优化牙支持式上颌骨前部牵引成骨术与上颌骨Le FortⅠ型前徙术治疗唇腭裂患者的效果及对其腭咽部结构的影响分析

Effect of Modified Tooth-borne Anterior Maxillary Segmental Distraction Osteogenesis and Le Fort Ⅰ Osteotomy on Velopharyngeal Structure Changes in Patients with Cleft Lip and Palate

目的探讨优化牙支持式上颌骨前部牵引成骨术与上颌骨Le FortⅠ型前徙术治疗唇腭裂患者的效果,以及对其腭咽部结构的影响。方法将大连市口腔医院2017年1月一2020年1月收治的63例唇腭裂伴上颌骨发育不足患者纳人研究,依据随机数字表法分为观察组31例和对照组32例。对照组实施上颌骨Le FortⅠ型前徙术治疗,观察组实施优化牙支持式上颌骨前部牵引成骨术治疗。比较并分析两组治疗前后腭咽部形态参数、上颌骨前移距离、吹气试验和语言清晰度测听结果。采用Pearson相关性分析明确上颌骨前移距离与腭咽部形态各项参数之间的关系。结果治疗后观察组静止位的腭咽腔深度低干对照组,差异有统计学意义(P<0.05);两组治疗前后腭咽部形态其余各项参数及上颌骨前移距离,差异均无统计学意义(P>0.05)。治疗后观察组不捏鼻、捏鼻吹气试验时间均短干对照组,语言清晰度高干对照组,差异均有统计学意义(P〈O.O5)。Pearson相关性分析显示,上颌骨前移距离与各项腭咽部形态参数均无相关性(P>0.05)。结论优化牙支持式上颌骨前部牵引成骨术与上颌骨Le FortⅠ型前徙术治疗唇腭裂均有效,但是,优化牙支持式上颌骨前部牵引成骨术相较于上颌骨Le FortⅠ型前徙术,对患者腭咽部结构影响较小,值得推荐采用。

Objective To investigate the effect of modified tooth-bome anterior maxillary segmental distraction osteogenesis and Le FortⅠosteotom y on velopharyngeal structure changes in patients with cleft lip and palate.Methods A total of 63 cases of cleft lip and palate with maxillary hypoplasia admitted to Dalian stomatological hospital from January 2017 to January 2020 were included in the study.A ccording to the random num ber table method,they were divided into the observation group(31 cases)and the control group(32 cases).The control group was treated with Le FortⅠosteotom y,and the observation group was treated with modified tooth-borne anterior maxillary segm ental distraction osteogenesis.The param eters of palatopharyngeal morphology,maxillary advancement distance,breath test and speech intelligibility were compared between the two groups before and after treatm ent.Pearson correlation analysis was used to determine the relationship between the distance of maxillary advancem ent and the param eters of palatopharyngeal morphology.Results After treatm ent,the depth of the palatopharyngeal cavity in the observation group was significantly lower than that in the control group(P<0.05),while the other param eters of the palatopharyngeal morphology and the distance of maxillary advancement were not significant between two groups before and after treatment(P>0.05).After treatment,the time of no pinching nose and pinching nose blowing test in the observation group was significantly shorter than that in the control group,and the sepeech intelligibility in the observation group was significantly higher than that in the control group(P<0.05).Pearson correlation analysis showed that there was no correlation between the distance of maxillary advancement and the parameters of palatopharyngeal morphology(P>0.05).Conclusion Compared with Le FortⅠosteotomy,the modified tooth-bome anterior maxillary segmental distraction osteogenesis has less effect on the palatopharyngeal structure,which is worthy of recommendation.