正畸—正頜聯(lián)合治療骨性Ⅲ類錯（牙合）畸形軟硬組織的變化及對其生活質(zhì)量的影響
發(fā)布時間：2018-08-25 14:21
【摘要】：目的:1.分析比較成人骨性Ⅲ類錯(牙合)畸形在正畸-正頜聯(lián)合治療前后頭影測量軟硬組織的改變,評價正畸-正頜聯(lián)合治療對成年人骨性Ⅲ類錯(牙合)畸形的治療效果。2.通過在治療前、中、后的不同階段對上述患者進(jìn)行口腔健康影響程度量表(OHIP-14)和正頜患者生活質(zhì)量調(diào)查問卷(OQLQ)的問卷調(diào)查,分析以上患者在治療前、中、后口腔健康相關(guān)生活質(zhì)量(OHRQOL)的變化,探討正畸-正頜聯(lián)合治療對其的影響。3.探討患者術(shù)后頭影測量指標(biāo)的改變與其生活質(zhì)量之間的關(guān)系。材料與方法:1.選擇2014年3月~2017年4月年廣西醫(yī)科大學(xué)附屬口腔醫(yī)院經(jīng)正畸-正頜聯(lián)合治療完成的21例骨性Ⅲ類錯(牙合)畸形患者(排除唇腭裂、Down綜合征等先天遺傳性疾病的患者),其中男性11例,女性10例,年齡范圍為18~27歲(治療開始時的年齡),平均年齡20.3歲。所有患者均經(jīng)過術(shù)前正畸-正頜會診討論,制定正畸-正頜聯(lián)合治療方案,并行術(shù)前正畸、模型外科、正頜手術(shù)、術(shù)后正畸、保持等治療步驟。每位患者分別在治療前(術(shù)前正畸開始前)、治療后(術(shù)后正畸結(jié)束后)拍攝X線頭顱定位側(cè)位片。所有患者進(jìn)行治療前和治療后頭顱側(cè)位片的X線頭影測量分析,并使用SPSS 20.0統(tǒng)計學(xué)軟件分析測量數(shù)據(jù),比較治療前后顱頜面部及上下頜骨軟硬組織X線頭影測量值的變化。2.對上述每一例患者進(jìn)行OHIP-14和OQLQ問卷調(diào)查,分別在術(shù)前正畸開始前(T0)、正頜手術(shù)前1周(T1)、正頜手術(shù)后3-6個月(T2)三個時間點進(jìn)行問卷調(diào)查,同時隨機(jī)選取平均年齡無統(tǒng)計學(xué)差異的普通人群(Tc)40例進(jìn)行問卷調(diào)查作為對照組進(jìn)行比較。OHIP-14的每份問卷均包含有14個項目,7個領(lǐng)域。各個項目的自我評價分為5個級別(0~4級),并依次計為0~4分,測得在上述不同時間點每位患者及對照組的生活質(zhì)量影響分?jǐn)?shù),得分越高則說明在相應(yīng)的時間點被測者的生活質(zhì)量越差。問卷總分范圍為0~56分,每個領(lǐng)域分值范圍為0~8分。OQLQ則包括四個領(lǐng)域22個項目,分別為口腔功能、面部美學(xué)、牙頜面畸形的自我感知以及社會交往。該測量表格的評分標(biāo)準(zhǔn)為四點量表,0至3依次增加表示了該行為的影響逐漸增大(即數(shù)值越大說明影響越大)。使用SPSS 20.0統(tǒng)計學(xué)軟件記錄數(shù)據(jù)并進(jìn)行分析,對量表的得分情況進(jìn)行統(tǒng)計描述,并采用Wilcoxon秩檢驗分別對21位患者的治療前、中、后以及治療后與正常組比較進(jìn)行統(tǒng)計學(xué)分析,探討骨性Ⅲ類錯牙合畸形患者正畸-正頜聯(lián)合治療過程中患者的心理狀態(tài)、身體機(jī)能、社會交往等方面因口腔健康的影響而產(chǎn)生的變化,繪制患者治療前、中、后及正常對照組問卷總分變化曲線,探討其變化的原因以及應(yīng)對措施,為后續(xù)的治療方案提供理論依據(jù)。在患者術(shù)后頭影測量指標(biāo)的改變與其生活質(zhì)量間關(guān)系的探討中,將納入SNA角,SNB角,ANB角,Go-Pg,ANS-Me,ANSMe/NMe,U1-L1角,UL-EP,LL-EP,Z角,N-Sn-Pg角,wits值(mm)等頭影測量指標(biāo),應(yīng)用SPSS 20.0來計算這些指標(biāo)的改變與患者生活質(zhì)量(OQLQ and OHIP 14)間的相關(guān)性。結(jié)果:1.經(jīng)正畸-正頜聯(lián)合治療,骨性III類錯(牙合)畸形患者的SNA角變大,SNB角變小(P0.05),ANB角與Wits值顯著增大(P0.01),提示顱骨與頜骨、上頜骨與下頜骨之間的相對位置得到改善;Go-Pg明顯減小(P0.01),提示下頜骨長度變短,Go-Co無明顯變化,提示下頜升支無明顯改變,Ptm-A,Ptm-s無明顯變化,提示上頜骨長度及位置無明顯改變;SN-MP,ANS-Me/N-Me減小(P0.05),ANS-Me明顯減小(P0.01),提示面高變短,面高比例更協(xié)調(diào);U1-SN角,U1-NA角變小,L1-MP角變大(P0.05),U1-NA距明顯變小(P0.01),提示上前牙舌傾去代償,下前牙唇傾去代償;N-Sn-Pg,Z angle,UL-EP,LL-EP明顯減小(P0.01),提示患者軟組織發(fā)生改變,面型發(fā)生變化,由凹面型變?yōu)橹泵嫘?與治療前相比得到顯著改善。2.在OHIP-14中:心理疾病、心理障礙、社會障礙三個指標(biāo)的T2顯著低于T0和T1(P0.01),且T1大于T0,T1大于T2(P0.05),三者均有統(tǒng)計學(xué)意義,而T2與T3相比較無統(tǒng)計學(xué)意義;在OQLQ中:四個領(lǐng)域中的T2均小于T0與T1,T1大于T0,二者差異均有統(tǒng)計學(xué)意義(P0.01),T2與Tc無統(tǒng)計學(xué)意義。說明經(jīng)過正畸-正頜聯(lián)合治療后,在OHIP-14中患者的心理疾病、心理障礙、社會障礙三個指標(biāo)得到顯著改善并與普通人群調(diào)查結(jié)果無統(tǒng)計學(xué)差異,在OQLQ中,患者的口腔功能、面部美學(xué)、自我感知以及社會交往四個領(lǐng)域均得到顯著改善并與普通人群調(diào)查結(jié)果無統(tǒng)計學(xué)差異。在骨性III類錯(牙合)畸形患者中,頜凸角、下唇突度以及上下頜骨之間的關(guān)系對其生活質(zhì)量影響最大。結(jié)論:1.成人骨性Ⅲ類錯(牙合)畸形患者經(jīng)過系統(tǒng)的正畸-正頜聯(lián)合治療后,III類骨面型得到顯著改善,治療效果確切。2.骨性Ⅲ類錯(牙合)正畸-正頜聯(lián)合治療對患者的口腔健康相關(guān)生活質(zhì)量有一定的改善,雖然在術(shù)前正畸去代償后,患者的生活質(zhì)量(quality of life,QOL)在手術(shù)前一段時間內(nèi)有暫時的降低,但在全部治療完成后,OQLQ調(diào)查發(fā)現(xiàn)患者的生活質(zhì)量在各個領(lǐng)域均得到提高,并顯著高于治療前,與普通人群無統(tǒng)計學(xué)差異。因此正畸-正頜聯(lián)合治療能夠改善成人骨性Ⅲ類錯(牙合)畸形患者的口腔健康及相關(guān)生活質(zhì)量。治療后患者軟硬組織的改變與其生活質(zhì)量的改善顯著相關(guān)。
[Abstract]:Objective: 1. To analyze and compare the cephalometric soft and hard tissue changes in adult skeletal class III malocclusion before and after orthodontic-orthognathic treatment, and to evaluate the effect of orthodontic-orthognathic treatment on adult skeletal class III malocclusion. 2. To evaluate the oral health impact of the above patients at different stages before, during and after treatment. The changes of oral health-related quality of life (OHRQOL) before, during and after treatment were analyzed by OHIP-14 and OQLQ questionnaires. The effects of orthodontic-orthognathic treatment on the quality of life were discussed. 