双颌手术矫治下颌前突的临床效果研究

Study on the clinical efficacy of double-jaw surgery in the correction of mandibular protrusion

目的探讨应用双颌手术联合正畸治疗矫治骨性Ⅲ类下颌前突畸形的临床效果。方法自2015年7月至2020年6月,辽宁省人民医院口腔科对7例骨性Ⅲ类下颌前突畸形患者,实施规范的术前X线头影测量分析、诊断,以及术前正畸、正颌外科手术、术后正畸和随访疗效评估的诊治程序进行双颌手术正颌外科联合正畸治疗。采用基本术式为LefortⅠ型切开截骨术(LefortⅠostotomy)整体前移上颌骨、双侧下颌升支矢状劈开截骨术后退下颌。结果所有患者术后伤口均一期愈合,无感染及骨坏死发生;随访1~3年,所有患者的上下颌骨关系正常,牙弓形态及牙颌曲线正常,牙排列整齐,咬关系及咀嚼效能良好,面部改善较明显,均达到了患者的期望。结论按照标准规范的正畸正颌联合诊治程序,应用双颌手术联合正畸治疗矫治骨性Ⅲ类下颌前突畸形患者,在临床上可取得一定的诊疗效果,不仅恢复了患者的咬关系和咀嚼功能,更改善了颜面外形和提高了生活质量。

Objective To explore the clinical efficacy of double-jaw surgery combined with orthodontic treatment in the correction of skeletal ClassⅢmandibular protrusion deformity.Methods From July 2015 to June 2020,7 patients with skeletal ClassⅢmandibular protrusion deformity were admitted to the Department of Stomatology of The People’s Hospital of Liaoning Province.The standard preoperative X-ray cephalometric measurement,analysis and diagnosis was performed.The preoperative orthodontic treatment,orthognathic surgery,postoperative orthodontic treatment and follow-up evaluation of the diagnosis and treatment procedures were conducted for double-jaw surgery and orthognathic surgery combined with orthodontic treatment.The basic surgical procedure was LefortⅠosteotomy.The maxilla was moved as a whole.The bilateral sagittal split ramus osteotomy was performed to withdrew the mandible.Results All incisions healed by first intention.No infection and necrosis occurred.All patients were followed up for 1 to 3 years.The relationship between the upper and lower jaws,shape of the dental arch and curve of the dental jaw were normal.The teeth were neatly arranged,and the occlusion and chewing efficiency was good.The facial improvement was obvious,which reached the patient’s expectation.Conclusion In accordance with the standard procedures of orthodontic and orthognathic diagnosis and treatment,the application of double-jaw surgery combined with orthodontic treatment in the correction of skeletal ClassⅢmandibular protrusion achieved a certain clinical diagnosis and treatment efficacy.This method not only restored the patient’s occlusion relationship and chewing efficiency,but also improved the facial appearance and the quality of life.