两种骨支抗牵引方法对唇腭裂术后上颌后缩患者疗效的对比研究

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目的:比较两种骨支抗前牵引方法治疗唇腭裂术后上颌后缩患者的疗效。方法:12例替牙晚期或恒牙早期唇腭裂上颌后缩患者,随机分为两组:A组上颌颧牙槽嵴处钛板配合面具前牵引;B组上、下颌钛板,配合颌间Ⅲ类牵引。牵引前后拍摄头颅侧位片进行比较。结果:A、B组牵引时间分别为12.1个月和12.5个月。A、B组上颌骨均发生明显前移,分别前移3.12及3.83 mm;颌骨间关系变得协调,ANB角分别增加3.69°及3.14°、Wit's值分别增加4.30及4.52 mm,软组织侧貌明显改善。然而,A组下颌骨发生了后下旋转及下切牙的舌倾。B组下颌骨发生了少量逆旋及下切牙轻度的唇倾。结论:上颌钛板面具牵引与上、下颌钛板颌间Ⅲ类牵引治疗替牙晚期及恒牙早期的唇腭裂上颌后缩患者均非常有效,但上、下颌钛板Ⅲ类牵引对垂直向控制更好,更有利于对高角病例的控制,受病例数量限制,还需要更大样本量的研究支持。“,”Objective:To compare the effects of 2 protocols of bone-anchored maxillary protraction for maxillary hypoplasia in post-surgery cleft patients .Methods:Twelve growing post-surgery cleft patients with maxillary deficiency in the late mixed or early permanent dentition were included in the study, and they were randomly divided into two groups. In group A (n n=6), skeletal-anchored facemasks were used with miniplates placed at the zygomatic buttress. In group B (n n=6), the patients were treated with Class Ⅲ elastics extending from infrazygomatic miniplates in the maxilla to symphyseal miniplates in the mandible. Cephalometric radiographs were analyzed before and after the protraction treatment.n Results:The protraction treatment periods were 12.1 and 12.5 months in groups A and B, respectively. The maxilla moved forward significantly in both groups (3.12 mm in group A, 3.83 mm in group B); The intermaxillary relationship variables (ANB, Wits appraisal) demonstrated highly significant improvements in two groups( 3.69°and 4.30 mm in group A, 3.14°and 4.52 mm in group B). Soft tissue harmony demonstrated great improvement. The mandible showed clockwise rotation with a downward and backward position and the mandibular incisors showed a significant retroclination in group A. However, group B showed a reduction of the mandibular plane angle and a slight proclination of the mandibular incisors.Conclusions:The two skeletal anchorage protocols for maxillary protraction effectively resolved the severe maxillary deficiently in growing cleft patients. However, Class Ⅲ elastics between miniplates can provide greater vertical closing of the mandibular plane than facemasks anchored with miniplates, which makes it a better choice in high angle patients. Due to the limited number of cases, a larger sample size is needed to support the study.
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