上颌前方牵引对替牙期唇腭裂患者软硬组织的影响

doi:10.13591/j.cnki.kqyx.2025.03.002

摘要/Abstract

摘要：

目的探讨替牙期单侧非综合征唇腭裂男性患者经上颌前方牵引治疗前后其软硬组织的三维变化。方法选择于南京医科大学附属口腔医院正畸科就诊并经上颌前方牵引治疗替牙期单侧非综合征唇腭裂男性患者20例(平均年龄(10.6±1.23)岁),拍摄治疗前后的锥形束CT,应用Dolphin 3D 11.95软件进行三维测量分析,采用SPSS 25.0软件包进行统计学分析,采用自身对照配对t检验对单侧唇腭裂男性患者治疗前后的软硬组织变化进行比较,其中ANS点前移量、A点前移量及B点后移量变化采用单样本t检验。结果矢状向骨性变化:∠SNA(P<0.01)、∠ANB(P<0.01)、Y轴角(P<0.05)、ANS点前移量(P<0.01)、A点前移量(P<0.01)和B点后移量(P<0.01)均显著增大,而∠SNB(P<0.05)则显著减小;垂直向骨性变化:∠MP-FH(P<0.01)、∠MP-SN(P<0.05)和ANS-Me线距(P<0.05)显著增加,而∠SN-PP(P<0.01)则显著减小;牙性变化:∠U1-NA(P<0.01)、U1-NA线距(P<0.01)、∠U1-SN(P<0.01)、前牙覆盖(P<0.01)和Wits值(P<0.01)均显著增加;而∠L1-NB(P<0.01)、L1-NB线距(P<0.01)和∠L1-MP(P<0.01)均显著减小;软组织变化:∠S-Ns-Sn(P<0.01)、∠Sn-Ns-Bs(P<0.01)、UL-EP线距(P<0.01)和LL-UL线距(P<0.01)均显著增加。结论对于生长发育期的唇腭裂患者,上颌前方牵引治疗可促进上颌骨向前生长,改善颌间关系及软组织侧貌,但需注意其不良反应。

关键词: 非综合征唇腭裂, 锥形束CT(CBCT), 上颌前方牵引

Abstract:

Objective To study the three-dimensional changes of soft and hard tissue in male patients with unilateral non-syndromic cleft lip and palate in the mixed dentition period before and after maxillary protraction. Methods Twenty male patients with unilateral non-syndromic cleft lip and palate in the mixed dentition period treated by maxillary anterior traction in the Department of Orthodontics of Affiliated Stomatological Hospital of Nanjing Medical University were selected (average age (10.6±1.23) years old). Cone beam CT was taken before and after treatment. Dolphin 3D 11.95 software was used for three-dimensional measurement and analysis. SPSS 25.0 software package was used for statistical analysis. The self-controlled paired t test was used to compare the changes in soft and hard tissues of male patients with unilateral cleft lip and palate before and after treatment. The changes in the anterior displacement of the ANS point, the anterior displacement of point A, and the posterior displacement of point B were tested using the one-sample t test. Results The sagittal skeletal changes were significantly increased in ∠SNA (P<0.01), ∠ANB (P<0.01), Y axis (P<0.05), the forward displacement of ANS point(P<0.01)and A point(P<0.01)and the backward displacement of B point (P<0.01), but ∠SNB(P<0.05) was decreased significantly. The vertical skeletal changes showed that ∠MP-FH(P<0.01), ∠MP-SN (P<0.05) and the distance of ANS-Me(P<0.05)were increased significantly, but ∠SN-PP(P<0.01)was decreased significantly. The dental changes including ∠U1-NA(P<0.01), the distance of U1-NA(P<0.01), ∠U1-SN(P<0.01), overjet and the Wits were increased significantly, but ∠ L1-NB(P<0.01), the distance of L1-NB(P<0.01)and ∠L1-MP(P<0.01)were decreased significantly. The changes of soft tissue including ∠S-Ns-Sn(P<0.01), ∠Sn-Ns-Bs(P<0.01), the distance of UL-EP(P<0.01)and LL-UL(P<0.01)were increased significantly. Conclusion After the treatment of maxillary protraction, the forward growth of maxilla will be possibly promoted on patients with cleft lip and palate in the peak of growth timing, as well as the intermaxillary relationship and soft tissue profile, but the side effects should be paid attention to.

