腭中缝骨皮质切开辅助快速扩弓矫治15~25岁上颌横向宽度不足患者临床研究

doi:10.3785/j.issn.1008-9292.2017.04.13

浙江大学学报（医学版）

2017, Vol. 46

Issue (2): 198-205 DOI: 10.3785/j.issn.1008-9292.2017.04.13

原著

腭中缝骨皮质切开辅助快速扩弓矫治15~25岁上颌横向宽度不足患者临床研究

翁露茜(

),宋晓佳,李娟,刘彭若峰,林军*(

)

浙江大学医学院附属第一医院口腔科, 浙江杭州 310000

Midpalatal cortex osteotomy assisted rapid maxillary expansion for correction of maxillary transverse deficiency in young adults

WENG Luxi(

),SONG Xiaojia,LI Juan,LIU Pengruofeng,LIN Jun*(

)

Department of Stomatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310000, China

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摘要：

目的：评价腭中缝骨皮质切开辅助快速扩弓法对上颌横向宽度不足的年轻成人治疗效果。方法：选取上颌横向发育横向宽度不足的年轻成人患者14例，采用腭中缝骨皮质切开辅助快速扩弓法，治疗前和扩弓3个月后行头颅侧位片及锥形束CT拍摄、测量，比较上颌骨基骨宽度变化、上颌牙弓宽度变化、上颌牙转矩变化等。结果：14例患者与治疗前相比均获得了明显的横向宽度扩大效果，表现为上颌基骨宽度和牙弓宽度的增加，第一磨牙间牙弓宽度治疗前（40.54±5.26）mm，治疗后（46.83±5.83）mm，根尖平面基骨宽度由（64.86±4.16）mm增加至（67.60±4.66）mm；而第一前磨牙间牙弓宽度治疗前（31.92±2.55）mm，治疗后（38.65±3.14）mm，根尖平面基骨宽度则由（43.33±3.70）mm增加至（45.78±4.57）mm，差异均有统计学意义（均P<0.05）；患者上颌支抗牙转矩增大（P<0.05）。结论：腭中缝骨皮质切开辅助快速扩弓能获得有效的扩弓效果，是年轻成人上颌横向宽度不足的微创疗法。

关键词： 错/治疗; 正畸学，矫正/方法; 上颌骨/外科学; 上颌骨/畸形; 锥束计算机体层摄影术; 矫正装置; 治疗结果

Abstract:

Objective: To evaluate the application of midpalatal cortex osteotomy assisted rapid maxillary expansion for correction of maxillary transverse deficiency in young adults. Methods: Fourteen young adult patients with maxillary transverse deficiency were treated with midpalatal cortex osteotomy assisted rapid maxillary expansion. Lateral cephalogram and cone beam CT (CBCT) were taken before and 3 months after treatment. The width of basal bone, arch of maxilla and the torque of anchorage teeth were compared before and after treatment. Results: The width of dental arch of maxilla was increased from 40.54±5.26 mm before treatment to 46.83±5.83 mm after treatment (P<0.05) and the width of basal bone was increased from 64.86±4.16 mm to 67.60±4.66 mm (P<0.05) at the plane of the maxillary first molars. Accordingly, the width of dental arch of maxilla was increased from 31.92±2.55 mm to 38.65±3.14 mm (P<0.05) and the width of basal bone was increased from 43.33±3.70 mm to 45.78±4.57 mm (P<0.05) at the plane of first premolar. And the torque of maxillary anchorage teeth were increased (P<0.05). Conclusion: Midpalatal cortex osteotomy assisted rapid maxillary expansion is an effective micro-invasive method in expansion of basal bone and arch of maxilla for young adult patients with maxillary transverse deficiency.

Key words: Malocclusion/therapy Orthodontics, corrective/methods Maxilla/surgery Maxilla/abnormalities Cone-beam computed tomography Orthotic devices Treatment outcome

收稿日期: 2017-01-21 出版日期: 2017-10-31

基金资助: 国家自然科学基金（81271955）

通讯作者: 林军 E-mail: wengluxi1989@163.com;junlin2@126.com

作者简介: 翁露茜(1989—)，女，硕士，住院医师，主要从事口腔正畸临床工作；E-mail：wengluxi1989@163.com；http://orcid.org/0000-0002-9915-8267

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引用本文:

翁露茜,宋晓佳,李娟,刘彭若峰,林军. 腭中缝骨皮质切开辅助快速扩弓矫治15~25岁上颌横向宽度不足患者临床研究[J]. 浙江大学学报（医学版）, 2017, 46(2): 198-205.

WENG Luxi,SONG Xiaojia,LI Juan,LIU Pengruofeng,LIN Jun. Midpalatal cortex osteotomy assisted rapid maxillary expansion for correction of maxillary transverse deficiency in young adults. J Zhejiang Univ (Med Sci), 2017, 46(2): 198-205.

链接本文:

http://www.zjujournals.com/xueshu/med/CN/10.3785/j.issn.1008-9292.2017.04.13 或 http://www.zjujournals.com/xueshu/med/CN/Y2017/V46/I2/198

图 1 Hyrax快速扩弓器实物图

图 2 腭中缝骨皮质示意图

图 3 CBCT扫描图像坐标轴方向调节示意图

图 4 CBCT图像线性距离和角度测量示意图

图 5 头颅侧位片测量示意图

表 1 腭中缝骨皮质切开联合快速扩弓治疗后上颌骨基骨宽度的变化

表 2 腭中缝骨皮质切开联合快速扩弓治疗后上颌牙弓宽度的变化

表 3 腭中缝骨皮质切开联合快速扩弓治疗后上颌支抗牙转矩的变化

表 4 腭中缝骨皮质切开联合快速扩弓治疗前后头影侧位测量指标的变化

图 6 典型病例治疗前面像、像及X线片、CBCT截图

图 7 典型病例扩弓后面像、像及X线片、锥形束CT截图

图 8 典型病例扩弓后上颌骨CBCT重建图像

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