自攻型微螺钉支抗与正颌手术矫治成年骨性开牙合患者的比较研究

摘要

目的 比较自攻型微螺钉支抗与正颌外科手术矫治成年开畸形患者疗效的差异.方法 将25例骨性开的成年患者分为微螺钉支抗组(n=14)、正颌手术组 (n=11) 两组.微螺钉支抗组将自攻型微螺钉分别植入在上下颌第一、第二磨牙之间颊侧齿槽骨,上下颌使用横腭杆和固定舌弓,每侧加力1.5 N以压低后部牙齿槽;正颌手术组对患者进行LeFort Ⅰ型截骨术+下颌升支矢状劈开截骨术(sagittal spilt ramus osteotomy,SSRO),或者单颌手术SSRO,两组患者在治疗前后分别拍摄头颅侧位定位片,并进行头影测量的分析比较.结果 25例骨性开畸形均得到有效治疗,微螺钉支抗组的前牙覆由治疗前的平均-4.6 mm增加至治疗后平均2.0 mm(P<0.05),正颌手术组的前牙覆由治疗前的平均-5.5 mm增加至治疗后平均1.7 mm(P<0.05).微螺钉支抗组压低后牙的效果更为明显,U6-PP(1.8 mm,0.2 mm,P<0.01)、L6-MP(1.2 mm,0.3 mm,P<0.05),差异有统计学意义,而正颌手术组对垂直向的控制更为有效,MP/SN(6.3°,3.3°,P<0.01)、N-Me(3.8 mm,1.8 mm,P<0.05)、ANS-Me(3.9 mm,1.6 mm,P<0.05)、Gn-TH(2.8 mm,0.9 mm,P<0.05).结论 自攻型微螺钉支抗能够实现后部牙齿槽高度的压低,是矫治骨性开畸形的一种损伤小、患者依从性好的治疗手段.%Objective To compare the trealmenl resulls in patients with skeletal open bile trealed with molar intrusion by u-sing miniscrew anchorage and orthognalhic surgery. Methods Twenly - five palienls wilh skelelal open bile were trealed eilher by mi-niscrew anchorage ( n = 14 ) or LeFort I osleolomy combined with sagillal split ramus osleolomy(SSRO) (n = ll). Self - drilling miniscrew implanls were inserted into the buccal alveolar bone belween maxillary molars and mandibular molars. Palalal and lingual arches were used respectively. 150 g force each side was added to miniscrew to intrude posterior teeth. Prelrealmenl and posllrealmenl lateral cephalograms were measured and compared. Results Skelelal open bile malocclusion in 25 palienls were corrected effectively. There was no significant difference between miniscrew anchorage and orlhognalhic surgery, wilh increased overbites of 6. 6mm and 7. 2 mm, respectively. Miniscrew was more effective than orlhognalhic surgery in intruding posterior teeth. U6 - PP (1.8 mm,0.2 mm,P <0. 01) and L6 - MP (1.2 mm,0.3 mm,P<0. 05) were intruded significantly. Orlhognalhic surgery was more effective than miniscrew anchorage in reducing vertical dimension. The MP/SN(6.3°,3.3°,P<0.01) ,N - Me (3.8 mm,1.8 mm,P<0.05), ANS-Me (3.9 mm, 1.6 mm, P<0.05) and Gn - TH (2. 8 mm,0. 9 mm,P <0. 05) were decreased significantly. Conclusion Self-drilling minisrcew implanl can be used as an efficient melhod to conlrol vertical anchorage and correct skeletal open bile malocclusion effectively through absolute intrusion of posterior denial alveoli.