国际口腔医学杂志

国际口腔医学杂志 ›› 2023, Vol. 50 ›› Issue (3): 293-301.doi: 10.7518/gjkq.2023028

• 论著 • 上一篇    下一篇

上颌Le Fort Ⅰ前徙术与前份根尖下截骨后退术术后软组织变化的比较研究

李沛然(),毕瑞野,王旻,王瑞宇,刘尧,姜楠,曹品银,祝颂松()   

  1. 口腔疾病研究国家重点实验室 国家口腔疾病临床医学研究中心四川大学华西口腔医院正颌及关节外科 成都 610041
  • 收稿日期:2022-08-07 修回日期:2023-01-06 出版日期:2023-05-01 发布日期:2023-05-16
  • 通讯作者: 祝颂松
  • 作者简介:李沛然，博士，Email：peiran_li@foxmail.com
  • 基金资助:
    国家自然科学基金(81801003);四川大学华西口腔医院新技术项目(LCYJ2020-YF-1)

Soft tissue changes of the maxillary region in patients after anterior maxillary osteotomy setback and Le Fort Ⅰ osteotomy advancement

Li Peiran(),Bi Ruiye,Wang Min,Wang Ruiyu,Liu Yao,Jiang Nan,Cao Pinyin,Zhu Songsong.()   

  1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Orthognathic and Temporomandibular Joint Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2022-08-07 Revised:2023-01-06 Online:2023-05-01 Published:2023-05-16
  • Contact: Songsong. Zhu
  • Supported by:
    National Natural Science Foundation of China(81801003);New Technology Project of West China Hospital of Stomatology, Sichuan University(LCYJ2020-YF-1)

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摘要：

目的 测量不同上颌骨正颌术式前后鼻唇区域软组织变化，分析可能导致变化的因素。 方法 2017—2021年于四川大学华西口腔医院正颌及关节外科住院行正颌手术的患者37例，其中因上颌后缩行上颌骨Le Fort Ⅰ型骨切开前徙术（LFIA）的患者18例，因上颌前突行上颌骨前份根尖下截骨后退术（AMOS）的患者19例。收集其术前即刻和术后6~12个月的螺旋CT影像，通过Mimics和3-Matic软件进行三维重建和匹配，测量软硬组织标志点变化。使用GraphPad Prism软件进行统计学分析，显著性水平α=0.05。 结果 2种术式术后最主要的软组织变化均发生在上唇区域且改变方向与骨组织移动方向相同。在前后向软组织改变上，LFIA组软硬组织改变的比例为0.628，而AMOS组为0.465。颊部和鼻尖软组织在2种术式后均发生了前移，其中AMDS组中颊部软组织前移的量与软组织厚度的改变具有显著正相关性。在垂直向软组织变化上，LFIA组鼻尖点发生上抬且其距离与颌骨前徙距离具有显著正相关性，AMOS组上唇缘点发生下降且其距离与颌骨后退距离具有显著正相关性。在水平向软组织变化上，鼻翼宽度在行2种术式后均出现增宽，但在AMOS组中鼻翼宽度增宽量与后退距离呈显著负相关。 结论 AMOS和LFIA术后的鼻唇区域软组织改变与颌骨移动量及方向具有显著相关性。上唇前后向改变与颌骨移动距离具有显著正相关性，鼻翼宽度改变与上颌骨后退距离具有相关性。以上相关性的发现可能帮助临床医生更准确地判断鼻唇区域的软硬组织改变。

关键词: 软组织, 牙颌面畸形, 上颌骨Le Fort Ⅰ型骨切开术, 上颌骨前份骨切开术, 正颌外科

Abstract:

Objective This work aimed to analyze nasolabial soft tissue changes in patients with maxillary advancement and setback via different maxillary orthognathic procedures. Methods A retrospective, observational, and analytical study was carried out for a period of 4 years involving 37 patients. A total of 18 patients diagnosed with maxillary retrusion were treated by Le Fort Ⅰ osteotomy advancement (LFIA), and 19 patients diagnosed with maxillary protrusion were treated by anterior maxillary osteotomy setback (AMOS). Similarity and distinction of soft tissue changes in these two groups (AMOS and LFIA) were investigated and compared. Spiral computed tomography was conducted immediately before surgery and 6-12 months after surgery. The hard and soft tissue landmarks were measured in a 3D coordinate system after CT reconstruction. The differences between pre- and postoperative images were recorded as surgical changes. The appropriate statistical test was carried using GraphPad Prism, and the level of significance was α=0.05. Results Both LFIA and AMOS brought greater soft tissue changes in the lip region compared with those in the nose and cheek regions. In the anteroposterior direction, the hard/soft tissue change ratio after LFIA (0.628) was higher than that after AMOS (0.465). Cheek and nose tips protruded after both surgical processes. Ck advancement was significantly correlated with soft tissue thickness change in the AMOS group. In the vertical direction, Prn presented uplift movement that was correlated with the maxilla advancement distance in the LFIA group, whereas Ls showed downward movement that was correlated with the maxilla setback distance in the AMOS group. Postoperative alar width increased in both groups. Interestingly, the degree of alar widening was negatively correlated with the maxilla setback distance in the AMOS group. Conclusion Postoperative nasolabial soft tissue changes in both LFIA and AMOS patients could be predicted through the direction and amount of maxilla movement to a large extent, especially in the lip region. Further investigations to illustrate the precise correlations between soft tissue changes and maxillary movement in the future could be beneficial for the prediction of postoperative appearance.

