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目的:基于颈椎骨龄定量分期法(Quantitative Cervical Vertebral Maturation,QCVM),探讨上颌发育正常的安氏II类I分类错牙合畸形患者的最佳矫形治疗时机。方法:随机选择在武汉协和医院口腔正畸科就诊的上颌发育正常、表现为安氏II类I分类错牙合畸形的患者,根据颈椎骨龄定量分期法(QCVM),双盲法将患者分为四期:QCVM第I期(加速期)、QCVM第II期(高峰期)、QCVM第III期(减速期)、QCVM第IV期(结束期),每期30例共120例患者入选。年龄8.2～16.1岁(平均年龄12.9岁,其中男62例,女58例)。分别利用Twin-block功能矫治器导下颌向前,改善颌骨畸形,疗程约7个月。治疗前后均拍摄X线头颅侧位片,对各参数指标进行测量分析比较。结果:颈椎骨龄不同时期的患者,矫治后面型均有不同程度的改善,在QCVM I期、II期和III期,SNB、ANB、Ar-Gn等骨骼测量参数治疗前后有显著性变化(P<0.05),治疗前后参数变化绝对值的顺序依次为:QCVM II期>QCVM III期>QCVM I期>QCVM IV期。而L1-NB、U1-L1等角度测量参数在QCVM IV期变化较明显(P<0.05)。结论:颈椎骨龄定量分期法能准确评估在不同的骨龄发育阶段下颌骨的生长发育潜力,在预测下颌骨矫形治疗的最佳时机方面有较好的指导意义。
OBJECTIVE: To investigate the optimal timing of orthopedic surgery in patients with maxillary normal Class Ⅱ division I malocclusion based on Quantitative Cervical Vertebral Maturation (QCVM). Methods: Patients with orthodontic maxillofacial disease treated at Department of Orthodontics in Peking Union Medical College Hospital were randomly selected. Patients with Class II malocclusion of Angle Class I malocclusion were randomly divided into four groups according to quantitative cervical cervical spine age (QCVM) Four phases: QCVM Phase I (acceleration phase), QCVM Phase II (peak phase), QCVM Phase III (deceleration phase), and QCVM Phase IV (termination phase). A total of 120 patients in each phase were enrolled. Aged 8.2 to 16.1 years (mean age 12.9 years, 62 males and 58 females). Twin-block appliance were used to guide the jaw forward, improve jaw deformity, the course of about 7 months. Before and after treatment were taken X-ray cephalograms, the parameters of the measurement analysis and comparison. Results: In the patients with different cervical skeletal ages, there was a significant improvement in the surface shape after treatment. The skeletal parameters such as SNB, ANB, Ar-Gn in QCVM stage I, II and III were significantly different before and after treatment (P < 0.05). The order of absolute value of parameter before and after treatment were as follows: QCVM II> QCVM III> QCVM I> QCVM IV. The parameters of angle measurement such as L1-NB and U1-L1 changed significantly in IV stage of QCVM (P <0.05). Conclusion: Quantitative staging method of cervical spine age can accurately evaluate the growth and development potential of mandible in different stages of skeletal age. It is helpful to predict the optimal timing of mandible orthopedic treatment.