3. The relationship between the changes of cephalometric parameters and the quality of life was investigated. Methods: 1. Twenty-one patients with skeletal class III malocclusion (excluding cleft lip and palate, Down syndrome and other congenital inherited diseases) were selected from the Department of Stomatology Affiliated to Guangxi Medical University from March 2014 to April 2017. Among them, 11 were males and 10 were females, aged 18-27 years (the first year of treatment). The average age was 20.3 years. All patients underwent orthodontic-orthognathic consultation before operation and formulated a combined orthodontic-orthognathic treatment plan. Preoperative orthodontics, model surgery, orthognathic surgery, postoperative orthodontics, and maintenance were performed. Each patient was taken X-ray skulls before treatment (before the beginning of orthodontic surgery), after treatment (after the end of orthodontic surgery). The cephalometric data were analyzed by SPSS 20.0 statistical software. The cephalometric values of craniomaxillofacial and maxillofacial soft and hard tissues were compared before and after treatment. 2. OHIP-14 and OQLQ questionnaires were conducted in each of the patients. At the same time, 40 normal subjects (Tc) with no significant difference in average age were randomly selected as control group. Each questionnaire of OHIP-14 contained 14 items and 7 fields. Objective Self-evaluation was divided into five grades (0-4 grades) and scored 0-4 points in turn. The higher the score, the worse the quality of life. The total score of the questionnaire ranged from 0-56 points, and the score of each field ranged from 0-8 points. Twenty-two items in each field, namely, oral function, facial aesthetics, self-perception of dentofacial deformities, and social interaction, were scored on a four-point scale, with 0-3 increasing in turn indicating a gradual increase in the impact of the behavior (i.e., the greater the value, the greater the impact). Data were recorded and scored using SPSS 20.0 statistical software. The scores of the scale were statistically described. The Wilcoxon rank test was used to analyze the mental state, physical function and social interaction of 21 patients with skeletal class III malocclusion before, during, after and after treatment. In order to provide a theoretical basis for the follow-up treatment, the change curves of the total scores of the questionnaires before, during, after and in the normal control group were drawn, and the causes and countermeasures were discussed. Cephalometric parameters such as SNB angle, ANB angle, Go-Pg, ANS-Me, ANSMe/NMe, U1-L1 angle, UL-EP, LL-EP, Z angle, N-Sn-Pg angle, with value (mm) were measured. SPSS 20.0 was used to calculate the correlation between the changes of these parameters and the quality of life (OQLQ and OHIP 14). Results: 1. After orthodontic-orthognathic treatment, the SNA angle of the patients with skeletal class III malocclusion (occlusion) became larger and SNB angle was higher. Angle became smaller (P 0.05), ANB angle and Wits value increased significantly (P 0.01), suggesting that the relative position between skull and jaw, maxilla and mandible was improved; Go-Pg decreased significantly (P 0.01), suggesting that the length of mandible became shorter, Go-Co did not change significantly, suggesting that mandibular ramus did not change significantly, Ptm-A, Ptm-s did not change significantly, suggesting that the length and position of maxilla did not change. SN-MP, ANS-Me/N-Me decreased significantly (P 0.05), ANS-Me decreased significantly (P 0.01), suggesting shorter facial height, more coordinated proportion of facial height; U1-SN angle, smaller U1-NA angle, larger L1-MP angle (P 0.05), significantly smaller U1-NA distance (P 0.01), suggesting that the upper anterior lingual inclination compensation, lower anterior lip inclination compensation; N-Sn-Pg, Z, UL-EP, LL-EP significantly reduced (P 0.01), suggesting that the disease occurred. In OHIP-14, T2 of mental disorders, mental disorders and social disorders were significantly lower than T0 and T1 (P 0.01), and T1 was greater than T0, T1 was greater than T2 (P 0.05), all