中国实用口腔科杂志

中国实用口腔科杂志 ›› 2022, Vol. 15 ›› Issue (5): 551-557.DOI: 10.19538/j.kq.2022.05.008

• 论著 • 上一篇    下一篇

前牵引治疗不同时期上颌发育不足患者疗效评价

温    馨，杨臣杰，钱玉芬   

  1. 上海交通大学医学院附属第九人民医院口腔正畸科，上海交通大学口腔医学院，国家口腔医学中心，国家口腔疾病临床医学研究中心，上海市口腔医学重点实验室，上海  200011
  • 出版日期:2022-09-30 发布日期:2022-10-14
  • 基金资助:
    国家自然科学基金（81771104）

  • Online:2022-09-30 Published:2022-10-14

摘要： 目的    应用头颅定位侧位片分析上颌发育不足患者在不同生长发育阶段进行前牵引治疗的临床效果。方法    选取2018年1月至2020年12月于上海交通大学附属第九人民医院口腔正畸科完成前牵引治疗的上颌发育不足患者36例，根据头颅定位侧位片颈椎骨龄分期（cervical vertebral maturation method，CVM），分为生长发育高峰前期组（CVM Ⅰ~Ⅱ期）7例、生长发育高峰期组（CVM Ⅲ~Ⅳ期）17例以及生长发育后期组（CVM Ⅴ~Ⅵ期）12例。各组患者治疗前后分别拍摄头颅定位侧位片，对其软硬组织相关指标进行测量分析。结果   骨性矢状向指标上牙槽座角（SNA角）、上颌突距（A-Np）、前鼻嵴点至垂直参考轴的距离（VRL-ANS）、上牙槽座点至垂直参考轴的距离（VRL-A）、有效上颌长度（Co-A）、上下牙槽座点交角（ANB角）、Wits值在3组治疗前后的差异均有统计学意义（P < 0.05），其中治疗后生长发育高峰前期组A-Np改变值［（2.61 ± 1.11）mm］与生长发育后期组［（1.00 ± 0.82）mm］相比，差异有统计学意义（P = 0.017）；骨性垂直向指标腭平面倾斜角（SN-PP角）在生长发育后期组治疗前后有明显改变［（-0.90 ± 1.36）°］，差异有统计学意义（P < 0.05），其余2组治疗前后SN-PP角差异均无统计学意义（P > 0.05）。牙性指标上中切牙倾斜度（U1-PP角、U1-SN角）在3组治疗前后比较，差异均有统计学意义（P < 0.05）；而其改变值组间差异分析，均未见统计学意义（P > 0.05）。软组织指标上唇点到VRL的距离（VRL-Ls）在3组治疗前后的差异均有统计学意义（P < 0.05）；治疗后生长发育高峰前期组软组织A点到VRL的距离（VRL-Ss）改变值［（3.25 ± 1.48）mm］与生长发育后期组［（0.91 ± 2.16）mm］相比，差异有统计学意义（P = 0.044）。结论    上颌前牵引治疗在生长发育高峰前期及生长发育高峰期可产生较为良好的上颌骨矢状向骨性效应；而在生长发育后期，上颌骨矢状向改善较其他两期差，但垂直向腭平面逆时针旋转最显著；上前牙唇倾效应在3个时期均较为显著。

关键词: 骨性Ⅲ类错牙合, 前牵引, 上颌发育不足, 颈椎骨龄分期

Abstract: Objective    To evaluate the effects of maxillary protraction in patients with maxillary hypoplasia in different growth periods based on lateral cephalograms. Methods    Thirty-six patients with maxillary hypoplasia treated with protraction in the Department of Orthodontics of Shanghai Ninth People′s Hospital from Jan. 2018 to Dec. 2020 were included in this study. Based on the cephalometric analysis of cervical vertebral maturation method（CVM），the patients were divided into prepubertal group（CVMⅠ~Ⅱ stage，7 cases），pubertal peak group（CVM Ⅲ ~ Ⅳ stage，17 cases）and late maturation group（CVMⅤ~Ⅵ stage，12 cases）. Lateral cephalometric films were obtained at the beginning and end of the treatment in all groups and the related indexes of soft and hard tissues were measured and analyzed. Results    For the sagittal skeletal indexes，including SNA，A-Np，VRL-ANS，VRL-A，Co-A，ANB and Wits，statistically significant differences were found before and after intervention in all 3 groups（P < 0.05）. The changes of A-Np in prepubertal group and in late maturation group were（2.61 ± 1.11）mm and（1.00 ± 0.82）mm respectively，and the difference between these two groups were statistically significant（P = 0.017）. The vertical skeletal index，SN-PP angle，changed most significantly in late maturation group ［（-0.90 ± 1.36）°］ after treatment （P < 0.05）. SN-PP had no statistical difference after treatment in the other two groups （P > 0.05）. For the dental indexes，U1-PP angle and U1-SN angle changed significantly in all 3 groups （P < 0.05）whereas differences in the changes among these groups were not statistically significant（P > 0.05）. The soft tissue index，VRL-Ls，changed significantly in all 3 groups （P < 0.05）. Furthermore，the changes in VRL-Ss in prepubertal group and in late maturation group were（3.25 ± 1.48）mm and（0.91 ± 2.16）mm respectively，and the difference between these two groups were statistically significant（P = 0.044）. Conclusion    At the prepubertal and pubertal peak stage of growth，maxillary protraction can produce a preferable forward movement of maxilla，while the maxillary bone effect is inferior in late maturation stage. Meanwhile，the most significant counterclockwise rotation of the palatal plane occurs in this stage. The proclination of the maxillary incisors is significant in all stages during protraction.

Key words: skeletal class Ⅲ malocclusion, protraction, maxillary hypoplasia, cervical vertebral maturation method