3D数字化技术指导下应用Le Fort Ⅰ和π型截骨术治疗上颌不规则牙弓畸形的临床疗效

Application of Le Fort Ⅰ combined with π osteotomy in the treatment of irregular arch of maxilla under 3D digital technology

摘要:

目的：评价3D数字化技术指导下的Le Fort Ⅰ和π型截骨术联合应用于矫治严重牙颌面畸形的临床疗效。方法：选取7例先天性发育性上颌骨牙弓不规则畸形成年患者。此项研究选用了12个测量指标（SNA、SNB、ANB、A-CP、B-CP、PG-CP、OP-FH、MP-FH、N-ANS、ANS-ME、NA-PA、SNPg）进行3D头模测量分析。将术前1周（T0）与术后3个月（T2）的3D头模测量数据（骨组织及软组织）进行对比分析。将所得的所有数据导入SPSS 21.0软件进行对比分析；术前1周（T0）、术后3个月（T2）间采取配对t检验；术前模拟（T1）、术后3个月（T2）间采用等效性检验。结果：本组7例患者，T0与T2测量结果显示，SNA、SNB、ANB、A-CP、B-CP、PG-CP、OP-FH、MP-FH、N-ANS、ANS-ME、NA-PA、SNPg、G-Sn-Pos、Cm-Sn-UL、A’UL-LLSi、LL-Si-Pos、UL-E plane、LL-E plane、Si-LLPos、H角、G-Sn、G-Ls、G-LL、G-Si、G-Pos的差异均有统计学意义（P<0.01）。T1与T2所有测量指标（SNA、SNB、ANB、A-CP、B-CP、PG-CP、OP-FH、MP-FH、N-ANS、ANS-ME、NA-PA、SNPg、上颌骨水平向位移误差、上颌骨垂直向位移误差、上颌骨前后向位移误差）双侧90%可信区间均在（-Δ，Δ）范围内，说明在3D数字化技术指导下，术后面部外形及口颌功能均达到术前设计的预测效果。结论：3D数字化技术指导下运用Le Fort Ⅰ型截骨术和π型截骨术联合矫正上颌骨复杂畸形是一种行之有效的治疗方法。

Abstract:

Objective：To explore the clinical efficacy of Le Fort I and π osteotomy guided by 3D digital technology in the correction of severe dento-maxillofacial deformities（DENTO）. Methods：seven patients displayed developmental DENTO with irregular maxillary arch were selected. In this study，12 measurement indicators（SNA，SNB，ANB，A-CP，B-CP，PG-CP，OP-FH，MP-FH，N-ANS，ANS-ME，NA-PA，SNPg） were selected to perform 3D head model measurement analysis. The 3D head model measurement data was compared between preoperative 1-week（T0） and postop－erative 3months（T2）. In addition，Lateral cephalograms（T0 and T2） were taken with the patient oriented to the Frankfort Hori－zontal Plane for soft tissue measurements. All data were presented as mean ± SD. Paired t test was used to detect the differences between（T0） and （T2） by SPSS 21.0 software. Equivalence test was used in preoperative simulation（T1） and three months after operation（T2） by SPSS 21.0 software. Results：All patients in this group，T0 and T2 measurements showed that the difference in SNA angle，SNB angle and other major soft and hard tissues were statistically significant（P<0.01）. All measurements of T1 and T2 had no statistical significance. Because both sides of the 90% confidence interval are in the range of （-Δ，Δ）. indicating that under the guidance of 3D digital technology. The pre-surgically designed effects in facial appearance and oral function were obtained after the surgery. Conclusion：there is an effective treatment to correct complex deformities of the maxilla by using the Le Fort I osteotomy combined with π osteotomy under the guidance of 3D digital technology.