标题：“手术优先”模式与正颌-正畸联合手术模式治疗成人骨性Ⅲ类错畸形的效果比较

      作者：李奎 1，李晓莉 2，雷科 1，王伦昌 1    (广元市中心医院口腔科 1、放射科 2，四川 广元 628000)

      卷次： 2017年28卷19期

      【摘要】 目的 比较“手术优先”模式与正颌-正畸联合手术模式治疗成人骨性Ⅲ类错畸形的效果。方法 回顾性分析广元市中心医院口腔科2013年1月至2015年12月收治的成人骨性Ⅲ类错畸形的患者30例病例资料，根据治疗方案分为正颌-正畸联合组(16例)和手术优先组(14例)。正颌-正畸联合组采用正颌-正畸联合治疗，手术优先组采用“手术优先”模式治疗，记录两组术后正畸时间、总疗程时间，治疗前和矫正结束后测定骨性硬组织[上颌骨相对于颅部前后位置的关系(SNA)、下颌骨相对颅部前后位置的关系(SNB)、上下颌骨之间的前后位置的关系 (ANB)、面部的上颌部相对整个侧面的关系 (NA-PA)]、牙性变化 [上中切牙长轴与 NA联系的距离(U1-NA)、上下中切牙牙长轴的交角(U1-LI)、上中切牙的唇倾程度(U1-SN)、下中切牙的唇倾程度(L1-MP)]、软组织变化[上唇突点至Ricketts审美平面的距离(UL-E)、下唇突点至Ricketts审美平面的距离(LL-E)]，比较/a/、/i/、/u/ 3个元音字母前3个共振峰频率值(F1、F2、F3)。结果 手术优先组术后正畸时间长于正颌-正畸联合组，但总疗程时间短于正颌-正畸联合组，差异有统计学意义(P<0.05)；两组治疗后 SNB、NA-PA、U1-NA、U1-LI、U1-SN均减小，ANB、L1-MP、UL-E、LL-E均增大，同组治疗前后差异有统计学意义(P<0.05)；手术优先组治疗后SNB、NA-PA大于正颌-正畸联合组，ANB、L1-MP低于正颌-正畸联合组，差异有统计学意义(P<0.05)；两组治疗后/i/元音F2、F3共振峰频率下降，/u/元音F2共振峰频率升高，差异有统计学意义(P<0.05)，其余组间比较差异无统计学意义(P>0.05)。结论 “手术优先”治疗模式、正颌-正畸联合手术均能改善软组织侧貌、发音不清，但前者可缩短治疗疗程，后者在改善骨性不协调上更具优势。
      【关键词】 成人骨性Ⅲ类错畸形；手术优先；正颌-正畸；语音不清
      【中图分类号】 R783.5 【文献标识码】 A 【文章编号】 1003—6350（2017）19—3156—04

Effects of surgery-first approach and orthognathic-orthodontic surgical treatment in adult patients with skeletalⅢ malocclusion.
LI Kui 1, LI Xiao-li 2, LEI Ke 1, WANG Lun-chang 1. Department of Stomatology 1, Department ofRadiology 2, Guangyuan Central Hospital, Guangyuan 628000, Sichuan, CHINA
【Abstract】 Objective To explore the effects of surgery-first approach and orthognathic-orthodontic surgicaltreatment in adult patients with skeletalⅢ malocclusion. Methods A retrospective analysis of medical records was car-ried out in 30 patients with skeletalⅢ malocclusion treated in the Department of Stomatology, Guangyuan Central Hos-pital from Jan. 2013 to Dec. 2015, which were assigned to orthognathic-orthodontic surgical treatment (orthogna-thic-orthodontic group, 16 cases) and surgery-first approach (surgery-first group, 14 cases) according to treatment plans.Postoperative orthodontic time, and total treatment time in the two groups were recorded. Skeletal hard tissue (relation-ship between the position of maxilla and front and back position of cranial part [SNA], relationship between the positionof jawbone and front and back position of cranial part [SNB], relationship between front and back position of mandibleand maxillary bones [ANB], relationship between partes maxillaris of face and complete side [NA-PA]), dental changes(distance between upper-middle incisor long axis and NA connection [U1-NA], high and low central incisor long axis oftooth corner [U1-LI], degree of lip tilting of upper-middle incisor [U1-SN], degree of lip tilting of lower-middle incisor[L1-MP]), soft tissue change (distance from upper lip to Ricketts esthetic plane [UL-E], distance from lower lip to Rick-etts esthetic plane [LL-E]) before the treatment and after correction were determined. The first three resonance peak fre-quency value (F1, F2, F3) of 3 vowels (/a/, /i/, /u/) were compared. Results Postoperative orthodontic time in sur-gery-first group was significantly longer than orthognathic-orthodontic group, but total treatment time was significantlyshorter (P<0.05). After treatment, SNB, NA-PA, U1-NA, U1-LI and U1-SN in the two groups were significantly de-creased, while ANB, L1-MP, UL-E and LL-E were significantly increased (P<0.05). After treatment, SNB and NA-PA insurgery-first group were significantly higher than those in orthognathic-orthodontic group, while ANB, L1-MP were sig-nificantly lower (P<0.05). F2, F3 resonance peak frequency of /i/ vowel in the two groups after the treatment were signif-icantly decreased, while resonance peak frequency of /u/ vowel were significantly increased (P<0.05). There was no sig-nificant difference in other indexes between the two groups (P>0.05). Conclusion Surgery-first approach and orthogna-thic-orthodontic surgical treatment can both improve soft tissue profile, mispronunciations, but the former can shortencourse of treatment and the latter has more advantages in improving skeletal inharmonious.
      【Key words】 SkeletalⅢ malocclusion; Surgery-first; Orthognathic-orthodontic;