改良Le Fort Ⅰ型截骨术+面中部植骨双颌手术矫治伴面中部凹陷成人骨性<br />Ⅲ类错牙合畸形临床分析<br />-《中国美容医学》

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Title:: Clinical Analysis of Double-jaw Surgery Using Modified Lefort Type I Osteomy with
Middle Bone Grafting in the Treatment of Adult Skeletal Type Ⅲ Malocclusion with
Maxillary Hypoplasia

文章编号:: 1008-6455(2021)10-0112-05

作者:: 蒋金宏; 曲卫国; 李阳; 于颖

Author(s):: JIANG Jin-hong; QU Wei-guo; LI Yang; YU Ying

关键词:: [关键词]改良Le Fort I型截骨术; 面中部植骨; 面中部凹陷; 骨性Ⅲ类错牙合

Keywords:: Key words:modified Le Fort Ⅰ osteotomy; middle bone grafting; midface concave; adult skeletal type Ⅲ malocclusion

分类号:: R782.2

文献标志码:: A

摘要:: [摘要]目的：探讨采用改良Le FortⅠ型截骨术+面中部植骨同期双颌手术矫治伴有上颌发育不足面中部凹陷的成人骨性Ⅲ类
错牙合畸形的临床效果。方法：选取笔者医院近3年收治的16例伴面中部凹陷的成人骨性Ⅲ类错牙合畸形患者作为研究对象，均
按正畸-正颌联合治疗模式，采用改良Le FortⅠ型截骨术+面中部植骨术+BSSRO+颏成形术同期双颌手术治疗，对治疗前后X
线头影测量19项软硬组织指标及3D重建软组织头颅面中部24个标记点的临床效果进行对比分析。结果：SNA、SNB、ANB、U1-
NA、L1-NB、Y值等14项硬组织指标，G-Sn-Pg’、Ls-EP、Li-EP、Cm-Sn-Ls 4项软组织指标手术前后对比，差异均具有统计
学意义（P ＜0.05），Si-LiPg无统计学意义（P ＞0.05）。面中部选取的24个标记点P值等于0，软组织变化量d值均不同，差
异显著，具有统计学意义（P ＜0.05）。术前术后3D软组织7个不同侧貌进行对比，发现各个侧平面的术后侧貌突度均较术前
有不同程度的改善。结论：改良Le Fort I型截骨术+面中部植骨手术具有操作相对简单，手术风险较低、植骨块来源直接、
并发症少等优点，不仅能矫正其异常咬合关系，恢复其正常口颌功能，还可获得令人满意的面容，尤其是在鼻旁、眶下、颧
部等面中部区域突度的改善、凹的侧貌趋向直面型或微突面型方面，患者容易接受，对于临床治疗此类畸形有一定的参考意
义。

Abstract:: Abstract:Objective To investigate the clinical effect of modified Le Fort I osteotomy combined with middle bone grafting in
the treatment of adult skeletal type Ⅲ malocclusion with maxillary hypoplasia,and to provide a certain reference for clinical
treatment. Methods From the last two years, 16 cases of adult patients with skeletal type Ⅲ malocclusion were selected as
research object,being treated with orthodontic and orthognathic treatment. The modified Le Fort I-type osteotomy,facial bone
grafting,BSSRO and chin angioplasty were all performed in the same period of jaw surgery, then make a comparative
analysis through the measurement of 19 soft and hard tissue indicators of the X-ray cephalometry before and after the
treatment and 24 soft tissue markers on the medial of craniofacial reconstructed by 3D. Results The differences were
statistically significant(P ＜0.05)before and after surgery in the soft tissue index of G-Sn-Pg’, Ls-EP, Li-EP and Cm-
Sn-Ls and 14 hard tissue indexes such as SNA, SNB, ANB, U1-NA, L1-NB and Y,while the Si-LiPg was nostatistical
significance (P ＞0.05).There was no significant difference between the two groups (P ＞0.05).The P value of 24 soft tissue
markers on the medial of craniofacial ware equal to 0, the change of d values are different, and the difference was significant
(P ＜0.05).Compared with the 7 different profiles of 3D soft tissue pre-post-operation, it was found that there was a different
degree of improvement on the postoperative profile protrusion of each plane. Conclusion The modified Le Fort I osteotomy
combined with middle bone grafting has such advantages such as relatively simple operation, lower risk of surgery,the source of
bone graft was directly,and less complications and so on. It’s not only to correct the abnormal occlusal relationship, to restore its
normal mouth and jaw function, but also to obtain a satisfactory face, especially in the nasal, suborbital, zygomatic.The concave
facet tends to face or micro-protrusion type, and the patient is easy to accept. It has some reference significance for the clinical
treatment of such deformities.

《中国美容医学》[ISSN:1008-6445/CN:61-1347/R]

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