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目的 :评价正畸联合单颌或双颌手术治疗骨性Ⅲ类畸形对咽腔间隙短期及长期的影响。方法 :选取骨性Ⅲ类患者54例(男28例,女26例),A组(28例)采用正畸联合下颌支矢状劈开术治疗。B组患者(26例)采用正畸联合上颌支Le Fort I型加下颌矢状劈开术治疗,正畸治疗前1周(T0)、术后6个月(T1)及术后3年(T2)拍摄锥形束CT(CBCT),三维重建上气道模型,对治疗前、后各段矢状径、冠状径、截面积和容积进行定量分析。采用SPSS17.0软件包进行统计学分析,比较治疗前、术后6个月及3年上气道的三维变化。结果:A组患者术后6个月各段矢状径和截面积均显著减小(P<0.05),口咽段、舌咽段容积及总容积显著小于治疗前(P<0.05)。术后3年,除第一颈椎平面处矢状径和截面积恢复到治疗前水平(T2-T0:P>0.05,T2-T1:P<0.05)外,其余部位均有所增加但未恢复到治疗前水平。B组患者术后6个月第二、三、四颈椎平面处矢状径和截面积显著减少,但在术后3年大部分缩窄的部位恢复到治疗前水平。结论:正畸-正颌联合治疗骨性Ⅲ类畸形会造成咽腔缩窄,随着时间延长,会有一定程度的恢复,但不能完全恢复到治疗前水平。
OBJECTIVE: To evaluate the short-term and long-term effects of orthognathic surgery combined with maxilla or bimaxillary surgery on pharyngeal cavities. Methods: 54 cases of skeletal class Ⅲ patients (28 males and 26 females) were selected. Group A (28 cases) were treated by orthodontics and mandibular sagittal split. The patients in group B (26 cases) were treated with orthodontic maxillary branch combined with Fort I and mandibular sagittal split, one week before orthodontic treatment (T0), six months after operation (T1) and three years after operation T2), cone beam computed tomography (CBCT) and three-dimensional reconstruction of upper airway model. The sagittal diameter, coronal diameter, cross-sectional area and volume of each segment before and after treatment were quantitatively analyzed. SPSS17.0 software package was used for statistical analysis. The three-dimensional changes of upper airway before and 6 months and 3 years after operation were compared. Results: The sagittal diameter and cross-sectional area of each group were significantly decreased at 6 months after operation (P <0.05). The volume and total volume of pharyngeal and pharyngeal segments were significantly lower than those before treatment (P <0.05). At 3 years after operation, all other sites were increased but not recovered except for the sagittal diameter and cross-sectional area of the first cervical vertebra restored to the level before treatment (T2-T0: P> 0.05, T2-T1: P <0.05) To the level before treatment. In group B, the sagittal diameter and cross-sectional area of the second, third and fourth cervical vertebrae at 6 months postoperatively decreased significantly, but most of the narrowed sites returned to pretreatment levels at 3 years postoperatively. Conclusion: Orthodontics and orthognathic treatment of skeletal Class Ⅲ deformity can cause pharyngeal constriction, with the extension of time, there will be a certain degree of recovery, but not fully restored to pre-treatment levels.