本文選題：下頜前突 + 顳下頜關(guān)節(jié)�。� 參考：《北京協(xié)和醫(yī)學(xué)院》2015年博士論文

【摘要】：目的：探討采用堅(jiān)強(qiáng)內(nèi)固定的單純雙側(cè)下頜升支矢狀劈開截骨成形術(shù)(bilateral sagittal split ramus osteotomy, BSSRO)-術(shù)后快速正畸治療下頜前突(mandibular prognathism, MP)的術(shù)后復(fù)發(fā)率情況及影響復(fù)發(fā)的相關(guān)因素,以及治療后顳下頜關(guān)節(jié)(temporomandibular joint, TMJ)位置的變化及與傳統(tǒng)治療方法的差別,為臨床應(yīng)用及改進(jìn)提供理論依據(jù)。方法：本研究納入了2012年01月至2014年10月在中國(guó)醫(yī)學(xué)科學(xué)院整形外科醫(yī)院顱頜面中心2接受治療的18位MP患者(男性9位,女性9位),術(shù)前未正畸,直接行BSSRO-術(shù)后快速正畸治療,術(shù)前(TO)、術(shù)后5天(T1)及術(shù)后1年及以上(T2)拍攝頭顱側(cè)位X片。應(yīng)用計(jì)算機(jī)軟件MedCeph4.0.1.x進(jìn)行標(biāo)志點(diǎn)測(cè)量。其次對(duì)24位MP患者(男性8位,女性16位)在術(shù)前及術(shù)后1年進(jìn)行頭顱計(jì)算機(jī)斷層(computed tomography, CT)掃描并三維重建。面部對(duì)稱及不對(duì)稱組12位,根據(jù)中線角設(shè)為偏頜側(cè)和非偏頜側(cè)。應(yīng)用醫(yī)學(xué)成像軟件Proplan 14對(duì)術(shù)前術(shù)后TMJ位置進(jìn)行測(cè)量,并與傳統(tǒng)治療方法進(jìn)行比較(參照2012年日本學(xué)者Ueki發(fā)表的文獻(xiàn))。應(yīng)用統(tǒng)計(jì)學(xué)軟件SPSS17.0進(jìn)行數(shù)據(jù)分析。結(jié)果：18位患者經(jīng)單純行BSSRO-術(shù)后快速正畸治療,術(shù)后效果滿意,無術(shù)后并發(fā)癥。在水平向上,B點(diǎn)在T1較TO平均后退7.5mm,在T2較T1平均前移21mm(28.0%)。Pog點(diǎn)在T1較TO平均后退6.6mam,在T2較T1平均前移29mm(43.9%)。在垂直向上,B點(diǎn)(1.3mm)和Pog點(diǎn)(1.0mm)在T1較TO向下移,在T2較T]向上移(分別為0.1mm和0.3mm)。Ramus angle在T1較TO平均增加4.3。,在T2較T1平均減小1.1。(25.6%)。在水平向和垂直向,B點(diǎn)和Pog點(diǎn)的后退距離(T1-TO)與術(shù)后長(zhǎng)期改變的距離(T2-T1)無顯著相關(guān)性(P0.05)。Ramus angle的改變(T1-TO)與Pog點(diǎn)的改變(T2-T1)無顯著相關(guān)性(P0.05)。對(duì)24位患者頭顱CT進(jìn)行分析,結(jié)果顯示在面部對(duì)稱組,術(shù)前偏頜側(cè)與非偏頜側(cè)對(duì)比各參數(shù)無顯著性差異(P0.05)；在面部不對(duì)稱組,術(shù)前矢狀位升支角偏頜側(cè)明顯小于非偏頜側(cè)(P=0.023)；術(shù)前偏頜側(cè)面部對(duì)稱組與面部不對(duì)稱組相比各參數(shù)統(tǒng)計(jì)學(xué)無顯著性差異(P0.05),非偏頜側(cè)面部對(duì)稱組冠狀位升支角明顯大于面部不對(duì)稱組(P=0.0161)。在面部對(duì)稱組,偏頜側(cè)術(shù)前術(shù)后各參數(shù)無顯著性差異,非偏頜側(cè)冠狀位髁突角(P=0.0355)及前間隙(P=0.0412)術(shù)后明顯大于術(shù)前；偏頜側(cè)與非偏頜側(cè)對(duì)比術(shù)前術(shù)后各參數(shù)變化值無顯著性差異(P0.05)。在面部不對(duì)稱組,偏頜側(cè)術(shù)前術(shù)后各參數(shù)無顯著性差異(P0.05),非偏頜側(cè)冠狀位升支角(P=0.0175)及矢狀位升支角(P=0.0398)術(shù)后明顯大于術(shù)前；上間隙術(shù)后明顯小于術(shù)前(P=0.0319)。在面部對(duì)稱組及面部不對(duì)稱組,偏頜側(cè)與非偏頜側(cè)對(duì)比術(shù)前術(shù)后各間隙變化幅度無明顯差異(P0.05)。經(jīng)單純BSSRO-術(shù)后快速正畸治療MP患者,其TMJ位置各參數(shù)的變化值與傳統(tǒng)治療方法相比,在面部對(duì)稱組,偏頜側(cè)及非偏頜側(cè)關(guān)節(jié)后間隙的變化存在顯著性差異(P值分別為0.007和0.037),變化幅度均小于傳統(tǒng)治療方法：在面部不對(duì)稱組,偏頜側(cè)各參數(shù)變化值無顯著性差異,非偏頜側(cè)關(guān)節(jié)上間隙的變化存在顯著性差異(P=0.020),變化幅度大于傳統(tǒng)治療方法。結(jié)論：?jiǎn)渭冃蠦SSRO-術(shù)后快速正畸治療MP存在一定的復(fù)發(fā)率,但是復(fù)發(fā)程度與B點(diǎn)和Pog點(diǎn)及ramus angle術(shù)中改變程度無顯著線性相關(guān)性。在面部對(duì)稱組,術(shù)前偏頜側(cè)與非偏頜側(cè)TMJ位置相近；在面部不對(duì)稱組,術(shù)前矢狀位升支角偏頜側(cè)較非偏頜側(cè)�。恍g(shù)前非偏頜側(cè)面部對(duì)稱組冠狀位升支角較面部不對(duì)稱組大。經(jīng)單純BSSRO-術(shù)后快速正畸治療MP,面部對(duì)稱組的非偏頜側(cè)術(shù)后冠狀位髁突角及前間隙出現(xiàn)了擴(kuò)張,面部不對(duì)稱組的非偏頜側(cè)術(shù)后冠狀位升支角及矢狀位升支角增加,上間隙縮小,而偏頜側(cè)無明顯改變。在面部對(duì)稱組及面部不對(duì)稱組,偏頜側(cè)與非偏頜側(cè)對(duì)比術(shù)前術(shù)后各間隙變化幅度相近。與傳統(tǒng)的MP矯正方法比較,單純BSSRO-術(shù)后正畸治療在面部對(duì)稱組偏頜側(cè)及非偏頜側(cè)髁突關(guān)節(jié)后間隙位置變化小于傳統(tǒng)治療方法,而在面部不對(duì)稱組非偏頜側(cè)上間隙位置變化大于傳統(tǒng)治療方法。
