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中华口腔医学研究杂志(电子版)

中华口腔医学研究杂志(电子版) ›› 2015, Vol. 09 ›› Issue (05) : 409 -415. doi: 10.3877/cma.j.issn.1674-1366.2015.05.011

所属专题： 文献；

临床研究

上颌前牵引中两种口内固位装置的临床对比研究
谢永建1,†(), 麦理想1, 卢新华1   
  1. 1. 510055　广州，中山大学光华口腔医学院·附属口腔医院，广东省口腔医学重点实验室
  • 收稿日期:2015-02-14 出版日期:2015-10-01
  • 通信作者: 谢永建
  • 基金资助:
    广东省自然科学基金(S2013040013793); 广东省医学科学技术研究基金(A2012207)

Comparison of two types of intra-oral fixation devices in maxillary protraction

Yongjian Xie1,†(), Lixiang Mai1, Xinhua Lu1   

  1. 1. Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
  • Received:2015-02-14 Published:2015-10-01
  • Corresponding author: Yongjian Xie
  • About author:
    Corresponding author: Xie Yongjian, Email: , Tel: 20-83802802
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引用本文：

谢永建, 麦理想, 卢新华. 上颌前牵引中两种口内固位装置的临床对比研究[J]. 中华口腔医学研究杂志(电子版), 2015, 09(05): 409-415.

Yongjian Xie, Lixiang Mai, Xinhua Lu. Comparison of two types of intra-oral fixation devices in maxillary protraction[J]. Chinese Journal of Stomatological Research(Electronic Edition), 2015, 09(05): 409-415.

目的

探讨快速扩弓与包绕垫式口内固位装置结合上颌前牵引矫治的效果差异，为临床治疗提供理论依据和参考。

方法

选择23例骨性Ⅲ类上颌后缩患者，分为快速扩弓结合上颌前牵引组（13例）和包绕垫结合上颌前牵引（10例）。对两组患者治疗前及前牵引后的头颅定位侧位片进行头影测量分析，并进行配对t检验；对两组患者治疗前、前牵引后的差值变化进行组间独立样本t检验。

结果

两组患者矫治后均出现SNA增大、ANB减小、下颌骨长度增加、Y-axis、MP/FH、MP/SN、PP/MP、U1-SN增大、前下面高、前面高、后面高增加。这些指标的变化差异有统计学意义。快速扩弓组患者前颅底长、上颌骨长度（Ptm-A）明显增加，下切牙明显舌倾。包绕垫组患者后颅底长明显增加，面角明显减小，前面高明显增加。两组间对比：S-Ba、NPg-FH变化两组差异有统计学意义（P < 0.05），其余测量值变化差异无统计学意义（P > 0.05）。

结论

使用快速扩弓与包绕垫加上颌前牵引矫治骨性Ⅲ类上颌后缩患者在临床上是确实可行的，可取得满意的疗效。

关键词: 快速扩弓, 前方牵引, 上颌后缩
Objective

To investigate the difference of the treatment effect of the maxillary protraction therapy with rapid palatal expansion appliance or with wrapped bite-plate removable appliance as intra-oral fixation devices.

Methods

Twenty-three skeletal ClassⅢ maxillary retrusion patients were selected and treated with maxillary protraction, the intra-oral devices were rapid palatal expansion appliance in 13 patients and wrapped bite-plate removable appliance in 10 patients. Paired t-test was used to compare the lateral cephalometric radiographs before and after treatment; the difference before and after treatment of two groups was compared with t-test of independent samples in group.

Results

SNA, Co-Po, Y-axis, MP/FH, MP/SN, PP/MP, U1/SN, ANA-Me, N-Me, S-Go increased, ANB decreased significantly in both groups. In rapid palatal expansion group, S-N, Ptm-A increased significantly, the lower incisors tipped lingual significantly. In wrapped bite-plate group, S-Ba, N-Me increased, facial angle decreased significantly (P<0.05) . The difference before and after maxillary protraction of two groups had no significant except S-Ba and NPg-FH (P>0.05) .

Conclusion

Maxillary protraction combined with rapid palatal expansion or with wrapped bite-plate removable appliance was effective in the treatment of Class Ⅲ patients with maxillary deficiency, the treatment effects had no significant difference in two groups.

