咬合导板配合弹性牵引在正畸正颌联合治疗偏颌畸形中的应用价值分析

Study on the effect of occlusal guide plate combined with elasti ctraction in orthodontic and orthognathic treatment of partia ljaw deformity

目的:分析咬合导板配合弹性牵引在偏颌畸形患者正畸正颌联合治疗中的应用价值。方法:选取2019年1月—2020年12月中山大学附属口腔医院收治入院的行正畸正颌联合治疗的偏颌畸形患者40例,随机分成两组各20例。对照组进行正颌术后采用单纯弹性牵引,观察组进行正颌术后采用咬合导板配合弹性牵引,两组均牵引期3个月。对两组患者正颌术后即刻、3个月及1年的头颅侧位片及CBCT数据进行颞下颌关节髁突尺寸及下颌骨位置进行测量及统计学分析。评价偏颌畸形正颌术后不同牵引方式下颞下颌关节的短期(术后3个月)及长期(术后1年)稳定性。结果:正颌术后1年,观察组偏斜侧髁突的体积及表面积变化显著比对照组小(P<0.05);而正颌术后3个月,两组比较,差异无统计学意义(P>0.05)。非偏斜侧髁突,其体积与表面积变化,两组短期牵引及长期牵引比较,差异均无统计学意义(P>0.05)。结论:严重偏颌畸形患者,咬合导板配合弹性牵引比单纯术后牵引更能维持正畸正颌联合治疗后的颞下颌关节稳定性,值得临床应用。

Objective To analysis the effect of occlusal guide combined with elastic traction on joint stability after orthognathic surgery in patients with partial jaw deformity,in order to provide reference for the treatment of such patients.Methods 40 patients with partial jaw deformity admitted to the Affiliated Stomatological Hospital of Sun Yat-sen University from January 2019 to December 2020 were randomly divided into two groups,with 20 cases in each group.The control group received routine postoperative traction,and the observation group received postoperative occlusal guide combined with elastic traction traction period:3 months Based on the lateral cephalogram and CBCT data 3 months and 1 year after orthognathic surgery,the condyle size and mandibular position of temporomandibular joint were measured and statistically analyzed to evaluate the short-term and long-term stability of temporomandibular joint under different traction methods after orthognathic surgery.Results One year after orthognathic surgery,the volume and surface area of the deviated condyle in the positioning occlusal plate combined with in observation group were significantly smaller than those in control group;Three months after orthognathic surgery,there was no significant difference between the two groups(P>0.05).There was no significant difference in volume and surface area between the two groups in shortterm traction 3 months after surgery and long-term traction one year after surgery(P>0.05).Conclusion In patients with severe partial jaw deformity,occlusal guide combined with elastic traction can maintain the stability of temporomandibular joint after combined orthodontic and orthognathic treatment better than simple postoperative traction.