-FH （3.5600±1.0440）° increased posttreatment. LSNA （0.5600±0.8206）°, LANB （4.7600±1.2000）°, LU1-NA（11.9200±1.4411）° and ∠U1-SN（13.1600±7720）° decreased posttreatment（P〈0.05）. CONCLUSIONS： Maxillary growth is successfully inhibited and mandibular growth is significantly promoted by Herbst appliance with headgear and rapid palatal expansion. The maxillary dentition is significantly retracted by fixed appliance with implant anchorage and the skeletal pattern of patients is significantly improved.