正颌正畸联合治疗唇腭裂继发颌骨畸形的稳定性评价

Stability of joint orthognathic and orthodontic treatment for dental-facial deformity in patients with cleft lip and palate

目的探讨唇腭裂继发颌骨畸形患者经正颌正畸联合治疗后的稳定性。方法2010年1月至2017年6月,上海交通大学医学院附属第九人民医院口腔颅颌面科就诊的唇腭裂继发颌骨畸形需正颌正畸患者15例,通过术前(T0)、术后2周(T1)、术后6个月(T2)、术后24个月(T3)头颅定位侧位片比较,分析正颌正畸联合治疗前后的颌骨稳定。并与15例非唇腭裂上颌发育不足、下颌发育过度同样接受正颌正畸联合治疗患者,在治疗后相同时间点进行稳定性分析。结果唇腭裂组患者上颌骨水平向前移(3.8±1.5) mm,垂直向下降(2.4±0.8) mm。术后6个月水平向复发(1.2±0.7) mm (T1~T21:31.6%),垂直向复发(0.9±0.6) mm(T1~T2:37.5%)。术后24个月水平向复发(1.0±0.5) mm(T1~T3:26.0%),垂直向复发(0.8±0.8) mm(T1~T3:33.3%)。非唇腭裂组患者上颌骨水平向前移(4.3±1.2)mm,垂直向下降(2.2±1.9) mm。术后6个月水平向复发(0.9±1.2) mm(T1~T2:20.9%),垂直向复发(0.8±0.9) mm(T1~T2:36.6%)。术后24个月水平向复发(1.1±0.6) mm(T1~T3:25.6%),垂直向复发(0.9±0.5) mm(T1~T3:40.9%)。两组术后6个月与术后12个月水平向与垂直向复发率结果比较,差异无统计学意义(P>0.05)。结论唇腭裂继发颌骨畸形正颌正畸联合治疗后复发率大于非裂颌骨畸形患者,但术后稳定性差异无统计学意义。

Objective To evaluate the skeletal stability of joint orthognathic and orthodontic treatment for cleft patients compared with non-cleft patients. Methods Fifteen cleft patient diagnosed with dental facial deformities underwent joint orthognathic and orthodontic treatment. Cephalometric analysis was carried out at T0 (before treatment), T1 (2 weeks after surgery), T2 (6 months after surgery) and T3 (24 months after surgery). The comparison of maxillary anterior-posterior and superior-inferior movement was performed with non-cleft orthognathic group (n=15) at the same follow-up time point. Results The maxilla was move forward for (3.8±1.5) mm and downward for (2.4±0.8) mm of cleft group. The relapse distance was (1.2±0.7) mm (T1-T2: 31.6%) in AP direction and (0.9±0.6) mm (T1-T2: 37.5%) in vertical direction. At the time of 24 months after operation, the relapse distance was (1.0±0.5) mm (T1-T3: 26.0%) in AP direction and (0.8±0.8) mm (T1-T3: 33.3%) vertically. In non-cleft group, the maxilla was move (4.3±1.2) mm anteriorly and (2.2±1.9) mm vertically. The relapse distance was (0.9±1.2) mm (T1-T2: 20.9%) anteriorly and (0.8±0.9) mm (T1-T2: 36.6%) vertically at 6 months post-operatively. At 24 months after surgery the relapse distance was (1.1±0.6) mm (T1-T3: 25.6%) anteriorly and (0.9±0.5) mm (T1-T3: 40.9%) vertically. There were no statistical significant in both 6 months and 24 months follow-up between cleft and non-cleft group (P>0.05). Conclusions There is no statistic difference of post-surgical relapse rate between cleft and non-cleft orthognathic and orthodontic treatments, although the relapse distances are greater than that in cleft group.