Key words: Rapid palatal expansion, Maxillary protraction, Maxillary retrusion
图1 头影测量分析的角度测量示意图
图2 头影测量分析的线距测量示意图
表1 两组骨性Ⅲ类错患者治疗前头影测量比较（±s）
测量项目 快速扩弓组 包绕垫组 t值 P值
N-S-Ba 129.53 ± 4.80 124.00 ± 2.98 -2.382 0.030
N-S-Ar 123.00 ± 6.50 119.50 ± 4.27 -1.106 0.285
S-N 59.66 ± 2.64 60.26 ± 2.78 0.425 0.676
S-Ba 45.39 ± 2.38 46.04 ± 1.98 0.539 0.597
N-Ba 94.84 ± 4.78 93.84 ± 2.99 -0.431 0.672
SNA 79.96 ± 3.85 81.60 ± 2.61 0.870 0.397
SNB 82.65 ± 3.21 86.90 ± 2.92 2.565 0.021
ANB -2.65 ± 1.25 -5.30 ± 1.79 -3.584 0.002
NPg-FH 89.27 ± 3.91 90.92 ± 3.05 0.845 0.411
Y-axis 60.54 ± 3.79 58.40 ± 3.78 -1.073 0.299
MP-FH 29.97 ± 4.81 25.96 ± 3.66 -1.678 0.113
MP-SN 36.54 ± 4.12 29.20 ± 2.77 -3.639 0.002
PP-FH 1.85 ± 5.39 4.90 ± 3.50 1.164 0.261
PP-MP 25.69 ± 5.91 20.80 ± 1.64 -1.794 0.092
S-Co 10.54 ± 3.02 12.18 ± 2.47 1.078 0.297
S-Ptm 15.83 ± 1.67 14.26 ± 2.09 -1.676 0.113
Ptm-A 40.15 ± 3.91 41.36 ± 1.98 0.655 0.522
Co-Po 98.48 ± 5.01 98.90 ± 4.86 0.162 0.874
U1-SN 108.65 ± 7.37 114.90 ± 3.13 1.806 0.090
U1-NA° 27.77 ± 7.59 32.60 ± 2.30 1.376 0.188
U1-NA 5.10 ± 2.11 4.52 ± 1.66 -0.549 0.591
L1-NB° 25.08 ± 4.36 17.80 ± 5.45 -2.971 0.009
L1-NB 5.46 ± 2.11 2.42 ± 2.04 -2.754 0.014
L1-MP 85.32 ± 6.53 81.70 ± 5.47 -1.093 0.290
U1-L1 130.08 ± 8.44 134.70 ± 6.76 1.091 0.291
N-ANS 48.28 ± 2.11 48.04 ± 3.37 -0.181 0.859
ANS-Me 60.13 ± 5.24 52.44 ± 2.46 -3.109 0.007
N-Me 107.67 ± 5.05 100.58 ± 5.43 -2.617 0.019
S-Go 66.91 ± 3.91 65.96 ± 2.41 -0.502 0.623
表2 不同固位装置上颌前牵引两组病例治疗前、前牵引后的头影测量项目比较（ ± s）
测量项目 快速扩弓组 包绕垫组 快速扩弓组差值 包绕垫组差值 P值
治疗前 治疗后 P值 治疗前 治疗后 P值
N-S-Ba 129.53 ± 4.80 129.73 ± 5.31 0.780 124.00 ± 2.98 125.40 ± 4.04 0.166 0.20 ± 2.53 1.40 ± 1.85 0.352
N-S-Ar 123.00 ± 6.50 124.27 ± 5.88 0.017 119.50 ± 4.27 119.20 ± 3.21 0.845 1.27 ± 1.65 -0.30 ± 3.21 0.185
S-N 59.66 ± 2.64 60.45 ± 3.19 0.034 60.26 ± 2.78 60.52 ± 3.50 0.580 0.79 ± 1.20 0.26 ± 0.97 0.407
S-Ba 45.39 ± 2.38 45.60 ± 2.54 0.500 46.04 ± 1.98 47.86 ± 1.36 0.035 0.21 ± 1.08 1.82 ± 1.30 0.016
N-Ba 94.84 ± 4.78 95.84 ± 5.51 0.070 93.84 ± 2.99 96.78 ± 3.50 0.013 1.00 ± 1.81 2.94 ± 1.55 0.051
SNA 79.96 ± 3.85 82.19 ± 4.80 0.002 81.60 ± 2.61 83.90 ± 2.46 0.026 2.23 ± 2.08 2.30 ± 1.48 0.947
SNB 82.65 ± 3.21 81.32 ± 4.58 0.056 86.90 ± 2.92 85.50 ± 3.50 0.073 -1.33 ± 2.27 -1.40 ± 1.29 0.978
ANB -2.65 ± 1.25 0.79 ± 1.71 0.000 -5.30 ± 1.79 -1.60 ± 1.71 0.005 3.45 ± 1.24 3.70 ± 1.44 0.715
