【作者】 周颖；

【导师】 胡敏；

【作者基本信息】 吉林大学 ， 口腔医学（专业学位）， 2021， 硕士

【摘要】 目的:1.本研究基于骨性Ⅱ类错畸形患者正颌手术前后上气道三维模型的构建,对该类患者舌骨位置与上气道空间受不同正颌术式的影响以及它们的稳定性展开分析。2.通过采用锥形束CT(CBCT)及头颅定位侧位片分析骨性Ⅱ类患者单纯颏成形术后颏部形态、上气道空间及舌骨位置的变化及其变化的相关性,对骨性Ⅱ类病人上气道本身、上气道附近组织受单纯颏成形术的影响展开分析,从理论层面指导确定骨性Ⅱ类错病人的临床治疗技术筛选。方法:1.选取2016-2020年就诊于吉林大学口腔医院正畸科及口腔颌面外科的骨性Ⅱ类错畸形患者17例,进行双颌手术组(A组)、单颌手术组(B组)划分。A组样本病例计10例,B组样本病例计7例,两组分别联合采用双侧下颌升支矢状劈开术前徙下颌骨和上颌骨Lefort Ⅰ型截骨术后退上颌骨(MAMS)、单纯下颌升支矢状劈开术前徙下颌骨(MA)。采集所有患者正颌手术前1周(T0)和术后1周(T1)及术后6个月(T2)的CBCT扫描数据,向Dolphin Imaging软件系统内导入扫描数据后随之展开上气道三维模型(含喉咽、口咽和鼻咽段)构建,对正颌手术前、后A、B组样本病例上气道空间结构及舌骨位置进行检测、分析。统计学分析工具选择SPSS 23.0进行。2.选取2016-2020年就诊于吉林大学口腔医院口腔颌面外科的骨性Ⅱ类错畸形患者13例,均于本院外科行单纯颏成形手术治疗,锥形束CT扫描与头颅定位侧位片分别于术前1周(T0),术后6个月(T1)拍摄。将CBCT数据及侧位片分别导入Dolphin Imaging及Sketchpad软件,随之测量上气道、舌骨及颏部形态的定点描绘和部分参数,数据分析工具采用SPSS 23.0,颏部形态、上气道空间结构及舌骨位置术前、后的变化状态以配对t检验为技术支撑展开对比,基于Spearson相关性检验分析颏部形态、上气道空间结构及舌骨位置变化的相关性。结果:1.三种常用正颌手术——单纯下颌前徙术、上颌后退伴下颌前徙术和单纯颏成形术,术后患者上气道空间、舌骨位置等指标发生显著变化。2.单纯下颌前徙术(MA)后,鼻咽段的气道空间无明显变化,而上气道总体积及口咽段、喉咽段的气道空间分别增加了32.6%、43.3%和39.3%,且在术后6个月稳定性较佳。3.上颌骨后退伴下颌前徙手术(MAMS)后,鼻咽段的气道空间减少10%,上气道总体积及口咽段、喉咽段的气道空间显著增加,分别为10.4%、17.8%及15.6%,但在术后6个月时存在复发。4.单纯颏成形术后,喉咽段的体积增加27.6%,舌骨向前下移动。5.三种手术术式均使舌骨有前移趋势,且颏部骨骼前移量与舌骨水平向移动及喉咽部气道空间改变呈正相关。结论:1.下颌前移可增加口咽及喉咽部气道空间,并使舌骨位置前移,而后退上颌骨对上气道空间增加的稳定性需要进一步长期观察。2.单纯颏成形手术可以改善骨性Ⅱ类患者颏部形态的美观与协调,并通过前徙颏部使舌骨位置前移,从而扩宽上气道喉咽部空间,有助于减小患OSAHS的风险。更多还原

【Abstract】 Objective:1.In order to obtain a good profile,patients with severe skeletal class Ⅱ malocclusion require orthognathic surgery,which may change their airway space.The objectives of this study are: 1)to determine the effects of different orthognathic surgery on upper airway space and hyoid position in skeletal class Ⅱ patients;2)to evaluate the stability of upper airway space and hyoid position changes after orthognathic surgery.2.The changes of chin shape,upper airway space and hyoid position of skeletal class Ⅱ patients after simple genioplasty were analyzed by cone beam CT(CBCT)and cephalometric lateral radiographs,and the effects of simple genioplasty on the upper airway and adjacent tissues of skeletal class Ⅱ patients were analyzed,so as to guide the screening of clinical treatment techniques for patients with skeletal class Ⅱ malocclusion from the theoretical level.Methods:1.In this study,17 patients with skeletal class Ⅱ malocclusion treated in the Department of Orthodontics and Oral and Maxillofacial surgery of Jilin University Stomatology Hospital from 2016 to 2020 were randomly divided into two groups.The CBCT images of 1 week before orthognathic surgery(T0),1 week after operation(T1)and 6 months after operation(T2)were collected and imported into dolphin imaging software to establish a three-dimensional model of upper airway.Changes in upper airway space and hyoid position were evaluated as the main outcome variables.Measurements were obtained before surgery(T0),one week after surgery(T1),and six months after surgery(T2)using Dolphin Imaging Software version 11.0.Differences in measurements between T1 and T0,and T2 and T0 were calculated and imported into SPSS software for data analysis.2.Thirteen patients with skeletal class Ⅱ malocclusion who were treated in the Department of Oral and Maxillofacial surgery of Jilin University Stomatology Hospital from 2016 to 2020 were treated with simple genioplasty.Cone beam CT scanning and cephalometric lateral radiography were taken 1 week before operation(T0)and 6months after operation(T1).The CBCT data and lateral films were imported into Dolphin Imaging and Sketchpad software respectively,and then the fixed-point description and some parameters of upper airway,hyoid and chin were measured.The data analysis tool was SPSS 23.0.The changes of chin shape,upper airway spatial structure and hyoid position before and after operation were compared with paired ttest as technical support.The correlation among chin shape,upper airway spatial structure and hyoid position was analyzed based on Spearson correlation test.Results:1.The indicators of the patient’s upper airway space,hyoid bone position were changed significantly after the three commonly used orthognathic surgery-mandibular advancement,maxillary setback with mandibular advancement and genioplasty.2.After mandibular advancement(MA),the airway space of the nasopharyngeal segment did not change significantly,while the total volume of the upper airway and the airway space of the oropharyngeal and laryngopharyngeal segments increased by32.6%,43.3% and 39.3% respectively,and the stability was better 6 months after surgery.3.After maxillary setback and mandibular advancement surgery(MAMS),the airway space of the nasopharyngeal segment was reduced by 10%,and the total volume of the upper airway and the airway space of the oropharyngeal and laryngopharyngeal segments were significantly increased 10.4%,17.8% and 15.6% respectively,but there was a recurrence at 6 months after the surgery,and the stability was not good.4.After genioplasty,the volume of the laryngopharyngeal segment increased by 27.6%,and the hyoid bone moved forward and downward.5.The three surgical methods all made the hyoid bone moved forward,and the forward movement of mandible was positively correlated with the horizontal movement of hyoid bone and the change of airway space in pharynx and larynx.Conclusions:1.Mandibular advancement can widen the oropharyngeal and hypopharyngeal airway space and move the hyoid bone forward.Maxillary recession has a negative effect on the long-term stability of the increased upper respiratory tract space.2.Genioplasty not only achieved better cosmetic results by advancing the chin but also exerted a significant positive impact on the posterior airway space for patients with skeletal class Ⅱ by moving the hyoid bone forward,thus helping reduce the prevalence of OSAHS.更多还原