Key words: non-syndromic cleft lip and palate, cone beam CT (CBCT), maxillary protraction

中图分类号:

R783.5

苏咏宽, 潘永初, 张晶超, 卞海峰, 方玉心, 侯伟, 韩霖霏. 上颌前方牵引对替牙期唇腭裂患者软硬组织的影响[J]. 口腔医学, 2025, 45(3): 168-174.

SU Yongkuan, PAN Yongchu, ZHANG Jingchao, BIAN Haifeng, FANG Yuxin, HOU Wei, HAN Linfei. The effects of maxillary protraction on soft and hard tissue in patients with cleft lip and palate in the mixed dentition period[J]. Stomatology, 2025, 45(3): 168-174.

图/表 11

图1

表1

表2

软硬组织测量项目"

测量项目	定义
SNA/(°)	由蝶鞍中心-鼻根点-上牙槽座点连线所构成角
SNB/(°)	由蝶鞍中心-鼻根点-下牙槽座点连线所构成角
ANB/(°)	由上牙槽座点-鼻根点-下牙槽座点连线所构成角
MP-FH/(°)	即下颌平面角,由下颌平面与眶耳平面的交角
SN-PP/(°)	前颅底平面与腭平面的交角
SN-MP/(°)	前颅底平面与下颌平面的交角
Y轴角/(°)	蝶鞍中心与颏顶点的连线与眶耳平面相交的下前角
U1-NA/(°)	上中切牙长轴与鼻根点-上牙槽座点连线交角
U1-SN/(°)	上中切牙长轴与前颅底平面相交的下内角
L1-NB/(°)	下中切牙长轴与鼻根点-下牙槽座点连线的交角
L1-MP/(°)	下中切牙长轴与下颌平面相交的上内角
U1-L1/(°)	上下中切牙长轴的交角
S-Ns-Sn/(°)	即上颌软组织突度,由蝶鞍点-软组织鼻根点-鼻下点连线交角
S-Ns-Bs/(°)	即下颌软组织突度,由蝶鞍点-软组织鼻根点-颏唇沟点连线交角
Sn-Ns-Bs/(°)	即上下颌软组织突度差的角度
UL-EP/mm	上唇突点与审美平面的距离
LL-EP/mm	下唇突点与审美平面的距离
LL-UL/mm	上下唇突度差的距离
A点前移量/mm	上牙槽座点前移量,即治疗前后A点的水平距离
B点后移量/mm	下牙槽座点后移量,即治疗前后B点的水平距离
ANS点前移量/mm	前鼻棘点前移量,即治疗前后ANS点的水平距离
N-ANS/mm	从鼻根点至前鼻棘点的距离,即上面高度
ANS-Me/mm	从前鼻棘点至颏下点的距离,即下面高度
U1-NA/mm	上中切牙长轴与鼻根点-上牙槽座点连线的垂直距离
L1-NB/mm	下中切牙长轴与鼻根点-下牙槽座点连线的垂直距离
前牙覆盖/mm	上下中切牙切缘的水平距离
Wits值/mm	上下牙槽座点AB向功能性𬌗平面作垂线,两垂足分别为Ao点和Bo点,然后测量Ao点与Bo点间的距离为Wits值