[Abstract]:Objective: To investigate the recurrence rate of bilateral sagittal split ramus osteotomy (BSSRO) and postoperative rapid orthodontic treatment of the mandibular protrusion (mandibular prognathism, MP) and the related factors affecting the recurrence, and the temporomandibular joint (temporoma) after treatment (temporoma). The changes in the position of NDIBULAR joint, TMJ) and the difference from the traditional treatment methods provide a theoretical basis for clinical application and improvement. Methods: This study included 18 MP patients (9 men, 9 women) who were treated in the Craniofacial Center of Plastic Surgery Hospital, CAMS, PUMC from 01 to October 2014 2012. Rapid orthodontic treatment after BSSRO-, preoperative (TO), 5 days after operation (T1) and 1 years and above (T2) were taken to photograph the lateral head of the head. Use the computer software MedCeph4.0.1.x to measure the mark point. Secondly, 24 MP patients (8 men, 16 women) were scanned by the skull computed tomography (computed tomography, CT) before and 1 years after the operation and three. Reconstruction. 12 positions of facial symmetry and asymmetry group were set at the midline angle to the mandibular and non mandibular sides. Proplan 14 was used to measure the position of TMJ before and after operation with the medical imaging software, and compared with the traditional method of treatment (referring to the literature published by Japanese scholar Ueki in 2012). The data should be analyzed with statistical software SPSS17.0. 18 patients were treated with rapid orthodontic treatment after simple BSSRO- operation. The postoperative effect was satisfactory without postoperative complications. At the level of level, the B point was 7.5mm in T1 compared with the TO average, and 21mm (28%).Pog at T2 compared to T1 averaging (43.9%). Move up and move up in T2 than T] (0.1mm and 0.3mm).Ramus angle increase 4.3. at T1 compared with TO, and T2 is less than T1 average 1.1. (25.6%). 1) there was no significant correlation (P0.05). 24 patients with cranium were analyzed. The results showed that there was no significant difference between the preoperative partial maxillary and the non mandibular side (P0.05) in the facial symmetry group (P0.05), and in the facial asymmetry group, the sagittal angle of the ascending branch was significantly smaller than the non lateral maxillary side (P=0.023) before the operation, and the symmetry group and the face in the lateral maxillary group before the operation. There was no significant difference between the asymmetric group and the parameters (P0.05). The angle of the coronal ascending branch in the asymmetric group of the non maxillary side was obviously greater than that of the facial asymmetry group (P=0.0161). In the facial symmetry group, there was no significant difference in the preoperative and postoperative parameters, and the non lateral coronal condyle angle (P=0.0355) and the anterior space (P=0.0412) were obviously greater than the