上下唇突度唇差在骨性错（牙合）畸形非手术治疗软组织变化评价中的应用研究

The application of lip difference in the evaluation of the soft tissue change among different skeletal malocclusions with non-surgical treatment

目的 研究上下唇突度差（唇差,Lip-Diff）对骨性Ⅰ、Ⅱ、Ⅲ类患者非手术治疗疗效评价水平及各类软组织测量项目在不同骨性错（牙合）非手术治疗前后敏感度分析.方法 选取北京大学口腔医院正畸科在1997至2005年完成正畸治疗的2093例非手术患者,其中包括1051例骨性Ⅰ类患者、851例骨性Ⅱ类患者、191例骨性Ⅲ类患者.通过治疗前后X线片头影测量对侧貌软组织形态变化进行比较研究,运用判别分析筛选出敏感指标,并用多重线性回归分析对影响唇差变化.结果 ①多因素判别分析结果示唇差在骨性Ⅲ类组治疗前后差异最明显[治疗前（-1.56±1.84） mm,治疗后（0.11±1.62） mm,P＜0.05],UL-E在骨性Ⅰ类减数组[治疗前（0.80±2.40） mm,治疗后（-0.80±2.12）mm,P＜0.05]、骨性]类非减数组[治疗前（0.28±2.44） mm,治疗后（-0.07±2.15） mm,P＜0.05]、骨性Ⅱ类组[治疗前（3.06±2.44） mm,治疗后（1.00±2.21）mm,P＜0.05]治疗前后差异最明显;②骨性Ⅰ类减数组与非减数组软组织变化相比,除鼻唇角、颏唇角、上唇倾角外,其余各测量项目变化值差异均有统计学意义（P＜0.05）;3.骨性Ⅲ类组治疗前后的唇差变化值受前牙覆盖变化影响较大.结论 ①唇差对软组织治疗疗效评价能力为骨性Ⅲ类组最优,其次为骨性Ⅰ类减数组患者,对骨性Ⅰ类非减数组及骨性Ⅱ类组疗效评价不敏感;②其他骨性错a类别可能有更敏感的评价指标.

Objective To study the validity of lip difference （Lip-Diff） in evaluating nonsurgical treatment effects among different skeletal malocclusion and to analyze the sensitivity of different soft tissue cephalometric values before and after treatment.Methods 2093 patients who had finished the treatment between 1997 to 2005 at Peking University School and Hospital of Stomatology were selected,including 1051 Skeletal Class Ⅰ patients,851 Skeletal Class Ⅱ patients and 191 Skeletal Class Ⅲ patients.The cephalometric radiographs were taken before and after the treatments.Soft tissue analyses were measured to evaluate the soft tissue changes and to screen out the value with high sensitivity that can reflect treatment efficacy.Multiple linear regression was used to study the main factors that were related to the change of Lip-Diff.Results ① The difference of Lip-Diff expressed the most significantly in Skeletal Class Ⅲl group [pretreatment （-1.56±1.84） mm,posttreatment （0.11 ± 1.62） mm,P〈0.05] and the difference of UL-E expressed the most significantly in Skeletal Class Iextraction group [pretreatment （0.80 ± 2.40） mm,posttreatment （-0.80± 2.12） mm,P 〈 0.05],non-extraction group [pretreatment （0.28 ± 2.44） mm,posttreatment （-0.07±2.15） mm,P〈0.05] and Class Ⅱ group [pretreatment （3.06±2.44） mm,posttreatment （1.00 ± 2.21） mm,P〈0.05] according to Multi factors discrimination analyzes.② Significant difference （P〈0.05）was found between the Skeletal Class Ⅰ extraction group and the Skeletal Class Ⅰ non-extraction group in all measurements except nasal lip angle,LL-B＆#39;-Pos and A＆#39;LL-FH.③ The change in value of Lip-Diff in Skeletal Class Ⅲ group was mostly affected by the change of anterior overjet.Conclusions ① Lip-Diff was most valid in evaluating treatment efficacy of Skeletal Class]]][group,followed by Skeletal Class Ⅰ extraction group.However,Lip Diff was not sensitive in Skeletal Class Ⅱ][group and Skeletal Class Ⅰ non-extraction group.② Other factors,might be more valid in evaluations of other malocclusion types.