表2

图2

图3

图4

图5

表3

表4

表5

表6

参考文献 25

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标记点	定义
蝶鞍点(S)	蝶鞍影像的中心点
鼻根点(N)	鼻额缝的最前点
耳点(P)	外耳道的最上点
眶点(O)	眶下缘的最低点
颧弓点(ZA)	为颧弓三角前部之尖点
上牙槽座点(A)	前鼻嵴与上牙槽缘点间的骨部最凹点
下牙槽座点(B)	下牙槽缘点与颏前点间的骨部最凹点
前鼻棘点(ANS)	前鼻棘之尖点
后鼻棘点(PNS)	硬腭后部骨棘之尖点
颏前点(Po)	颏部之最突点
颏下点(Me)	颏部之最下点
颏顶点(Gn)	颏前点与颏下点之中点
软组织鼻根点(Ns)	软组织侧面上相应的鼻根点
颏唇沟点(Bs)	颏唇沟最凹点
上唇突点(UL)	上唇的最突点
下唇突点(LL)	下唇的最突点
眶耳平面(FH)	经过眶点和耳点的连接平面
腭平面(PP)	经过前鼻棘点和后鼻棘点的连接平面
下颌平面(MP)	通过颏下点与下颌角下缘相切的线
审美平面(EP)	通过鼻尖和颏部最突点的切线

测量项目	治疗前(T1)	治疗后(T2)	T2-T1	P
SNA/(°)	75.10±3.75	76.49±3.98	1.38±1.00	0.000^*
SNB/(°)	76.55±4.97	75.87±5.16	-0.69±1.27	0.026^*
ANB/(°)	-1.45±2.28	0.62±2.56	2.07±1.22	0.000^*
Y轴角/(°)	61.70±4.72	62.42±5.01	0.72±1.15	0.012^*
ANS点前移量/mm	—	—	1.65±0.61	0.000^*
A点前移量/mm	—	—	1.64±0.66	0.000^*
B点后移量/mm	—	—	1.63±1.34	0.000^*

测量项目	治疗前(T1)	治疗后(T2)	T2-T1	P
MP-FH/(°)	29.68±5.35	31.14±5.96	1.47±1.74	0.001^*
MP-SN/(°)	39.72±6.24	41.09±6.21	1.38±2.30	0.015^*
SN-PP/(°)	16.32±6.28	14.11±6.65	-2.22±2.74	0.002^*
N-ANS/mm	53.07±3.50	53.18±3.95	0.11±1.35	0.719
ANS-Me/mm	66.65±6.60	70.11±7.14	3.47±2.58	0.000^*

测量项目	治疗前(T1)	治疗后(T2)	T2-T1	P
U1-NA/(°)	19.59±10.02	22.93±7.93	3.34±4.69	0.005^*
U1-NA/mm	1.99±3.17	4.14±2.43	2.16±1.75	0.000^*
U1-SN/(°)	94.64±10.57	99.52±8.88	4.88±4.81	0.000^*
L1-NB/(°)	15.65±7.82	12.91±7.66	-2.74±3.19	0.001^*
L1-NB/mm	3.80±2.63	2.43±2.64	-1.38±1.39	0.000^*
L1-MP/(°)	79.56±8.57	76.18±8.56	-3.38±3.45	0.000^*
U1-L1/(°)	145.87±13.92	144.94±12.13	-0.94±6.64	0.537
前牙覆盖/mm	-3.75±3.50	4.08±2.67	7.83±2.14	0.000^*
Wits值	-2.29±4.05	2.98±3.87	5.27±1.96	0.000^*

测量项目	治疗前(T1)	治疗后(T2)	T2-T1	P
S-Ns-Sn/(°)	86.01±4.37	88.29±3.61	2.29±1.73	0.000^*
S-Ns-Bs/(°)	85.68±5.40	85.80±4.93	0.13±2.08	0.791
Sn-Ns-Bs/(°)	0.63±3.51	2.49±3.21	1.86±2.88	0.009^*
UL-EP/mm	-2.96±2.08	-0.44±1.52	2.52±1.29	0.000^*
LL-EP/mm	2.40±2.20	2.16±1.82	-0.24±1.45	0.477
LL-UL/mm	-5.35±2.95	-2.60±2.19	2.76±1.60	0.000^*