锥形束CT研究上颌反复扩缩前方牵引后上颌骨缝的三维变化

doi:10.19723/j.issn.1671-167X.2022.02.024

摘要/Abstract

摘要：

目的: 使用锥形束CT (cone-beam computed tomography,CBCT)影像研究上颌反复快速扩缩前方牵引后上颌及周围骨缝的三维变化,探讨该变化与颧颌缝成熟度之间的关系,分析上颌前移的影响因素,为骨性Ⅲ类错牙合畸形的早期治疗提供参考。方法: 选择36例上颌后缩患者,使用随机化区组设计分为单次扩弓组和反复扩缩组(临床试验注册号:ChiCTR2000034909), 患者7~13岁,安氏Ⅲ类错牙合,前牙反牙合,头影测量显示ANB角<0°,Wits值<-2 mm,上齿槽座点(A点)至过鼻根点(N点)的眼耳平面垂线的距离(A-Np)<0 mm。单次扩弓组行上颌单次快速扩弓后面罩前方牵引,反复扩缩组行上颌反复快速扩缩后面罩前方牵引。使用Dolphin 11.7软件对每组治疗前后的CBCT影像进行头位校正,使用Mimics 10.01软件进行三维重建,测量上颌骨及其周围骨缝标志点,使用独立样本t检验、双因素方差分析、Pearson相关性分析和回归分析进行统计学分析。结果: 除2例患者未完成复诊随访外,其余34例患者均完成治疗。与单次扩弓组相比,反复扩缩组患者治疗后上颌及周围骨缝标志点矢状前移量更大,颧颞缝、颧颌缝及颧额缝标志点矢状向分别前移1.21 mm、2.20 mm及1.43 mm,组间差异均有统计学意义(P<0.05)。除颧颞缝外,其余骨缝标志点矢状向前移量不受颧颌缝成熟度影响(P>0.05)。反复扩缩组治疗后,颧颌缝标志点和A点矢状向前移量之间相关性较强(P<0.01),回归分析R²=42.5%。结论: 与上颌单次快速扩弓相比,上颌反复快速扩缩前方牵引对于早期治疗上颌后缩可能效果更佳;上颌反复快速扩缩前方牵引后,颧颌缝作为上颌矫形力作用的主要骨缝之一,其矢状向前移量与上齿槽座点的前移量相关性较强。

关键词: 错牙合, 安氏Ⅲ类, 上颌骨, 腭扩张术, 颅缝, 锥形束CT

Abstract:

Objective: To assess three-dimensional (3D) changes of circummaxillary sutures following maxillary protraction with alternate rapid palatal expansions and constrictions (RPE/C) facemask protocol in maxillary retrusive children, and to investigate the relationship between the changes of circum-maxillary sutures and zygomaticomaxillary suture (ZMS) maturation, and to explore the factors of maxilla forward movement with RPE/C and facemask. Methods: In the study (clinical trial registration No: ChiCTR2000034909), 36 maxillary retrusive patients were recruited and block randomized to either the rapid palatal expansion (RPE) group or the RPE/C group. Patients aged 7 to 13 years, Class Ⅲ malocclusion, anterior crossbite, ANB less than 0°, Wits appraisal less than -2 mm, and A-Np less than 0 mm were included in the study. The RPE group received rapid palatal expansion, whereas the RPE/C group received alternate rapid palatal expansions and constrictions, and both with facemask protraction. Head orientations of cone-beam computed tomography (CBCT) images were implemented by Dolphin 11.7. 3D measurements of circummaxillary sutures on CBCT images were evaluated using Mimics 10.01 before (T0) and after treatment (T1). The changes were analyzed with independent t test, two-way ANOVA, Pearson correlation and regression analysis. Results: Two subjects in the RPE/C group were lost to follow-up. A total of 34 patients reached the completion criteria and were analyzed. Compared with the RPE group, sagittal changes of circummaxillary sutures were significantly increased in the RPE/C group with 1.21 mm advancement of zygomaticotemporal suture, 2.20 mm of ZMS, 1.43 mm of zygoma-ticofrontal suture (P<0.05, respectively). Except for the zygomaticotemporal suture, the rest forward sagittal changes of other circummaxillary sutures showed no major difference in terms of the ZMS maturation. The Spearman’s correlation in RPE/C indicated a strong positive correlation of sagittal changes between ZMS and point A (P<0.01) with a regression analysis R ²=42.5%. Conclusion: RPE/C might be more effective on the treatment of maxillary retrusive children. As one of the major mechanical loading sutures during orthopedic therapy, ZMS showed a strong positive correlation with point A on sagittal changes.

