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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) ›› 2019, Vol. 13 ›› Issue (02) : 90 -96. doi: 10.3877/cma.j.issn.1674-1366.2019.02.005

所属专题： 文献；

临床研究

下颌骨牵张成骨术后1 ~ 3年稳定性的回顾性研究
喻幸娜1, 侯世达1, 黄弋欢1, 曾融生1,†()   
  1. 1. 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，广州　510055
  • 收稿日期:2019-01-24 出版日期:2019-04-01
  • 通信作者: 曾融生

A retrospective clinical study of the long-term stability of mandibular distractions in 1 ~ 3 years

Xingna Yu1, Shida Hou1, Yihuan Huang1, Rongsheng Zeng1,†()   

  1. 1. Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
  • Received:2019-01-24 Published:2019-04-01
  • Corresponding author: Rongsheng Zeng
  • About author:
    Corresponding author: Zeng Rongsheng, Email:
  • Supported by:
    National Natural Science Foundation of China(81070818)
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引用本文：

喻幸娜, 侯世达, 黄弋欢, 曾融生. 下颌骨牵张成骨术后1 ~ 3年稳定性的回顾性研究[J]. 中华口腔医学研究杂志(电子版), 2019, 13(02): 90-96.

Xingna Yu, Shida Hou, Yihuan Huang, Rongsheng Zeng. A retrospective clinical study of the long-term stability of mandibular distractions in 1 ~ 3 years[J]. Chinese Journal of Stomatological Research(Electronic Edition), 2019, 13(02): 90-96.

目的

通过头影测量牵张成骨术后下颌骨的变化，评估手术的长期稳定性并探讨影响术后复发的因素。

方法

筛选2009—2018年于中山大学附属口腔医院口腔颌面外科因患有下颌骨畸形而接受下颌牵张成骨治疗的5例患者，对比不同治疗阶段[T0（下颌骨牵张成骨术前）、T1（牵张成骨治疗完成时/取出牵张器时）、T2（术后最长随访时间）]的头影测量数据，检测记录牵张成骨治疗过程中下颌骨长度（Go-Gn、Ar-Gn）及升支高度（Cr-Go）、下颌后缩程度（SNB角）的数值变化，评估牵张成骨治疗的长期稳定性。采用配对t检验的方法对头影测量数据进行统计学分析。

结果

全颌曲面断层片显示，患者下颌骨长度在下颌牵张成骨手术后随访时比手术前平均增长6.09 mm（t = 2.97，P = 0.025），下颌升支平均增长5.72 mm（t = 3.21，P = 0.018）。侧位片显示患者下颌骨长度在下颌牵张成骨手术后随访时比手术前平均增长8.17 mm（t = 5.21，P = 0.006），下颌总长度平均增长12.58 mm（t = 4.34，P = 0.01），下颌升支平均增长6.36 mm（t = 4.26，P = 0.01），SNB角平均增大6.28°（t = 5.28，P = 0.006）。但是测量结果示：升支高度在手术后随访时比手术刚完成时平均降低2.25 mm（t = -3.42，P = 0.014）。

结论

牵张成骨手术对下颌骨畸形患者的下颌骨体部长度和升支高度有明显的效果，并且具有良好的长期稳定性，但术后1 ~ 3年全颌曲面断层片可检测到升支高度的轻微复发现象。

关键词: 下颌骨, 骨生成，内脱位, 头影测量分析
Objective

The aim of this study was to evaluate the long-term stability of mandibular distractions by cephalometric analysis before and after the distractions and discuss the factors that influence the recurrence.

Methods

Five patients with mandibular deformities who underwent distraction osteogenesis from 2009 to 2018 were selected. The cephalometric data of T0 (before distraction osteogenesis) , T1 (distraction osteogenesis was completed/distraction distractor was removed) , and T2 (the longest follow-up after distraction osteogenesis) were compared. The length of mandible (Ar-Gn, Go-Gn, Co-Go) were measured and recorded. The numerical changes of data were compared to evaluate the stability of distraction therapy. SPSS 20.0 was used for statistical analysis, and paired t-test was used to obtain statistical analysis results.

