【作者】 马丹；

【导师】 王旭霞； 张君；

【作者基本信息】 山东大学 ， 口腔临床医学（专业学位）， 2013， 硕士

【摘要】 骨性安氏Ⅱ类错(?)畸形是临床上常见的牙颌面畸形之一,对其进行治疗和研究一直是口腔科医生关注的焦点。正畸-正颌联合治疗被广泛认为是一种良好地治疗成人骨性Ⅲ类错(?)畸形的方法。上颌Le Fort Ⅰ型截骨术和下颌双侧升支矢状骨劈开术(BSSRO)是治疗骨性Ⅲ类错(?)最为常用的手术方式。临床上根据畸形的程度和部位选择采用一种或两种术式相结合来进行治疗。根据手术部位通常分为单纯下颌手术和双颌手术,但对单、双颌手术方法的选择尚无统一的标准。通过对骨性Ⅲ类错(?)者治疗不同时期X线头颅定位侧位片的测量分析,明确单、双颌手术方式的选择标准,评价两种手术方式的临床治疗效果,掌握不同术式对骨骼及牙齿改变的异同,以期更好的选择手术方案。尽管正颌外科取得了突飞猛劲的进步,但术后稳定性仍是困扰着口腔科医师的问题。术后稳定性是衡量正颌外科治疗成功与否的关键。国内外对术后稳定性的报道,多为对单纯下颌手术或双颌手术的研究。鲜见对单、双颌手术复发程度、部位及原因的对比研究。比较单颌手术与双颌手术治疗严重骨性Ⅲ类错(?)者面部硬组织的变化,可以明确术后复发部位、复发程度及影响复发的因素,为手术方式的选择提供可靠的理论依据。目的：通过对单颌与双颌正颌手术治疗的骨性安氏Ⅲ类错(?)患者治疗不同时期X线头颅定位侧位片的测量分析,比较单、双颌手术后颌面部硬组织变化规律及其稳定性,明确单、双颌手术方式的选择标准,为骨性安氏Ⅲ类错(?)患者治疗前诊断设计、手术方法的选择提供可靠的理论依据和技术指导。方法：选择60例骨性安氏Ⅲ类错(?)者,其中30例接受单纯下颌手术,30例接受双颌手术。分别在治疗前(T0),手术前(T1),手术后6周(T2),以及治疗结束时(T3)拍摄X线头颅定位侧位片。选择颅面部17个硬组织标志点,测量它们所形成的角度、线距及其在垂直方向和矢状方向上线距间的变化。全部测量数据使用SPSS20.0软件包进行统计学处理。结果(1)治疗前(T0)与手术前(T1)各硬组织标志点变化的比较除单颌手术组上切牙相应测量值无显著变化外(P>0.05),单颌手术组下切牙和双颌手术组上、下切牙的相应测量项目均发生了显著变化(P<0.05)。表明术前正畸去代偿作用明显。(2)手术前(T1)与手术后6周(T2)各硬组织标志点变化的比较双颌手术组上颌各硬组织标志点明显向前向上移位,单、双颌手术组下颌各硬组织标志点均明显向后向上移位(P<0.05)。双颌手术组SNA角以及两组的SNB角、ANB角、Wits值均发生了显著变化(P<0.05),术后患者由Ⅲ类骨面型变成Ⅰ类骨面型。双颌手术组OP-SN增大显著(P<0.05),表明患者(?)面发生了逆时针方向的旋转,单颌手术组无此改变(P>0.05)。双颌组上面高(N-ANS)、下面高(ANS-Me)变化显著(P<0.05),术后颌面部垂直比例关系更为协调。两组患者均由反覆(?)反覆盖变为覆(?)、覆盖正常,获得了良好的咬合关系。(3)手术后6周(T2)与治疗结束时(T3)各硬组织标志点变化的比较双颌手术组上颌各硬组织标志点有轻度的向后向下位移的趋势,单、双颌手术组下颌各硬组织标志点均有轻度的向前向上位移的趋势,但其变化均无统计学意义(P>0.05)。两组比较发现：在矢状方向上,双颌手术组术后稳定性优于单颌手术组(P<0.05)；在垂直方向上,两组术后稳定性无统计学差异(P>0.05)。结论(1)双颌手术在上颌畸形治疗、面部垂直比例关系改善、(?)平面倾斜度改变方面优于单颌手术。(2)在矢状方向上,双颌手术组术后稳定性优于单颌手术组；在垂直方向上,两组术后稳定性无统计学差异。更多还原

