唇腭裂继发上颌骨发育不足牵引成骨后颌骨变化

目的　比较唇腭裂术后继发上颌骨发育不足患者颅外支架式牵引成骨术 (RigidExternalDistraction ,RED)前后上下颌骨前后向和垂直向位置及牙颌关系变化 ,评价RED治疗上颌发育不足效果。方法　唇腭裂术后继发上颌骨发育不足患者 2 2名 ,其中男性 1 4名 ,女性 8名 ,平均年龄为 1 5 3岁。所有患者在改良高位LeFortⅠ型截骨术基础上行颅外支架式上颌骨牵引成骨术。测量RED前后头颅定位侧位片上下颌骨位置及牙颌关系各项指标 ,用配对t检验比较RED术前术后变化。　结果　RED前后SNA角、NA与FH夹角、Ptm至S距离、Ptm至A距离、上中切牙至腭平面距离、上颌第一磨牙至腭平面距离、SNB角、面角、颌凸角、下颌平面角、ANB角、Y轴角、NA与AMe比、覆牙合和覆盖变化具高度显著性差异。　结论　RED用于唇腭裂术后继发上颌骨发育不足患者 ,可有效地延长上颌骨长度和高度并使之前移 ;下颌骨则顺时针旋转 ,上下颌骨间位置和比例更为协调 ,下颌骨的生长发育方向更趋于正常

SKELETAL PROFILE CHANGES IN CLEFT LIP AND PALATE PATIENTS AFTER MAXILLARY DISTRACTION OSTEOGENESIS

Objective This study was conducted to evaluate the skeletal profile changes after maxillary distraction osteogenesis by using a Rigid External Distraction Device (RED) in cleft lip and palate patients with maxillary dysplasia. Methods Twenty two cleft lip and palate patients with maxillary dysplasia were included in this study. There were 14 male and 8 female patients, with average age 15 3 years. All the patients underwent maxillary advancement with rigid external distraction after a high Le Fort I osteotomy. Pretreatment and post treatment lateral cephalograms were compared, and paired T test was used to evaluate the changes in skeletal profile. Results After RED, SNA, NA FH, distance of Ptm to S, distance of Ptm to A, distance of upper incisor to palated plane, distance of upper molar to palatal plane, SNB, facial angle, angle of convexity, MP FH, ANB, Y axis, NA:AMe, overjet and overbite changed significantly. Conclusion After maxillary RED, the length and height of maxilla increased; the maxilla moved forward; the mandible rotated clockwise; the position and proportion of maxilla and mandible harmonized more; and the vector of the development of the mandible was going to normal. Maxillary distraction osteogenesis by using RED improved the skeletal profile effectively.