【摘要】：目的:觀察單側(cè)完全性唇腭裂術(shù)后(Unilateral cleft lip and palate,UCLP)患者上腭裂隙內(nèi)骨再生情況,探究其對牙弓形態(tài)發(fā)育的影響。資料與方法:隨機選取2015年6月~2017年1月在蚌埠醫(yī)學(xué)院第一附屬醫(yī)院整形外科就診的單側(cè)完全性唇腭裂術(shù)后患者共計35例作為觀察組,年齡9歲~18歲,平均年齡12.34±2.85歲,其中男性22例,女性13例;隨機選取20例正常牙鄈作為對照組,男性10例,女性10例,年齡9歲~18歲,平均年齡12±2.69歲,所有研究對象均行CT高分辨平掃。在觀察組中,經(jīng)冠狀面骨窗圖像查看上腭裂隙內(nèi)是否有再生骨橋形成,根據(jù)是否有再生骨橋的形成,將所有研究對象分為兩組:有再生骨橋形成組,無再生骨橋形成組;測量有再生骨橋形成組內(nèi)再生骨的長度及分布情況;分別測量兩組間牙弓前段、中段、后段寬度,對測量結(jié)果行統(tǒng)計學(xué)分析比較兩組間是否有差異;測量對照組牙弓前段、中段、后段寬度,再分別將有再生骨橋形成組與正常對照組比較,無再生骨橋形成組與正常對照組比較。結(jié)果:(1)觀察組35例單側(cè)完全性腭裂患者中,共計25例上頜骨腭突有不同程度的骨再生并相互連接形成骨橋,再生骨橋陽性率為71.4%,其中男性16例,女性9例,再生骨橋長度介于5mm~21mm,平均長度11.59±4.74mm,寬度介于6mm~14mm,再生骨的厚度、密度不均一;再生骨主要分布于尖牙至第一磨牙段,冠狀位骨窗示健側(cè)各牙位再生骨橋陽性率分別為:中切牙(0例),側(cè)切牙(0例),尖牙(0例),第一前磨牙(11例、44%),第二前磨牙(23例、92%),第一磨牙(21例、84%),第二磨牙(5例、20%),所有患者共計60個牙位陽性,不同牙位所占比例分別為:第一前磨牙18.3%,第二前磨牙38.3%,第一磨牙35%,第二磨牙8.3%;余下10例上腭裂隙內(nèi)可見不同程度的再生骨質(zhì)形成,但未連接形成骨橋。(2)切牙孔至前方牙槽骨裂隙段無再生骨,腭骨橫板處未見明顯再生骨。(3)觀察組中有再生骨橋形成組牙弓前段寬度平均值為30.45±1.63mm,牙弓中段寬度平均值為40.96±1.92mm,牙弓后段寬度平均值50.84±1.81mm,無再生骨橋形成組牙弓前段寬度平均值為30.55±1.89mm,牙弓中段寬度平均值為37.76±1.51mm,牙弓后段寬度平均值50.52±1.94mm;對照組牙弓前段寬度平均值為37.27±1.66mm,牙弓中段寬度平均值為44.37±1.57mm,牙弓后段寬度平均值54.26±1.57mm;觀察組中有再生骨橋形成組牙弓中段寬度大于無再生骨橋形成組(P0.05),牙弓前段、后段寬度未見明顯差異(P0.05),見表1;有再生骨橋形成組與正常對照組相比,牙弓前段寬度、中段寬度、后段寬度均小于對照組(P0.05),見表2;無再生骨橋形成組與正常對照組相比,牙弓前段、中段寬度、后段寬度均小于對照組(P0.05),見表3。結(jié)論:(1)高分辨螺旋CT可以用于上頜骨三維重建并進行精確的觀察、測量,能較直觀的反映上頜骨三維形態(tài)。(2)部分單側(cè)完全性腭裂患者術(shù)后上頜骨雙側(cè)腭突有不同程度的再生骨相互連接形成骨橋封閉裂隙,主要分布于第一前磨牙至第二磨牙間,尤以第二前磨牙近點至第一磨牙遠點之間顯著,可能與局部軟組織張力大、瘢痕攣縮牽拉有關(guān)。(3)觀察組牙弓各段寬度均明顯小于對照組;觀察組內(nèi)有骨橋再生組牙弓中段寬度值較無骨橋再生組大,牙弓前段及牙弓后段未見顯著差異,這與骨橋分布位置相對應(yīng),再生骨橋有利于牙弓形態(tài)更好的發(fā)育。(4)單側(cè)完全性唇腭裂患者術(shù)后牙槽嵴裂、牙槽嵴至切牙孔段、腭骨橫突段裂隙仍然存在,未見明顯再生骨,可能與局部解剖結(jié)構(gòu)有關(guān),具體原因有待于進一步探討。(5)再生骨橋形成有利于牙弓及上頜骨形態(tài)的發(fā)育,在以后的研究中可以進一步探究如何誘導(dǎo)腭突的再生,指導(dǎo)并應(yīng)用于臨床,必將改善患者頜面部的發(fā)育狀況。
[Abstract]:Objective: To observe the bone regeneration in the upper palate cleft of patients with unilateral complete cleft lip and palate (UCLP) and to explore its effect on dental arch morphology and development. A total of 35 cases were selected as the observation group, aged 9-18 years, with an average age of 12.34 (+ 2.85), including 22 males and 13 females; 20 cases of normal dentin were randomly selected as the control group, 10 males and 10 females, aged 9-18 years, with an average age of 12 (+ 2.69). All subjects underwent high-resolution plain CT scanning. In the observation group, the images of coronal bone window were examined. All subjects were divided into two groups according to the formation of regenerated bone bridge: regenerated bone bridge formation group and non-regenerated bone bridge formation group; the length and distribution of regenerated bone in regenerated bone bridge formation group were measured; the width of anterior, middle and posterior segments of dental arch between the two groups were measured and compared. Results Statistical analysis was performed to compare the differences between the two groups. The width of anterior, middle and posterior segments of the dental arch in the control group was measured and compared with that in the normal control group. The positive rate of regenerated bone bridge was 71.4%. There were 16 males and 9 females. The length of regenerated bone bridge ranged from 5 mm to 21 mm, with an average length of 11.59 (+ 4.74 mm) and a width of 6 mm to 14 mm. The positive rates of regenerated bone bridge were central incisor (0 cases), lateral incisor (0 cases), canine (0 cases), first premolar (11 cases, 44%), second premolar (23 cases, 92%), first molar (21 cases, 84%) and second molar (5 cases, 20%) respectively. There were 60 positive teeth in all patients. The