【Abstract】 Skeletal class Ⅲ deformity is one of the most common dento-maxillofacial deformities in the clinical, correction of it has been the focus attention of stomatology doctors. Combined orthodontic and orthognathic treatment is widely used to correct skeletal class Ⅲ adult patients. Maxillary Le Fort Ⅰ osteotomy and mandibular bilateral ramus sagittal split ramus osteotomy (BSSRO) are two operation methods used to correct skeletal Class Ⅲ malocclusion. We usually choose one or two kinds of the operation methods in the basis of the position and degree of the deformity. According to the operation site is usually divided into single-jaw or double-jaw procedures,but the criteria is not clear. Analyze the changes of hard tissues at each treatment stage in patients with Skeletal Class Ⅲ malocclusion after mandibular or bimaxillary orthognathic sugery, and to discuss the different effects after treatment, so as to give some guidelines for clinical work.Although orthognathic surgery has achieved great progress, but the postoperative stability is still plague Stomatology doctors. Postoperative stability is the key measure of orthognathic surgery success. Reports on postoperative stability almost are the study of single-jaw or double-jaw procedures at home and abroad, seldom in single-jaw versus double-jaw procedures. Comparison skeletal changes after single and double jaw procedures can provide reliable theoretical basis for the selection of operation.Objective:The purpose of this study was to analyze the changes of hard tissues at each treatment stage in patients with Skeletal Class III malocclusion after mandibular or bimaxillary orthognathic sugery, and to discuss the different effects and skeletal stability after treatment, so as to give some guidelines for clinical work.Methods:60patients who had been diagnosed with Class III skeletal deformities were divided into2groups and had undergone mandibular or bimaxillary orthognathic sugery. The standardized lateral cephalograms were taken at the following stages:before treatment(To);before surgery(Ti);6weeks after surgery(T2); after treatment (T3). A total of17hard tissues landmarks were selected. We measured and evaluated the alteration of these points in angular and distance measurements, horizontal and vertical directions between the different stages. SPSS20.0soft ware was used to analyze the changes of the hard tissues.Results(1) Except the landmarks of the upper incisors in the single jaw group shown no significant changes(P>0.05), all the landmarks of both upper and lower incisors have significant changes(P<0.05)at the stage of T1compared with the stage of To.(2) Compared with the stage of Ti, in the bimaxillary surgery group the maxilla move forwards and downwards,while the mandible move backwards and upwards at the stage of T2(P<0.05)In the single jaw surgery group only the mandible moved backwards and upwards(P<0.05).The change of the SNA angle in the bimaxillary surgery group and the SNB angle, ANB angle, Wits appraisal in both group have passed the statistical significance level in both group(P<0.05). In contrast with the single jaw surgery group, an increase in occlusal plane inclination in bimaxillary surgery group was found(P<0.05). In the bimaxillary surgery group, upper and lower facial height change significantly(P<0.05), the vertical facial proportions more harmonious. All the patients have established good occlusion relationship after surgery. (3) Although there was some relapse in the maxilla of the bimaxillary surgery group and in the mandible of both group,it has no meaning in statistics (P>0.05). The horizontal mandibular skeletal of double-jaw procedure was more stable when compared with the single-jaw procedure(P<0.05). No other differences in vertical mandibular skeletal stability was identified (P>0.05).Conclusion(1)These results indicate that, bimaxillary surgery is preferable to correct maxilla deformity,improve vertical facial proportions,change occlusal plane inclination than single-jaw procedure.(2)The double-jaw procedure may lead to more stability, leading to less skeletal relapse, than single-jaw procedure in horizontal. No differences were noted between the two groups when examining the mandibular vertical stability.更多还原