operation. There was no significant difference between the preoperative and postoperative parameters (P0.05). In the asymmetric facial group, there was no significant difference in the parameters (P0.05), the unbiased coronal elevation (P=0.0175) and the sagittal angle of ascending branch (P= 0.0398) were significantly higher than those before the operation. Before (P=0.0319). There was no significant difference in the gap between the facial symmetry group and the facial asymmetry group. There was no significant difference in the gap between the partial maxillary and the non mandibular sides (P0.05). The changes of the parameters of the TMJ position of the MP patients after the simple BSSRO- operation were compared with the traditional treatment methods, in the facial symmetry group, the partial maxillary side and the unbiased side joint. There was a significant difference in the changes of the posterior space (P value was 0.007 and 0.037 respectively), and the change amplitude was less than the traditional treatment method: there was no significant difference in the change values of the parameters of the anomandibular side in the asymmetric facial group, and there was a significant difference in the changes of the upper intermaxillary joint space (P=0.020), and the change amplitude was greater than the traditional treatment method. Conclusion: simple There was a certain recurrence rate in the rapid orthodontic treatment of MP after BSSRO-, but there was no significant linear correlation between the degree of recurrence and the degree of change of B points and Pog points and ramus angle. In the facial symmetry group, the preoperative partial maxillary side was similar to the unbiased TMJ position; in the facial asymmetry group, the sagittal angle of the ascending branch of the maxillofacial side was smaller than the non maxillary side. The coronal ascending branch angle of the anterior non lateral maxillary side was larger than that in the asymmetric face group. After the simple BSSRO- treatment of MP, the coronal condyle and the anterior space of the facial symmetry group expanded. The ascending branch angle and the sagittal angle of the sagittal position increased and the upper space narrowed after the unbiased facial asymmetry group. There was no obvious change in the lateral maxillary side. In the facial symmetry group and the facial asymmetry group, the changes in the gap between the partial maxillary and the non mandibular sides were similar. Compared with the traditional MP correction method, the post BSSRO- orthodontic treatment in the facial symmetry group was less than the traditional treatment side in the facial symmetry group and the non partial maxillary condyle joint. However, in the facial asymmetry group, the position of the non maxillary side gap was larger than that of the traditional treatment.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R782.2

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本文編號(hào)：2001372