双[牙合]垫矫治器治疗下颌后缩的临床疗效及对患儿气道改善与颅面硬软组织的影响

Clinical efficacy Twin-block appliance in the treatment of mandibular retraction and its influence on airway improvement and craniofacial hard and soft tissues in children

目的探讨双[牙合]垫矫治器治疗下颌后缩的临床疗效及对患儿气道改善与颅面硬软组织的影响。方法选取2019年1月至2021年3月于河北省眼科医院治疗的60例下颌后缩患儿作为研究对象,按照随机数字表法分为观察组与对照组,每组30例。对照组给予常规固定矫治器治疗,观察组给予双[牙合]垫矫治器治疗,比较两组上气道指标、颅面硬组织指标、颅面软组织指标、睡眠指标、鼾声评分表(SS)评分及Epworth嗜睡量表(ESS)评分。结果治疗后,两组口咽腔直径、舌根后咽腔直径均长于治疗前,且观察组长于对照组,差异有统计学意义(P<0.05)。治疗后,两组下颌体后面高[PFH(Ar-Go)]、下颌体前面高[AFH(Me-PP)]均高于治疗前,下颌体长度(GoPg)均长于治疗前,下切牙相对于下颌平面的倾斜度(L1-MP)、颌相对于颅部的前后位置关系(SNB)值均大于治疗前,上下颌骨对颅部的相互位置关系(ANB)值均小于治疗前,且观察组PFH(Ar-Go)、AFH(Me-PP)均高于对照组,GoPg长于对照组,L1-MP、SNB值大于对照组,ANB值小于对照组,差异有统计学意义(P<0.05)。治疗后,两组颏唇沟的深度(Si-LLPos)均浅于治疗前,下唇软组织相对于颅部的前后位置关系(LLSi-SN)、软组织下面部相对于前颅底平面的前后向位置(SNsSi)值均大于治疗前,上下唇的相对位置(SnNsSi)值均小于治疗前,且观察组Si-LLPos浅于对照组,LLSi-SN、SNsSi值大于对照组,SnNsSi值小于对照组,差异有统计学意义(P<0.05)。治疗后,两组最低血氧饱和度(LSaO_(2))均高于治疗前,氧减指数(ODI)、呼吸暂停低通气指数(AHI)及SS、ESS评分均低于治疗前,且观察组LSaO_(2)高于对照组,ODI、AHI及SS、ESS评分均低于对照组,差异有统计学意义(P<0.05)。结论双[牙合]垫矫治器治疗下颌后缩,可牵引患儿下颌骨前移,扩大口咽腔与舌根后咽腔部位的间隙,促进下颌骨的正常生长发育,进而改善患者的呼吸功能及睡眠质量。

Objective To explore the clinical efficacy Twin-block appliance in the treatment of mandibular retraction and its influence on airway improvement and craniofacial hard and soft tissues in children.Methods 60 children with mandibular retraction who were treated at Hebei Eye Hospital from January 2019 to March 2021 were selected as the study subjects,they were randomly divided into the observation group and the control group according to the random number table method,with 30 cases in each group.The control group was treated with conventional fixed appliances,while the observation group was treated with Twin-block appliance,the upper airway indicators,craniofacial hard tissue indicators,craniofacial soft tissue indicators,sleep indicators,snoring scale(SS)scores,and Epworth drowsiness scale(ESS)scores were compared between the two groups.Results After treatment,the diameter of the oropharyngeal cavity and the diameter of the retrolingual pharyngeal cavity of the two groups were longer than before treatment,and the observation group was longer than the control group,the differences were statistically significant(P<0.05).After treatment,the posterior height of mandibular body(PFH[Ar-Go])and anterior height of mandibular body(AFH[Me-PP])of the two groups were higher than before treatment,corpora mandibulae length(GoPg)was longer than before treatment,the inclination of the lower incisors relative to the mandibular plane(L1-MP)and the relationship between the anteroposterior position of mandible relative to anterior cranial base(SNB)values were larger than before treatment,the position of maxilla and mandible in relation to one another relative to anterior cranial base(ANB)value was samaller than before treatment,and PFH(Ar-Go)and AFH(Me-PP)in the observation group were higher than those in the control group,GoPg was longer than that in the control group,L1-MP and SNB values were larger than those in the control group,and ANB values were samller than that in the control group,the differences were statistically significant(P<0.05).After treatment,the depth of the chin labial sulcus(Si-LLPos)of the two group were shallower than before treatment,the relationship between the anterior and posterior positions of the soft tissue of the lower lip relative to the anterior cranial base(LLSi-SN)and the anteroposterior position of the lower part of the soft tissue relative to the plane of the anterior cranial base(SNsSi)values larger than before treatment,and the relative position of the upper and lower lips(SnNsSi)values smaller than before treatment,and Si-LLPos in the observation group was shallower than that in the control group,LLSi-SN and SNsSi values larger than those in the control group,and SnNsSi values smaller than that in the control group,the differences were statistically significant(P<0.05).After treatment,the lowest oxygen saturation(LSaO_(2))levels of the two groups were higher than before treatment,and the oxygen reduction index(ODI),apnea-hypopnea index(AHI)and SS,ESS scores were lower than before treatment,and the LSaO_(2) levels in the observation group was higher than that in the control group,and the ODI,AHI and SS,ESS scores were lower than those in the control group,the differences were statistically significant(P<0.05).Conclusion The Twin-block appliance can treat mandibular retrusion in children by pulling the mandible forward,expanding the gap between the oropharyngeal cavity and the posterior pharyngeal cavity of the tongue root,promoting the normal growth and development of the mandible,and improving the patient's respiratory function and sleep quality.