of them had statistical significance, while T2 had no statistical significance compared with T3. In OQLQ, T2 was lower than T0 and T1, T1 was higher than T0 in all four fields, and the difference was statistically significant (P 0.01). T2 and Tc were not statistically significant. In OQLQ, oral function, facial esthetics, self-perception and social interaction were significantly improved, and there was no significant difference between OQLQ and the general population. Conclusion: 1. After systematic orthodontic-orthognathic treatment, the class III facial shape of adult patients with skeletal class III malocclusion has been significantly improved, and the treatment effect is definite. 2. The combined orthodontic-orthognathic treatment of skeletal class III malocclusion can improve the oral health-related quality of life of the patients to some extent, although after preoperative orthodontic decompensation, the patients suffer from the disease. The quality of life (QOL) of the patients had a temporary decrease during the preoperative period, but after the completion of all the treatments, the OQLQ survey found that the quality of life of the patients had been improved in all areas, and was significantly higher than that before treatment. There was no significant difference between the patients and the general population. Oral health and related quality of life in patients with malocclusion were significantly correlated with the improvement of quality of life.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R783.5
[Abstract]:Objective: 1. To analyze and compare the cephalometric soft and hard tissue changes in adult skeletal class III malocclusion before and after orthodontic-orthognathic treatment, and to evaluate the effect of orthodontic-orthognathic treatment on adult skeletal class III malocclusion. 2. To evaluate the oral health impact of the above patients at different stages before, during and after treatment. The changes of oral health-related quality of life (OHRQOL) before, during and after treatment were analyzed by OHIP-14 and OQLQ questionnaires. The effects of orthodontic-orthognathic treatment on the quality of life were discussed. 3. The relationship between the changes of cephalometric parameters and the quality of life was investigated. Methods: 1. Twenty-one patients with skeletal class III malocclusion (excluding cleft lip and palate, Down syndrome and other congenital inherited diseases) were selected from the Department of Stomatology Affiliated to Guangxi Medical University from March 2014 to April 2017. Among them, 11 were males and 10 were females, aged 18-27 years (the first year of treatment). The average age was 20.3 years. All patients underwent orthodontic-orthognathic consultation before operation and formulated a combined orthodontic-orthognathic treatment plan. Preoperative orthodontics, model surgery, orthognathic surgery, postoperative orthodontics, and maintenance were performed. Each patient was taken X-ray skulls before treatment (before the beginning of orthodontic surgery), after treatment (after the end of orthodontic surgery). The cephalometric data were analyzed by SPSS 20.0 statistical software. The cephalometric values of craniomaxillofacial and maxillofacial soft and hard tissues were compared before and after treatment. 2. OHIP-14 and OQLQ questionnaires were conducted in each of the patients. At the same time, 40 normal subjects (Tc) with no significant difference in average age were randomly selected as control group. Each questionnaire of OHIP-14 contained 14 items and 7 fields. Objective Self-evaluation was divided into five grades (0-4 grades) and scored 0-4 points in turn. The higher the score, the worse the quality of life. The total score of the questionnaire ranged from 0-56 points, and the score of each field ranged from 0-8 points. Twenty-two items in each field, namely, oral function, facial aesthetics, self-perception of dentofacial deformities, and social