proportion of different tooth positions was 18.3% in the first premolar, 38.3% in the second premolar. There were 35% of the first molars and 8.3% of the second molars, and 10 cases of upper palate cleft showed different degrees of regenerated bone formation, but no bone bridge was formed. (2) There was no regenerated bone from incisor to anterior alveolar bone cleft, and no obvious regenerated bone was found at palatal bone transverse plate. (3) The average width of anterior segment of dental arch in regenerated bone bridge formation group was 30.45 [1.63 mm] and the average width of anterior segment of dental arch was 30.45 The average width of the middle segment of the arch was 40.96 (+ 1.92 mm), the average width of the posterior segment of the arch was 50.84 (+ 1.81 mm), the average width of the anterior segment of the arch was 30.55 (+ 1.89 mm), the average width of the middle segment of the arch was 37.76 (+ 1.51 mm), the average width of the posterior segment of the arch was 50.52 (+ 1.94 mm) and the average width of the anterior segment of the dental arch was 37.27 (+ 1.66 mm) and that of the middle segment of the In the observation group, the width of the middle segment of the dental arch in the regenerated bone bridge formation group was larger than that in the non-regenerated bone bridge formation group (P 0.05), and there was no significant difference in the width of the anterior segment and the posterior segment of the dental arch (P 0.05), as shown in Table 1. Compared with the normal control group, the width of the anterior segment of the dental arch in the regenerated bone bridge formation group was larger than that in the non-regenerated bone bridge formation group (P 0.05). The width of the anterior, middle and posterior segments of the dental arch were smaller than those of the control group (P 0.05), and the width of the posterior segments was smaller than that of the control group (P 0.05). 3-D morphology. (2) After partial unilateral complete cleft palate surgery, bilateral palatal processes of maxilla had different degrees of regenerated bone interconnected to form a bone bridge to seal the cleft, mainly distributed between the first premolar and the second molar, especially between the proximal point of the second premolar and the distal point of the first molar, which may be associated with local soft tissue tension, scar contracture and distraction. (3) The width of each segment of the dental arch in the observation group was significantly smaller than that in the control group; the width of the middle segment of the dental arch in the group with bone bridge regeneration was larger than that in the group without bone bridge regeneration, and there was no significant difference between the anterior segment and the posterior segment of the dental arch, which corresponded to the distribution of the bone bridge. The regenerated bone bridge was conducive to the better development of the dental arch morphology. (4) Unilateral complete cleft lip and PAL Postoperative alveolar ridge cleft, alveolar ridge to incisor foramen, palatal transverse process cleft still exist, no obvious regenerated bone, may be related to local anatomical structure, the specific reasons need to be further explored. (5) Regenerated bone bridge formation is conducive to the development of dental arch and maxillary bone morphology, in future research can be further explored how to induce the palate. Sudden regeneration, guided and applied to clinical practice, will improve the development of the maxillofacial region.
【學(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R782

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