摘要
目的:探讨半侧颜面短小畸形(HFM)患者在下颌牵引成骨术后出现的髁突吸收情况及影响因素。方法:回顾性分析2008年10月至2021年8月,在中国医学科学院整形外科医院颌面整形中心行下颌牵引成骨术治疗的HFM患者的临床资料。利用数字化软件ProPlan CMF 3.0对术前及取出延长器前的CT图像进行三维重建,测量髁突的高度与体积,所得数据进行统计学分析。根据术前、后髁突高度和体积的变化,可计算髁突高度吸收率和体积吸收率。Ⅱa型与Ⅱb型,佩戴与未佩戴口腔颌板,以及童年期与青春期半侧颜面短小患者间的患侧髁突体积吸收率比较,采用Mann-Whitney U检验,患侧髁突体积吸收率及患侧髁突高度吸收率与牵引距离、术前髁突高度、患者手术年龄、延长器置入时间各指标间的关系,采用Spearman相关分析,P<0.05为差异有统计学意义。结果:纳入47例Ⅱa型HFM患者,其中男36例,女11例,初诊年龄为(8.49±2.60)岁(5~20岁),童年期(5~<10岁)36例,青春期(10~20岁)11例;46例Ⅱb型HFM患者,其中男34例,女12例,初诊年龄为(8.93±3.43)岁(5~20岁),童年期(5~<10岁)36例,青春期(10~20岁)10例。Ⅱa型及Ⅱb型HFM患者术后随访时间分别为(9.22±2.21)个月、(9.79±2.59)个月,面部不对称情况得到有效改善,CT示骨断端成骨良好,张闭口活动、语音、进食等均正常。Ⅱa型HFM患者的患侧髁突体积吸收率为34.8%(19.1%,54.3%),其与牵引距离存在中等程度的相关性(r=0.46,P=0.001),与术前髁突高度(r=-0.12,P=0.421)、患者年龄(r=-0.06,P=0.691)及延长器置入时间(r=-0.10,P=0.517)无相关性。Ⅱb型HFM患者的患侧髁突体积吸收率为61.0%(11.2%,95.0%),与术前髁突高度存在中等程度的负相关性(r=-0.45,P=0.002),与牵引距离相关性较弱(r=0.29,P=0.049),与患者年龄(r=0.06,P=0.705)及延长器置入时间(r=0.21,P=0.157)无相关性,Ⅱa型与Ⅱb型HFM患者的患侧髁突体积吸收率比较,差异无统计学
Objective To investigate the condylar resorption and influencing factors in post mandibular distraction osteogenesis of the hemifacial microsomia patients.Methods This retrospective study investigated the clinical data of hemifacial microsomia patients who underwent mandibular distraction osteogenesis in the Department of Maxillofacial Surgery,Plastic Surgery Hospital,Chinese Academy of Medical Sciences from October 2008 to August 2021.Three-dimensional models of pre-operation and pre-distractor extraction were created by the analysis of CT data via ProPlan CMF 3.0.The height and volume of the condyle were measured.Data were analyzed statistically.According to the changes of condylar height and volume pre-and post-operation,the condylar height resorption rate and volume resorption rate could be calculated.The volume resorption rate of the affected side between Type-Ⅱa and Type-Ⅱb hemifacial microsomia patients,hemifacial microsomia patients whether wearing a bite plate,prereproductive and adolescent hemifacial microsomia patients were compared with the Mann-Whitney U test.The Spearman correlation coefficient analysis was used to determine the correlations of the condylar volume resorption rate and condylar height resorption rate in the affected side with measurements of elogation distance,preoperative condylar height,patient age,and distractor remaining time in mandible.P<0.05 indicates that the difference was statistically significant.Results Forty-seven Type-Ⅱa hemifacial microsomia patients(36 male patients,11 female patients)were included,patient age ranged from 5 to 20 years and the mean age was(8.49±2.60)years,36 patients were in the prereproductive age(5-<10 years old),and 11 patients were in the adolescent age(10-20 years old).Forty-six Type-Ⅱb hemifacial microsomia patients(34 male patients,12 female patients)were included,patient age ranged from 5 to 20 years and the mean age was(8.93±3.43)years.Thirty-six patients were in the prereproductive age(5-<10 years-old),and ten patients were in the a
作者
舒凯翊
赵久丽
刘伟
张智勇
珊巴嘎
李曦源
马伦昆
Shu Kaiyi;Zhao Jiuli;Liu Wei;Zhang Zhiyong;Shan Baga;Li Xiyuan;Ma Lunkun(Department of Maxillofacial Surgery,Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100144,China)
出处
《中华整形外科杂志》
CSCD
2023年第1期10-18,共9页
Chinese Journal of Plastic Surgery
基金
中国医学科学院医学与健康科技创新工程(2021-I2M-1-068)。
关键词
下颌骨
骨生成
牵张
颞下颌关节
髁突
骨吸收
半侧颜面短小
Mandible
Osteogenesis,distraction
Temporomandibular joint
Condylar process
Bony resorption
Hemifacial microsomia