Key words: soft tissue, dentofacial deformity, Le Fort Ⅰ osteotomy, anterior maxillary osteotomy, orthognathic surgery

中图分类号: 

  • R 782.2+3

表 1

纳入病例分组信息"

测量项目总体AMOS组LFIA组
病例数/例371918
性别/例男1138
女261610
年龄/岁24.0±4.826.7±4.821.2±2.6
术式/例单上颌手术532
联合下颌升支矢状劈开术16016
联合下颌前份根尖下截骨术16160
联合颏成形术15123

图 1

术前、术后影像三维重建及配准A：以眶耳平面定义X-Y平面（以红线显示）；选择垂直于FH平面并通过双侧耳点的平面作为X-Z平面（以蓝线显示）；垂直于上述2个平面并穿过鼻根点的平面被选择为Y-Z平面（以绿线显示）；B：通过颅底配准进行术前和术后重建图像的配准；C：直方图呈现叠加区域的表面对比分析结果。"

表 2

软硬组织标志点"

测量标志缩写说明
鼻根点Na位于面中线上的鼻额缝投影点，用于表示鼻根位置
鼻尖点Prn鼻尖最凸点
鼻下点Sn位于面中线上的鼻小柱与上唇交界点
上唇缘点Ls位于面中线上的上唇唇红上缘点
鼻翼点Al正面观双侧鼻翼轮廓最凸点
鼻基底点Sbal双侧鼻翼向下至与上唇皮肤移行处的标志点
颊点Ck口角-外眦连线与过双侧鼻翼点的直线的交点位于面颊软组织的投影点
口裂点Ch双侧口裂缘点
鼻翼宽度Al-Al双侧鼻翼点间连线的距离
鼻基底宽度Sbal-Sbal双侧鼻基底点间连线的距离
上唇宽度Ch-Ch双侧口裂点间连线的距离
上齿槽缘点Prs位于面中线上的上颌牙槽突最凸点
上齿槽座点A位于面中线上的，由前鼻棘点至上齿槽缘点之间上颌骨体最凹处的标志点
尖牙牙槽缘点Cn双侧上颌尖牙牙槽骨的颈缘最凹点

图 2

软硬组织标志点示意图"

表 3

前后向软组织的改变"

测量项目LFIA组AMOS组
平均值标准差平均值标准差
Na-0.030.400.060.50
Prn1.390.400.420.36
Sn2.570.75-0.190.63
Ls3.491.13-2.620.91
Ck_R1.830.651.310.74
Ck_L1.830.771.270.67

表 4

垂直向软组织的改变"

测量项目LFIA组AMOS组
平均值标准差平均值标准差
Na-0.271.04-0.311.09
Prn1.631.310.001.00
Sn1.030.80-0.270.70
Ls0.011.92-2.131.75

表 5

软组织宽度的改变"

测量项目LFIA组AMOS组
平均值标准差平均值标准差
Al-Al2.171.281.650.81
Sbal-Sbal1.791.45-0.831.06
Ch-Ch-0.572.68-1.852.57

表 6

软组织厚度的改变 (mm)"

测量项目LFIA组AMOS组
平均值标准差平均值标准差
Ls-0.041.491.630.91
Sn-0.432.123.171.21
Ck_R0.920.921.130.73
Ck_L0.901.150.840.82
Al_R2.341.221.791.02
Al_L2.740.811.820.83

图 3

软组织前后向改变与上颌骨移动的相关性A：上颌后缩患者CT三维重建，红点为Prs，蓝点为Ls；B：LFIA组Prs点水平前移距离与Ls点水平前移距离的相关性，n=18，r=0.628，P=0.005；C：上颌前突患者CT三维重建，红点为Prs，蓝点为Ls；D：AMOS组Prs点水平后退距离与Ls点水平后退距离的相关性，n=19，r=0.465，P=0.045。"

图 4

软组织垂直向改变与上颌骨移动的相关性A：上颌后缩患者CT三维重建，红点为Prs，蓝点为Prn；B：LFIA组Prs点水平前移距离与Prn点垂直上抬距离的相关性，n=18，r=0.628，P=0.005；C：上颌前突患者CT三维重建，红点为Prs，蓝点为Ls；D：AMOS组Prs点水平后退距离与Ls点垂直下降距离的相关性，n=19，r=0.724，P=0.001。"

图 5

AMOS组鼻翼宽度改变与颌骨后退量的相关性AMOS组Prs水平后退距离与鼻翼宽度变化的相关性，n=18，r=0.525，P=0.021。"

图 6

AMOS组颊部软组织前移与厚度改变的相关性AMOS组颊部软组织厚度变化与双侧Ck点前移距离的相关性，n=19，r=0.512，P=0.001。"

《口腔正畸隐适美隐形矫治技术》出版发行"

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