NPg-FH 89.27 ± 3.91 88.42 ± 3.91 0.100 90.92 ± 3.05 87.60 ± 3.58 0.001 -0.85 ± 1.71 -3.32 ± 0.84 0.008
Y-axis 60.54 ± 3.79 63.19 ± 4.04 0.003 58.40 ± 3.78 62.40 ± 4.29 0.004 2.65 ± 2.60 4.00 ± 1.46 0.296
MP-FH 29.97 ± 4.81 31.81 ± 5.02 0.019 25.96 ± 3.66 29.70 ± 4.84 0.004 1.83 ± 2.44 3.74 ± 1.36 0.122
MP-SN 36.54 ± 4.12 39.42 ± 4.48 0.001 29.20 ± 2.77 32.00 ± 4.30 0.013 2.88 ± 2.26 2.80 ± 2.59 0.946
PP-FH 1.85 ± 5.39 1.19 ± 4.51 0.417 4.90 ± 3.50 5.70 ± 3.77 0.120 -0.65 ± 2.80 0.80 ± 0.91 0.280
PP-MP 25.69 ± 5.91 30.15 ± 6.04 0.001 20.80 ± 1.64 24.76 ± 3.06 0.008 4.46 ± 3.50 3.96 ± 1.82 0.767
S-Co 10.54 ± 3.02 10.79 ± 2.34 0.577 12.18 ± 2.47 13.40 ± 1.88 0.277 0.25 ± 1.60 1.22 ± 2.17 0.312
S-Ptm 15.83 ± 1.67 16.40 ± 1.69 0.126 14.26 ± 2.09 14.00 ± 2.46 0.549 0.57 ± 1.25 -0.26 ± 0.89 0.197
Ptm-A 40.15 ± 3.91 42.61 ± 4.12 0.000 41.36 ± 1.98 42.44 ± 2.43 0.197 2.46 ± 1.57 1.08 ± 1.56 0.113
Co-Po 98.48 ± 5.01 101.50 ± 5.93 0.001 98.90 ± 4.86 101.20 ± 4.82 0.034 3.02 ± 2.32 2.30 ± 2.13 0.554
U1-SN 108.65 ± 7.37 113.12 ± 7.87 0.020 114.90 ± 3.13 118.80 ± 4.01 0.031 4.46 ± 5.99 3.90 ± 2.68 0.845
U1-NA° 27.77 ± 7.59 30.12 ± 7.62 0.267 32.60 ± 2.30 34.50 ± 2.57 0.254 2.35 ± 7.26 1.90 ± 3.19 0.898
U1-NA 5.10 ± 2.11 6.00 ± 1.52 0.056 4.52 ± 1.66 6.88 ± 1.83 0.122 0.90 ± 1.53 2.36 ± 2.69 0.162
L1-NB° 25.08 ± 4.36 20.54 ± 6.30 0.006 17.80 ± 5.45 14.90 ± 6.97 0.462 -4.54 ± 4.92 -2.90 ± 7.97 0.606
L1-NB 5.46 ± 2.11 4.88 ± 2.62 0.148 2.42 ± 2.04 1.76 ± 2.42 0.604 -0.58 ± 1.34 -0.66 ± 2.63 0.929
L1-MP 85.32 ± 6.53 81.04 ± 6.93 0.004 81.70 ± 5.47 78.60 ± 7.63 0.445 -4.28 ± 4.29 -3.10 ± 8.18 0.692
U1-L1 130.08 ± 8.44 127.77 ± 10.48 0.295 134.70 ± 6.76 131.20 ± 8.79 0.355 -2.31 ± 7.59 -3.50 ± 7.48 0.768
N-ANS 48.28 ± 2.11 49.25 ± 3.43 0.174 48.04 ± 3.37 49.00 ± 3.35 0.020 0.98 ± 2.44 0.96 ± 0.57 0.988
ANS-Me 60.13 ± 5.24 65.26 ± 5.41 0.000 52.44 ± 2.46 58.20 ± 3.40 0.004 5.13 ± 1.98 5.76 ± 2.20 0.566
N-Me 107.67 ± 5.05 114.65 ± 6.55 0.000 100.58 ± 5.43 107.32 ± 6.71 0.004 6.98 ± 3.33 6.74 ± 2.60 0.889
S-Go 66.91 ± 3.91 69.48 ± 4.29 0.000 65.96 ± 2.41 69.44 ± 2.16 0.015 2.58 ± 1.89 3.48 ± 1.91 0.378
图3 典型病例1治疗前面相及口内相
图4 典型病例1前方牵引面相及口内相
图5 典型病例1前方牵引后面相及口内相
图6 典型病例2治疗前面相及口内相
图7 典型病例2前方牵引面相及口内相
图8 典型病例2治疗后面相及口内相
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