骨性下颌前突正畸—正颌联合治疗前后髁突位置变化的研究

摘要

AIM; By observing whether there exixt condylar position changes before and after orthodonticLsurgical treatment, to investigate whether bilateral sagittal split ramus osteotomy(BSSRO)can be safely used to correct skeletal class III malocclusion with mandibular hyperplasia without causing additional TMJ symptoms. METHODS: Fifteen patients with mandibular prognathism were included in this study. The patients were treated with orthodontic and bilateral sagittal split ramus osteotomy (BSSRO). Both sides of the anterior, posteria and upper spaces were measured two weeks before and six months after the operation respectively. The data was analyzed by SPSS 16. 0 software package for paired t test. RESULTS:After treatment, oral function was recovered and facial esthetic effect was improved in all 15 patients. Before operation,the left mean anterior, posterior and upper spaces were 1. 91 mm,2. 30 mm and 2. 51 mm. The right mean anterior, posterior and upper spaces were 2. 14 mm, 2. 65 mm and 2. 98 mm. After operation,the left mean anterior, posterior and upper spaces were 1. 99 mm, 2. 38 mm and 2. 62 mm. The right mean anterior, posterior and upper spaces were 2. 14 mm,2. 66 mm and 2. 60 mm. There was no statistical significant difference among the 3 spaces pre and post operation with BSSRO (P >0. 05 ). CONCLUSION: Combined orthodontic and BSSRO can be used safely to correct skeletal class III malocclusion with mandibular hyperplasia without causing additional TMJ symptoms.%目的:研究骨性下颌前突正畸-正颌联合治疗前后髁突位置的变化,探讨下颌双侧升支矢状劈开后退术对于治疗骨性下颌前突的可靠性和安全性.方法:15例骨性下颌前突的安氏Ⅲ类错(牙合)畸形病人,行下颌双侧升支矢状劈开后退术(bilateral sagittal split ramus osteotomy,BSSRO)与正畸矫治联合治疗,分别在术前两周和术后半年拍摄许勒式X线片,测量BSSRO术前、术后双侧髁突在关节窝内前、后、上间隙的距离,进行统计学分析比较术前术后髁突位置的变化情况.结果:15例病例经BSSRO配合正畸治疗后均达到正常的咬合关系,恢复了口腔功能,改善了面部容貌；正颌术前:左侧关节前、后、上间隙均数为1.91、2.30、2.51 mm;右侧前、后、上间隙均数为2.14、2.65、2.98 mm；正颌术后:左侧关节前、后、上间隙均数为1.99、2.38、2.62 mm；右侧前、后、上间隙均数为2.14、2.66、2.60 mm.术后半年双侧髁突在关节窝内的上、前、后间隙与术前两周相比,差异均无统计学意义.结论:下颌双侧升支矢状劈开后退术(BSSRO)配合正畸治疗,能够安全有效的矫治骨性下颌前突,并且未使其出现新的关节症状.