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目的 :研究功能矫治器作用下青春期骨性Ⅱ类下颌后缩患者上气道结构的变化。方法 :选取处于生长发育高峰期的骨性Ⅱ类下颌后缩患者(实验组)及骨性Ⅰ类均角型患者(对照组)各30例,男女各半。实验组患者使用肌激动器(Activator)治疗,促进下颌骨向前下生长,平均治疗时间12个月;对照组患者同期进行非减数固定矫治。所有患者在功能矫治器治疗前、后,固定矫治前及中期拍摄锥形束CT(CBCT)图像,检测患者治疗前、后骨性指标及上气道线距,并与参考标准对比。观察后鼻棘点(PNS)到第3颈椎(C3)下缘范围内的气道形态,三维重建并测量相应组织结构。应用SAS 8.0软件包对数据进行统计学分析,独立样本t检验比较实验组治疗前各测量项目与参考标准及对照组患者之间的差异,配对t检验比较所有患者治疗前、后各测量项目的差异。结果:治疗前,实验组患者骨性测量指标SNB及APDI显著小于参考标准,ANB、Wits及OJ显著大于参考标准和对照组患者;上气道线距中,MPW和PAS显著小于参考标准和对照组患者。上气道经三维重建后容积及最小横截面积显著小于对照组患者。经Activator引导下颌前伸后,实验组患者骨性测量指标及上气道线距均与参考标准接近,上气道经三维重建后容积及最小横截面积显著增大,与对照组患者无显著差异。对照组患者治疗前、后骨性指标、上气道线距及三维重建指标无显著差异。治疗前、后2组患者不同性别之间上气道指标无显著差异。结论:骨性Ⅱ类下颌后缩患者多伴有上气道缩窄。Activator引导下颌骨前伸,可改善患者骨性Ⅱ类下颌后缩的骨性特征,改善口咽腔和舌根后咽腔部位的狭窄,使上气道容积及最小横截面积增大,缓解上气道缩窄现象。
Objective: To study the changes of upper airway structure in adolescent skeletal class Ⅱ mandibular retrusion under the action of functional appliance. Methods: Thirty patients with skeletal Class Ⅱ mandibular retrusion (experimental group) and patients with skeletal Class Ⅰ angiography (control group) at the peak of growth and development were selected, 30 males and half females. Patients in the experimental group were treated with Activator to promote the forward mandibular growth, with an average treatment time of 12 months. Patients in the control group were treated with non-subtracted fixed orthodontics. All patients underwent cone beam CT (CBCT) imaging before and after functional appliance treatment, before and after fixed appliance treatment, and before and after treatment, the bony indexes and upper airway lineage were measured and compared with the reference standard. The airway morphology was observed from the posterior nasal point (PNS) to the lower edge of the third cervical vertebra (C3), and the three-dimensional reconstruction and measurement of the corresponding tissue structure were performed. The SAS 8.0 software package was used to analyze the data. The independent sample t-test was used to compare the difference between the test items and the reference standard and the control group before the treatment in the experimental group. Paired t-test was used to compare the differences of the measured items before and after treatment difference. Results: Before treatment, the SNB and APDI of the experimental group were significantly lower than the reference standard, ANB, Wits and OJ were significantly greater than the reference standard and control group; MPW and PAS in the upper airway were significantly less than the reference standard and control Group patients. After three-dimensional reconstruction of the upper airway, the volume and the minimum cross-sectional area were significantly smaller than those in the control group. After the activator guided mandibular protraction, the bony measurement index and upper airway line distance of the experimental group were close to the reference standard. The volume and the minimum cross-sectional area of the upper airway were significantly increased after three-dimensional reconstruction, which was not significantly different from the control group difference. There was no significant difference between the two groups in the control group before and after treatment for bony indexes, upper airway line spacing and three-dimensional reconstruction indexes. There was no significant difference in upper airway index between the two groups before and after treatment. Conclusion: Patients with skeletal Class Ⅱ mandibular retrusion are often accompanied by upper airway constriction. Activator guided the mandibular anterior extension can improve the skeletal characteristics of skeletal Class Ⅱ mandibular retrusion and improve the stenosis of oropharyngeal and posterior pharyngeal parts of the tongue and the upper airway volume and the smallest cross-sectional area, Airway narrowing phenomenon.