朱 菲　何冬梅　郝 静　王天丛

[關键词]正畸正颌联合矫治;骨性Ⅲ类错牙合畸形;前牙区;牙槽骨厚度

[中图分类号]R783.5    [文献标志码]A    [文章编号]1008-6455（2021）12-0147-05

The Clinical Effect of Combined Orthodontics and Orthognathic Treatment on Skeletal Class Ⅲ Malocclusion

ZHU Fei， HE Dong-mei， HAO Jing， WANG Tian-cong

（Department of Orthodontics， Nanjing Stomatological Hospital， Medical School of Nanjing University， Nanjing 210008，Jiangsu，China）

Abstract： Objective Analysis of the clinical effects of combined orthodontics and orthognathic treatment on patients with skeletal Class Ⅲ malocclusion. Methods  To select 30 cases of skeletal Class III malocclusion patients collected by the hospital from January 2016 to March 2018，all perform orthodontic and orthognathic combined treatment in the hospital.To evaluate the soft and hard tissue changes and the thickness of the alveolar bone in the anterior teeth before and after treatment， and to evaluate the quality of life. Results  After the operation， the face and middle 1/3 ratio of the face is coordinated， the chin point is good， the lips are closed naturally， the temporomandibular joint has no tenderness， and the movement is no bounce.The chewing and swallowing functions are restored.The postoperative facial lobes and nasolabial angles were higher than those before surgery， the chin-labial angles were lower than before surgery， MP-SN and L1-SA were lower than before surgery， TLL' and TBs were higher than those before surgery， and DA， DSN， DUI and DUL' are higher than before operation， the difference is statistically significant （P<0.05）. U1-SA， TSn， TUL'， TPos before and after operation are compared （P>0.05）.Postoperative UW， UW-m， UA， UP-m， LW， LW-m， LP， LP-m were lower than preoperatively， and LA was higher than preoperatively （P<0.05）.Preoperative and postoperative UA-m， Comparison of UP and LA-M （P>0.05）.The total OHRQOL score and the scores of each dimension were higher than that of the preoperative one month after orthognathic surgery （P<0.05），the total OHRQOL score and the scores of each dimension decreased after all treatments， and were lower than those before and after orthognathic surgery 1 month （P<0.05）. Conclusion  Patients with skeletal Class Ⅲ malocclusion received orthodontic treatment， with coordinated facial proportions， improved oral and jaw function， and improved soft and hard tissues after surgery. However， the thickness of the alveolar bone in the upper and lower anterior teeth will be reduced after the operation Therefore， clinicians should control tooth movement within a certain limit to reduce the loss of alveolar bone thickness.

Key words： orthodontic orthognathic syndrome; skeletal Class Ⅲ malocclusion; anterior teeth area; alveolar bone thickness

骨性Ⅲ类错牙合畸形患者主要表现为下颌前突或（和）上颌后缩，伴（或不伴）下颌偏斜;侧貌呈现新月形[1]。一直以来，该病属于一种易复发、处理棘手的颌骨畸形，据不完全统计，亚洲人患病率达到14%，我国发生率高达12.8%[2]。严重骨性Ⅲ类错牙合畸形不仅会影响患者美观，使心理健康、社会交往能力下降，也会影响患者的咀嚼、发音功能，导致生活质量显著下降。临床治疗时，根据青少年时期具备的生长潜力，通过上颌前牵引、功能矫治器等方法，能纠正错牙合畸形[3-4]。但成年畸形患者，生长发育已完成，若症状轻微、能接受容貌改变者，可尝试采用掩饰性正畸治疗。若患者过度重视容貌美观，或疾病表现严重，手术是其唯一治疗方法，其中正畸正颌联合是最佳治疗方案。本研究旨在探讨正畸正颌联合治疗后的临床效果，并观察是否会影响患者的牙槽骨厚度，现将结果报道如下。

1  资料和方法

1.1 临床资料：该研究符合笔者医院医学伦理委员会审批标准，并审核通过（批准文号：2015-5-12）。选取2016年1月-2018年3月医院收取的30例骨性Ⅲ类错牙合患者为研究对象，其中男12例，女18例，初诊年龄18～35岁，平均（24.18±1.36）岁;错牙合畸形严重程度分类，其中轻度18例，中度12例。自愿接受正畸正颌联合治疗。

1.2 纳入标准：①磨牙尖牙为近中关系;②骨性Ⅲ类错牙合畸形，下颌前突，ANB<0°，符合判定标准[5];③无正畸治疗史;④无唇腭裂畸形、口腔外伤史等;⑤具有完整的临床资料、影像学资料及随访资料;⑥患者对研究知情，签署同意书。……