Komori E, Sagara N, Aigase K
Department of Dentistry, Jikei University School of Medicine, Tokyo, Japan.
Am J Orthod Dentofacial Orthop. 1991 Jul;100(1):38-46. doi: 10.1016/0889-5406(91)70047-Z.
Although skeletal relapse after orthognathic surgery can be considered primarily the results of unbalanced tension in the surgically modified stomatognathic system (i.e., skeletal relapsing force [SRF] acting on the mandibular segment), no study of SRF has been reported and its nature still remains unclarified. This article presents a practicable method for evaluating SRF during the fixation period with the use of a foil strain gauge fixed to the upper arch wire between the central incisors, with a preliminary result after mandibular advancement by sagittal split ramus osteotomy to demonstrate the value of this method for studying SRF. The pattern and degree of SRF were shown to vary during the postoperative period and in accordance with experimental situations, including the mandibular resting posture, swallowing, clenching, and speaking. On day 3, a constant SRF of 550 gm existed even in the resting posture and was increased by 450 gm to a maximum of about 1 kg on swallowing; clenching and speaking also produced an increase. Thus it was inferred that SRF arose not only from surgically stretched perimandibular connective tissues but also from intermittent physiologic muscle actions. The constant SRF subsided gradually with time, and after day 33, swallowing as well as clenching no longer increased the SRF, which indicates that the critical period for postoperative skeletal stability was the first few weeks, during which muscle readaptation and primary bone healing occurred. It was concluded that this method of evaluating SRF, which is capable of immediately revealing any tendency to relapse or the progress of soft tissue adaptation and bone healing, could be used as an effective research tool.
尽管正颌外科手术后的骨骼复发主要可被认为是手术改造后的口颌系统中张力不平衡的结果（即作用于下颌节段的骨骼复发力[SRF]），但尚未有关于SRF的研究报道，其本质仍未明确。本文介绍了一种在固定期评估SRF的可行方法，即使用固定于中切牙之间上颌弓丝上的箔式应变片，并通过下颌升支矢状劈开截骨术进行下颌前徙后的初步结果，以证明该方法对研究SRF的价值。结果显示，SRF的模式和程度在术后期间以及根据包括下颌休息姿势、吞咽、紧咬和说话在内的实验情况而有所不同。在术后第3天，即使在休息姿势下也存在550克的恒定SRF，吞咽时增加450克，最大可达约1千克；紧咬和说话也会使其增加。因此可以推断，SRF不仅源于手术拉伸的下颌周围结缔组织，还源于间歇性的生理肌肉活动。恒定的SRF随时间逐渐消退，在第33天后，吞咽以及紧咬不再增加SRF，这表明术后骨骼稳定性的关键时期是最初几周，在此期间肌肉重新适应和初期骨愈合发生。结论是，这种评估SRF的方法能够立即揭示任何复发倾向或软组织适应及骨愈合的进展情况，可作为一种有效的研究工具。
