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目的 :建立一种可同时反映上颌骨位置及姿势的三维测量方法 ,对唇腭裂患者上颌骨正颌术后的短期稳定性进行三维评估。方法:选取因唇腭裂继发上颌骨发育不足而行正颌手术的25例患者,按照患侧分为左侧唇腭裂组10例、右侧唇腭裂组8例、双侧唇腭裂组7例;收集术前6周(T0)、术后4天(T1)、术后3个月(T2)、6个月(T3)的全头颅螺旋CT资料,利用计算机辅助设计软件Pro Plan建立三维坐标系,设定22个描述上颌骨空间位置的指标,并定义3个姿势角∠PP-CP、∠RP-CP、∠YP-CP,分别表示上颌骨在空间内俯仰、侧滚、摆尾。利用SPSS16.0软件包对T2、T3时的测量结果进行配对t检验。结果 :成功建立了较为完整反映上颌骨空间位置及姿势的测量方法。在垂直向上,颌骨前部牙骨段向上的总体复发率为7.46%;在矢状向上,各组复发率分别为30.95%、8.01%和34.76%,无显著差异;在水平向上,单侧完全性唇腭裂组均出现整体向健侧平移,且前部偏向健侧、而后部偏向患侧偏转的复发趋势。结论:腭裂患者正颌术后上颌骨在三维方向内存在复发趋势,本研究建立的三维测量比二维研究能更有效地从平移和旋转的角度进行评估。
OBJECTIVE: To establish a three-dimensional (3D) measurement method that can simultaneously reflect the position and posture of the maxilla and evaluate the short-term stability of maxillary orthognathic surgery in patients with cleft lip and palate. Methods: Twenty-five patients undergoing orthognathic surgery due to cleft lip and palate secondary to maxillary hypoplasia were divided into three groups: left cleft lip and palate group (n = 10), right cleft palate group (n = 8) and cleft palate cleft palate group (n = 7) (T0), 4 days after operation (T1), 3 months after operation (T2) and 6 months (T3) were collected. Three-dimensional coordinates were obtained using computer-aided design software Pro Plan Department, set 22 indicators of the spatial location of the maxilla, and define the three posture angle ∠PP-CP, ∠RP-CP, ∠YP-CP, respectively, said the maxillary space pitch, roll, tail swing. Using SPSS16.0 package on T2, T3 when the measured results were paired t test. Results: A relatively complete measurement of maxillary space position and posture was successfully established. In the vertical direction, the overall recurrence rate of the anterior jaw segment was 7.46%, while in the sagittal direction, the recurrence rates were 30.95%, 8.01% and 34.76% respectively. There was no significant difference between the two groups Complete cleft lip and palate group showed the whole contralateral translation, and the front tend to the contralateral side, while the deviation of the ipsilateral tendon recurrence trend. CONCLUSIONS: Orthognathic surgery in patients with cleft palate present a recurrence trend in maxilla in three dimensions. The three-dimensional measurement established in this study is more efficient than two-dimensional studies in terms of translation and rotation.