interaction, were scored on a four-point scale, with 0-3 increasing in turn indicating a gradual increase in the impact of the behavior (i.e., the greater the value, the greater the impact). Data were recorded and scored using SPSS 20.0 statistical software. The scores of the scale were statistically described. The Wilcoxon rank test was used to analyze the mental state, physical function and social interaction of 21 patients with skeletal class III malocclusion before, during, after and after treatment. In order to provide a theoretical basis for the follow-up treatment, the change curves of the total scores of the questionnaires before, during, after and in the normal control group were drawn, and the causes and countermeasures were discussed. Cephalometric parameters such as SNB angle, ANB angle, Go-Pg, ANS-Me, ANSMe/NMe, U1-L1 angle, UL-EP, LL-EP, Z angle, N-Sn-Pg angle, with value (mm) were measured. SPSS 20.0 was used to calculate the correlation between the changes of these parameters and the quality of life (OQLQ and OHIP 14). Results: 1. After orthodontic-orthognathic treatment, the SNA angle of the patients with skeletal class III malocclusion (occlusion) became larger and SNB angle was higher. Angle became smaller (P 0.05), ANB angle and Wits value increased significantly (P 0.01), suggesting that the relative position between skull and jaw, maxilla and mandible was improved; Go-Pg decreased significantly (P 0.01), suggesting that the length of mandible became shorter, Go-Co did not change significantly, suggesting that mandibular ramus did not change significantly, Ptm-A, Ptm-s did not change significantly, suggesting that the length and position of maxilla did not change. SN-MP, ANS-Me/N-Me decreased significantly (P 0.05), ANS-Me decreased significantly (P 0.01), suggesting shorter facial height, more coordinated proportion of facial height; U1-SN angle, smaller U1-NA angle, larger L1-MP angle (P 0.05), significantly smaller U1-NA distance (P 0.01), suggesting that the upper anterior lingual inclination compensation, lower anterior lip inclination compensation; N-Sn-Pg, Z, UL-EP, LL-EP significantly reduced (P 0.01), suggesting that the disease occurred. In OHIP-14, T2 of mental disorders, mental disorders and social disorders were significantly lower than T0 and T1 (P 0.01), and T1 was greater than T0, T1 was greater than T2 (P 0.05), all of them had statistical significance, while T2 had no statistical significance compared with T3. In OQLQ, T2 was lower than T0 and T1, T1 was higher than T0 in all four fields, and the difference was statistically significant (P 0.01). T2 and Tc were not statistically significant. In OQLQ, oral function, facial esthetics, self-perception and social interaction were significantly improved, and there was no significant difference between OQLQ and the general population. Conclusion: 1. After systematic orthodontic-orthognathic treatment, the class III facial shape of adult patients with skeletal class III malocclusion has been significantly improved, and the treatment effect is definite. 2. The combined orthodontic-orthognathic treatment of skeletal class III malocclusion can improve the oral health-related quality of life of the patients to some extent, although after preoperative orthodontic decompensation, the patients suffer from the disease. The quality of life (QOL) of the patients had a temporary decrease during the preoperative period, but after the completion of all the treatments, the OQLQ survey found that the quality of life of the patients had been improved in all areas, and was significantly higher than that before treatment. There was no significant difference between the patients and the general population. Oral health and related quality of life in patients with malocclusion were significantly correlated with the improvement of quality of life.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R783.5
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