不同的早期治疗模式对单侧完全性唇腭裂患者颌面形态的影响

The effect of different treatment protocols on maxillofacial morphology of unilateral complete cleft lip and palate

目的探讨不同的早期治疗模式对非综合征性单侧完全性唇腭裂患者(UCCLPAs)颌面形态的影响。方法纳入47位6~7岁的非综合征性单侧完全性唇腭裂患者为病例组,将其按不同的早期治疗模式分为4组,纳入13位性别及年龄与之相当的单侧不完全性唇裂患者为对照组。通过比较反映颌面形态的8个指标来评价病例组和对照组颌面部骨性形态差异。统计采用t检验、单因素方差分析及秩和检验方法。结果与对照组相比,12月龄前修复唇裂的UCCLPAs的骨性咽腔深度(Ba-PMP)减小(P<0.05)。与未修复腭裂的UCCLPAs相比,12月龄前修复唇裂,24月龄前修复腭裂的UCCLPAs的面突度(SNA)减小(P<0.05),上颌骨后面高(R-PMP)减小(P<0.05)。病例组间相比,3月龄前行唇粘连术,12月龄前行硬腭犁骨瓣整复术的UCCLPAs的上颌骨位置(S-Ptm)偏后(P<0.05)。结论当UCCLPAs 6~7岁时,3月龄前行唇粘连术,且12月龄前行硬腭犁骨瓣整复术者的患者上颌骨生长受抑制最严重。24月龄内行硬腭裂整复术者上颌骨向前的生长及后面高的生长均会受抑制。

Objective To evaluate the effect of four treatment protocols on maxillafacial morphology of patients with non-syndromic unilateral complete cleft lip,palate and alveolus（ UCCLPAs）. Methods Torty-seven non-syndromic UCCLPAs and 13 age and gender matched UICLs were selected into this study. Eight cephalometric measurements were performed to evaluate the facial skeleton morphology. Results Compared with control group,UCCLPAs who received cleft lip repair before 12 months showed a shallow bony pharyngeal cavity（ Ba-PMP,P 〈 0. 05）. Compared with UCCLPAs who received cleft lip repair only,UCCLPAs who unnderwent cleft lip repair before 12 months and cleft palate repair before 24 months showed a less protruded maxilla（ SNA,P 〈 0. 05） and a decreased posterior facial height（ R-PMP,P 〈 0. 05）.UCCLPAs who had taken lip adhesion before 3 month and vomer flap repair before 12 months showed a retroposed maxilla（ S-Ptm,P 〈 0. 05）. Conclusion When UCCLPAs aged 6 to 7 received lip adhesion before 3 months and vomer flap repair before 12 months,the maxillary growth was most severely inhibited. The patients who underwent cleft lip surgery before 12 months and palate surgery before 24 months showed less protruded maxilla and decreased posterior facial height.