Results

Panoramic films showed that the mandibular length increased by 6.09 mm (t = 2.97, P = 0.025) and the mandibular ramus increased by 5.72 mm (t = 3.21, P = 0.018) at the follow-up after distraction osteogenesis. The cephalometric images showed that mandibular length increased by 8.17 mm (t = 5.21, P = 0.006) , total mandibular length increased by 12.58 mm (t = 4.34, P = 0.01) , ramus height increased by 6.36 mm (t = 4.26, P = 0.01) , and SNB increased by 6.28° (t = 5.28, P = 0.006) . However, the results of panoramic tomography showed that the height of ramus decreased on average at the time of follow-up compared with that at the time of completion of surgery by 2.25 mm (t = -3.42, P = 0.014) .

Conclusions

Mandibular distraction osteogenesis has obvious effect on improving mandibular malformation and good long-term stability. However, slight recurrence of ramus height can be detected on panoramic films 1-3 years postoperatively.

Key words: Mandible, Osteogenesis, distraction, Cephalometric analysis
表1 本研究5例下颌牵张成骨治疗患者的基本资料
序号 性别 手术时年龄（岁） 随访时间（年） 手术部位 病因 牵张长度（mm）
1 男 5 2.75 双侧 后天 15.6
2 女 13 1.17 右侧 先天 23.1
3 女 14 3.17 左侧 先天 25.2
4 女 22 2.25 双侧 后天 11.2
5 男 16 1.75 左侧 后天 19.6
平均 - 14 2.22 - - 18.9
图1 头影测量标记点　注：A为上牙槽座点；B为下牙槽座点；S为蝶鞍点；N为鼻根点；Ar为髁突点；Pog为颏前点；Me为颏顶点；Gn为颏下点；Go为下颌角点；Li为下唇点；Pog′为软组织颏前点；Me′为软组织颏下点；FH为法兰克福线；0-degree meridian为垂直于法兰克福线的零度子午线
表2 牵张成骨过程患者患侧下颌长度（Go-Gn）和高度（Cr-Go）变化的全颌曲面断层测量结果（±s，mm）
测量项目 例数 T0 T1 T2 T1-T0 T2-T0 T2-T1
Go-Gn 5 85.68 ± 10.09 93.76 ± 8.87 91.77 ± 10.48 8.08 ± 4.10 6.09 ± 5.42 -1.99 ± 2.43
t值 - - - - 5.22 2.97 -2.17
P值 - - - - 0.002 0.025 0.073
Cr-Go 5 53.44 ± 11.68 61.41 ± 10.72 59.16 ± 11.32 7.97 ± 5.96 5.72 ± 4.72 -2.25 ± 1.74
t值 - - - - 3.54 3.21 -3.42
P值 - - - - 0.012 0.018 0.014
表3 牵张成骨过程患者下颌长度（Go-Gn、Ar-Gn）、高度（Cr-Go）和SNB角度变化的侧位片测量结果（±s）
测量项目 例数 T0 T1 T2 T1-T0 T2-T0 T2-T1
Go-Gn（mm） 5 53.55 ± 11.88 60.56 ± 11.20 61.71 ± 10.07 7.02 ± 2.47 8.17 ± 3.50 1.15 ± 2.84
t值 - - - - 6.34 5.21 0.91
P值 - - - - 0.003 0.006 0.42
Ar-Gn（mm） 5 91.61 ± 9.01 102.98 ± 9.44 104.20 ± 8.49 11.37 ± 2.29 12.58 ± 6.49 1.21 ± 5.71
t值 - - - - 11.09 4.34 0.48
P值 - - - - <0.001 0.01 0.66
Cr-Go（mm） 5 44.53 ± 9.39 53.05 ± 8.42 50.89 ± 8.67 8.52 ± 4.77 6.36 ± 3.34 -2.16 ± 2.17
t值 - - - - 4.00 4.26 -2.22
P值 - - - - 0.02 0.01 0.09
SNB（°） 5 64.98 ± 3.94 71.09 ± 2.44 71.06 ± 1.70 6.11 ± 1.67 6.08 ± 2.58 -0.03 ± 1.42
t值 - - - - 8.17 5.28 0.05
P值 - - - - 0.001 0.006 0.96
图2 下颌牵张成骨治疗患儿各时期侧面像及侧位片对比　A、D：患者下颌牵张成骨术前；B、E：患者牵张成骨术后；C、F：患者术后随访时
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