骨性Ⅲ类错伴下颌偏斜患者行BSSRO术后近心骨段的三维变化及相关因素分析

doi:10.19438/j.cjoms.2025.02.006

摘要/Abstract

摘要： 目的：探讨骨性Ⅲ类错伴下颌偏斜患者术后近心骨段的稳定性及其影响因素,为术前数字化正颌手术方案设计提供参考。方法：纳入骨性Ⅲ类错畸形患者70例,其中非偏颌35例（A组,对照组）,偏颌35例（B组,实验组）,术中均行双侧下颌支矢状劈开截骨术（bilateral sagittal split ramus osteotomy,BSSRO）。获取患者术前1周（T0）、术后1周（T1）以及术后1年（T2）的CBCT数据,利用ProPlan CMF 3.0软件进行重建并分离,得到包含颞下颌关节窝不含下颌骨的3D头颅模型以及下颌骨模型,对不同时期双侧近心骨段的相关项目进行测量,包括近心骨段髁突中心点（CoC）、冠突点（Cor）以及下颌角点（Go）的连线所在的平面在三维空间上位置的移动和旋转变化,并分析影响骨性Ⅲ类错伴下颌偏斜患者行BSSRO术后近心骨段的稳定性因素。采用SPSS 27.0 软件包对数据进行统计学分析。结果：B组患者T0期的左右侧下颌升支在yaw和roll位置上的差异具有统计学意义（P<0.05）,其余时期无显著差异;与T0期比较,T1期2组患者双侧近心骨段均垂直向下移动、前倾、内旋（P<0.05）,同时B组中偏斜侧近心骨段外倾（roll）（P<0.05）,偏斜侧与偏斜对侧近心骨段在yaw和roll上的变化均具有统计学意义（P<0.05）;B组患者的偏斜侧近心骨段的内旋量和外倾量与术前下颌偏斜量有一定相关性（r值分别为-0.590和0.573）;与T1期比较,T2期2组患者双侧近心骨段均垂直向上移动、后倾、外展（P<0.05）,且B组偏斜侧近心骨段整体水平向内侧移动（P<0.05）;利用ROC曲线获取引起偏斜侧近心骨段水平向复发的术前偏斜量的截断值为6.31 mm,对于术前偏斜量大于6.31 mm的患者,偏斜侧近心骨段在水平向的变化具有统计学意义（P<0.05）。结论：骨性Ⅲ类错伴下颌偏斜患者行BSSRO术后偏斜侧近心骨段较不稳定,可能发生水平内侧移位。若术前下颌偏斜量较大（大于6.31mm）,术前进行数字化正颌手术方案设计时,应警惕术后偏斜侧近心骨段可能发生水平向内侧移动而加重或者引起颞下颌关节紊乱,以及术后复发的风险。

关键词: 骨性Ⅲ类错, 下颌偏斜, 双侧下颌支矢状劈开截骨术, 近心骨段, 稳定性

Abstract: PURPOSE: To investigate the stability and influencing factors of proximal bone segment in patients with bony Class Ⅲ malocclusion with mandibular deviation after surgery, and to provide reference for the design of preoperative digital orthognathic surgery. METHODS: Seventy patients with bony Class Ⅲ malocclusion were included in this study, which included 35 patients with non-deviated jaws (group A) and 35 patients with deviated jaws(group B), all of them underwent bilateral sagittal split ramus osteotomy(BSSRO). CBCT data were obtained from the patients at 1 week preoperatively(T0), 1 week postoperatively(T1), and 1 year postoperatively (T2). ProPlan CMF 3.0 software was used for reconstruction and separation, and three-dimensional models of the upper and lower jaws were obtained. Relevant items on bilateral paracardial bone segments were measured at different periods. The spatial position movement and rotation of the plane where the connections of the proximal condyle center(CoC), coronoid point(Cor) and mandibular angle point(Go) were located were included. The factors affecting the stability of proximal bone segment after BSSRO in patients with bony Class Ⅲ malocclusion and mandibular deviation were analyzed. SPSS 27.0 software package was used for data analysis. RESULTS: There were statistically significant differences in yaw and roll positions of left and right mandibular ascending branches in group B at stage T0(P< 0.05), but no significant differences in other stages. Compared with stage T0, both proximal cardial segments moved vertically downward, tilted forward, and rotated in patients in stage T1(P< 0.05); meanwhile, in group B, skewed proximal cardial segment rolled(P< 0.05), and the changes of yaw and roll in the skewed and oblique proximal cardial segments were statistically significant(P< 0.05). In group B, the internal rotation and extroversion of the oblique side were correlated with the preoperative mandibular deviation (R-values were -0.590 and 0.573, respectively). Compared with T1, the proximal core segment in T2 group moved vertically upward, tilted backward and abducted (P< 0.05), and the proximal core segment in group B moved horizontally to the medial side as a whole(P< 0.05). ROC curve was used to obtain the preoperative truncation value of the skew of the skew proximal bone segment that caused the horizontal recurrence of the skew proximal bone segment, which was 6.31mm. For patients with skew greater than 6.31mm before surgery, the horizontal change of the skew proximal bone segment had statistical significance(P< 0.05). CONCLUSIONS: The proximal bone segment on the deviated side is more unstable after BSSRO in patients with bony Class Ⅲ malocclusion with mandibular deviation, and may be displaced horizontally and medially. If the preoperative mandibular deviation is large(more than 6.31 mm), when designing the preoperative digital orthognathic surgery plan, it is necessary to be aware of the horizontal movement of the proximal cardiac segment of the postoperative deviation to the medial side, which may aggravate or cause temporomandibular joint disorder, and the risk of postoperative recurrence.;

Key words: Bony Class Ⅲ malocclusion, Mandibular deviation, Bilateral sagittal split ramus osteotomy, Proximal bone segment, Stability

中图分类号:

R782.2

宋鑫利, 胥雷, 李敏, 李大鲁. 骨性Ⅲ类错伴下颌偏斜患者行BSSRO术后近心骨段的三维变化及相关因素分析[J]. 中国口腔颌面外科杂志, 2025, 23(2): 137-144.

SONG Xin-li, XU Lei, LI Min, LI Da-lu. Three-dimensional changes and related factors of proximal bone segments after BSSRO in patients with bony Class Ⅲ malocclusion and mandibular deviation[J]. China J Oral Maxillofac Surg, 2025, 23(2): 137-144.

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