不同矢状向骨性错[牙合]畸形患者的头颈姿势比较研究

Comparative study of head and neck postures in patients with different sagittally oriented osseous malocclusions

目的探究不同矢状向骨性错[牙合]畸形患者的头颈姿势差异,以期为临床诊疗提供参考。方法选取2022年10月至2023年4月于四川大学华西口腔医院正畸科就诊的454例矢状向骨性错[牙合]畸形患者的临床和影像学资料进行回顾性分析。根据ANB(上齿槽座点-鼻根点-下齿槽座点角)对患者的矢状向错[牙合]畸形进行分类,比较不同矢状向骨性错[牙合]畸形患者的头颈姿势指标(Ba-C3ia、C2ap-C4ip、CVT-OPT、CVT-NSL、CVT-RL、OPT-MP、OPT-FH、OPT-NSL、OPT-RL及NSL-C2′)差异,以及按照患者性别(男性和女性)、年龄(成年和未成年)分层后的头颈姿势指标差异;并通过多元线性回归分析调整性别、年龄后的头颈姿势指标与不同矢状向骨性错[牙合]畸形的相关性。结果纳入的454例患者中,骨性Ⅰ类错[牙合]畸形患者212例(占46.7%),骨性Ⅱ类错[牙合]畸形患者170例(占37.4%),骨性Ⅲ类错[牙合]畸形患者72例(占15.9%),3类骨性错[牙合]畸形患者年龄、性别分布情况比较,差异均无统计学意义(均P>0.05)。骨性Ⅱ类错[牙合]畸形患者的CVT-NSL、OPT-NSL及NSL-C2′明显大于骨性Ⅰ类、Ⅲ类错[牙合]畸形患者,骨性Ⅲ类错[牙合]畸形患者的OPT-RL明显大于骨性Ⅰ类错[牙合]畸形患者;且女性患者中,骨性Ⅱ类错[牙合]畸形的Ba-C3ia和C2ap-C4ip还明显大于骨性Ⅰ类错[牙合]畸形,差异均有统计学意义(均P<0.05)。不同矢状向骨性错[牙合]畸形成年患者头颈姿势指标差异与整体情况一致;而在未成年患者中,骨性Ⅱ类错[牙合]畸形的CVT-NSL、OPT-FH及OPT-NSL明显大于骨性Ⅰ类错[牙合]畸形,骨性Ⅲ类错[牙合]畸形的CVT-NSL、CVT-RL、OPT-MP及OPT-RL明显大于骨性Ⅰ类错[牙合]畸形,差异均有统计学意义(均P<0.05);且不同矢状向骨性错[牙合]畸形未成年女性患者存在差异的头颈姿势指标多于未成年男性患者。调整年龄和性别混杂因素后的多元线性回归分析结果显示,相较于骨性Ⅰ类错[牙合]畸形,Ba-C3ia(B=1.164,P=0.011,95%CI:0.276~2.053)、C2ap-C4ip(B=1.339,P=0.007,95%CI:0.364~2.314)、CVT-NSL(B=4.154,P<0.001,95%CI:2.717~5.591)、OPT-NSL(B=4.059,P<0.001,95%CI:2.454~5.664)及NSL-C2′(B=3.773,P<0.001,95%CI:1.977~5.568)与骨性Ⅱ类错[牙合]畸形呈正相关;CVT-RL(B=3.172,P<0.001,95%CI:1.313~5.031)和OPT-RL(B=3.003,P=0.004,95%CI:0.978~5.029)与骨性Ⅲ类错[牙合]畸形呈正相关。结论骨性Ⅱ类错[牙合]畸形患者头颈姿势较骨性Ⅰ类、Ⅲ类错[牙合]畸形患者明显前倾,尤其是成年女性患者,且未成年骨性Ⅲ类错[牙合]畸形患者头颈姿势较未成年骨性Ⅰ类错[牙合]畸形患者前倾。早期矫治骨性Ⅱ类、Ⅲ类错[牙合]畸形可能会改善异常的头颈姿势。

Objective To investigate the differences in head and neck posture in patients with different sagittally oriented osseous malocclusions,aiming to provide guidance for clinical diagnosis and treatment.Methods The clinical and imaging data of 454 patients with sagittally osseous malocclusion who attended the orthodontic department of West China Hospital of Stomatology,Sichuan University between October 2022 to April 2023 were selected for retrospective analysis.The patients were categorized according to ANB for sagittally osseous malocclusion,and the parameters of head and neck posture(Ba-C3ia,C2ap-C4ip,CVT-OPT,CVT-NSL,CVT-RL,OPT-MP,OPT-FH,OPT-NSL,OPT-RL,and NSL-C2′)were compared among the patients.Additionally,differences in head and neck posture indices were compared after stratifying patients according to their sex(male and female)and age(adult and adolescent),the correlation between the parameters of head and neck posture adjusted for sex and age and different sagittally osseous malocclusion was analyzed by multiple linear regression.Results In the 454 patients,there were 212 patients(46.7%)with osseous classⅠmalocclusion,170 patients(37.4%)with osseous classⅡmalocclusion,and 72 patients(15.9%)with osseous classⅢmalocclusion.Comparison of the age and gender distribution of the patients showed no difference of statistically significant(all P>0.05).The CVT-NSL,OPT-NSL and NSL-C2′of patients with osseous classⅡmalocclusion were significantly higher than those of patients with osseous classⅠandⅢmalocclusions.The OPT-RL of patients with osseous classⅢmalocclusion was significantly higher than that of patients with osseous classⅠmalocclusion.In female patients,the Ba-C3ia and C2ap-C4ip of osseous classⅡmalocclusion were also higher than those of osseous classⅠmalocclusion(P<0.05).The differences in parameters of head and neck postures in adult patients were consistent with the overall situation;whereas in adolescent patients,CVT-NSL,OPT-FH and OPT-NSL were higher in osseous classⅡmalocclusion than in osseous classⅠ,and CVT-NSL,CVT-RL,OPT-MP and OPT-RL in osseous classⅢmalocclusion were significantly greater than those of classⅠpatients(P<0.05).More differences in parameters of head and neck postures were witnessed in adolescent female patients than in adolescent male patients.Multiple linear regression analyses after adjusting for age and sex confounders showed that compared to osseous classⅠmalocclusions,Ba-C3ia(B=1.164,P=0.011,95%CI:0.276-2.053),C2ap-C4ip(B=1.339,P=0.007,95%CI:0.364-2.314),CVT-NSL(B=4.154,P<0.001,95%CI:2.717-5.591),OPT-NSL(B=4.059,P<0.001,95%CI:2.454-5.664)and NSL-C2′(B=3.773,P<0.001,95%CI:1.977-5.568)were positively correlated with osseous classⅡmalocclusion;CVT-RL(B=3.172,P<0.001,95%CI:1.313-5.031)and OPT-RL(B=3.003,P=0.004,95%CI:0.978-5.029)were positively correlated with osseous classⅢmalocclusions.Conclusion The head and neck postures of patients with osseous classⅡmalocclusions were significantly more anterior than those of patients with osseous classⅠandⅢmalocclusions,especially in adult female patients.The head and neck postures of underage patients with osseous classⅢmalocclusions were more anterior than those with osseous classⅠmalocclusions.Early orthodontic treatment of osseous classⅡandⅢmalocclusions may improve the abnormal head and neck postures.