手术优先和正畸优先方法在Ⅲ类骨性错牙合患者中产生相似的髁突移位和改建模式。
Surgery-First and Orthodontic-First Approaches Produce Similar Patterns of Condylar Displacement and Remodeling in Patients With Skeletal Class III Malocclusion.
作者信息
He Xiaotong, He Jiayi, Yuan Hua, Chen Wenjing, Jiang Hongbing, Cheng Jie
机构信息
Resident Doctor, Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology and Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Jiangsu, China.
Resident Doctor, Department of Oral and Maxillofacial Surgery, The First People's Hospital of Changzhou and The Third Affiliated Hospital of Soochow University, Jiangsu, China.
出版信息
J Oral Maxillofac Surg. 2019 Jul;77(7):1446-1456. doi: 10.1016/j.joms.2019.01.061. Epub 2019 Feb 13.
PURPOSE
Condylar displacement and remodeling are critically involved in occlusal and skeletal stability after orthognathic surgery. The aim of the present study was to characterize condylar displacement and surface remodeling after bimaxillary orthognathic surgery in adult patients with skeletal Class III malocclusion treated by the surgery-first approach (SFA) or the orthodontic-first approach (OFA).
MATERIALS AND METHODS
This retrospective cohort study recruited adult patients with mandibular hyperplasia treated with SFA or OFA. Simultaneous Le Fort I osteotomy for maxillary advancement and bilateral sagittal split ramus osteotomy for mandibular setback were performed in all patients. Original cone-beam computed tomographic data before surgery (T0), immediately after surgery (T1), and 12 months postoperatively (T2) were collected and reconstructed for 3-dimensional (3D) quantitative analyses. Three-dimensional condylar displacement and remodeling after SFA and OFA were characterized and statistically compared by Mann-Whitney U test and χ test. The significance level was set at a P value less than .05.
RESULTS
Twenty-four (male-to-female ratio, 1:2; mean age, 21.2 yr) and 20 (male-to-female ratio, 1:1; mean age, 23.1 yr) patients were enrolled in the OFA and SFA groups, respectively. Condylar inferolateral displacement with inward and anterior rotations from T0 to T1 and return movements from T1 to T2 were observed regardless of treatment approach. Significantly greater amount of 3D bodily shift immediately after surgery (2.04 ± 1.05 mm in SFA group vs 1.22 ± 0.66 mm in OFA group; P < .05) and downward movement 1 year after surgery were observed in the SFA versus OFA group. Bone resorption in the condylar surface was prevalent and predominant in its lateral areas, whereas bone formation was frequently observed in the anteromedial area in the SFA (45%) and OFA (42.9%) groups.
CONCLUSIONS
Similar patterns of 3D condylar displacement and surface remodeling were observed in patients treated with SFA or OFA.
目的
髁突移位和重塑在正颌外科手术后的咬合和骨骼稳定性中起着关键作用。本研究的目的是描述采用手术优先方法（SFA）或正畸优先方法（OFA）治疗的成年骨性III类错牙合患者双颌正颌外科手术后的髁突移位和表面重塑情况。
材料与方法
这项回顾性队列研究纳入了采用SFA或OFA治疗的下颌前突成年患者。所有患者均同时进行上颌前徙的Le Fort I截骨术和下颌后退的双侧矢状劈开截骨术。收集术前（T0）、术后即刻（T1）和术后12个月（T2）的原始锥形束计算机断层扫描数据，并进行三维（3D）重建以进行定量分析。通过Mann-Whitney U检验和χ检验对SFA和OFA术后的三维髁突移位和重塑进行特征描述和统计学比较。显著性水平设定为P值小于0.05。
结果
OFA组和SFA组分别纳入了24例（男女性别比为1:2；平均年龄21.2岁）和20例（男女性别比为1:1；平均年龄23.1岁）患者。无论采用何种治疗方法，均观察到从T0到T1髁突向外侧下移位并伴有向内和向前旋转，以及从T1到T2的复位运动。SFA组术后即刻的三维整体移位量（2.04±1.05mm）显著大于OFA组（1.22±0.66mm；P<0.05），且术后1年SFA组髁突向下移位比OFA组更明显。髁突表面的骨吸收普遍存在且在其外侧区域占主导，而在SFA组（45%）和OFA组（42.9%）的前内侧区域经常观察到骨形成。
结论
采用SFA或OFA治疗的患者观察到相似的三维髁突移位和表面重塑模式。
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