Key words: Malocclusion, angle class Ⅲ, Maxilla, Palatal expansion technique, Cranial sutures, Cone-beam computed tomography

中图分类号:

R783.5

刘伟涛,王怡然,王雪东,周彦恒. 锥形束CT研究上颌反复扩缩前方牵引后上颌骨缝的三维变化[J]. 北京大学学报（医学版）, 2022, 54(2): 346-355.

LIU Wei-tao,WANG Yi-ran,WANG Xue-dong,ZHOU Yan-heng. A cone-beam computed tomography evaluation of three-dimensional changes of circummaxillary sutures following maxillary protraction with alternate rapid palatal expansions and constrictions[J]. Journal of Peking University (Health Sciences), 2022, 54(2): 346-355.

图/表 7

图1

图2

表1

单次扩弓组和反复扩缩组患者基本情况和基线资料比较"

Items	RPE group	RPE/C group	P value
Gender (female/male)	11/7	10/6	0.934
Zygomaticomaxillary suture maturational stages (B/C)	9/9	8/8	>0.999
Age/years, $x -$ ±s	9.80±1.31	10.27±1.56	0.342
A-CRP/mm, $x -$ ±s	75.30±4.00	76.99±4.64	0.264
A-HRP/mm, $x -$ ±s	-27.22±2.51	-27.15±3.36	0.943
ZTM-CRP/mm, $x -$ ±s	41.31±2.16	41.49±2.64	0.827
ZTM-HRP/mm, $x -$ ±s	-2.83±1.23	-2.16±1.89	0.237
ZTM width/mm, $x -$ ±s	109.84±6.11	109.83±4.57	0.995
ZMM-CRP/mm, $x -$ ±s	64.09±2.89	64.65±3.79	0.625
ZMM-HRP/mm, $x -$ ±s	-9.76±1.59	-9.24±1.89	0.394
ZMM width/mm, $x -$ ±s	67.05±3.81	68.04±3.60	0.444
ZFM-CRP/mm, $x -$ ±s	62.20±3.15	62.46±3.00	0.804
ZFM-HRP/mm, $x -$ ±s	23.12±1.93	23.47±2.22	0.628
ZFM width/mm, $x -$ ±s	93.28±5.25	92.81±3.96	0.770
Protraction time/month, $x -$ ±s	8.84±4.19	8.45±2.76	0.750
Total treatment time/month, $x -$ ±s	9.57±4.17	10.95±2.82	0.262

表1

表2

单次扩弓组和反复扩缩组患者治疗前后三维方向变化的比较"

Items	RPE group/mm, $x -$ ±s	RPE/C group/mm, $x -$ ±s	Net differences (95%CI)	P value
Sagittal
A-CRP	2.16±1.27	3.06±1.29	-0.91 (-1.80, -0.01)	0.047
ZTM-CRP	0.52±1.10	1.21±0.53	-0.69 (-1.31, -0.08)	0.029
ZMM-CRP	1.53±0.78	2.20±0.72	-0.67 (-1.20, -0.14)	0.014
ZFM-CRP	0.36±1.08	1.43±1.00	-1.07 (-1.80, -0.34)	0.006
Vertical
A-HRP	-0.47±1.52	-1.20±2.03	0.73 (-0.51, 1.98)	0.239
ZTM-HRP	-0.01±1.00	-0.48±0.98	0.47 (-0.23, 1.16)	0.183
ZMM-HRP	0.13±1.18	-0.53±1.58	0.66 (-0.31, 1.62)	0.175
ZFM-HRP	0.58±1.50	0.01±1.42	0.57 (-0.46, 1.59)	0.267
Transverse
ZTM width	1.74±1.27	1.86±1.22	-0.12 (-0.99, 0.75)	0.784
ZMM width	2.45±0.83	2.98±1.29	-0.53 (-1.30, 0.25)	0.177
ZFM width	1.69±0.92	1.52±0.78	0.16 (-0.44, 0.76)	0.590

表2

表3

颧颌缝成熟度B级和C级治疗前后三维方向变化的比较"

Items	Stage B/mm, $x -$ ±s	Stage C/mm, $x -$ ±s	Net differences (95%CI)	P value
Sagittal
A-CRP	2.52±1.26	2.65±1.45	-0.13 (-1.08, 0.82)	0.783
ZTM-CRP	1.16±0.97	0.53±0.80	0.63 (0.00, 1.25)	0.049
ZMM-CRP	1.73±0.70	1.97±0.92	-0.24 (-0.81, 0.33)	0.398
ZFM-CRP	0.59±1.11	1.13±1.18	-0.54 (-1.34, 0.26)	0.180
Vertical
A-HRP	-0.91±1.89	-0.72±1.74	-0.19 (-1.46, 1.08)	0.764
ZTM-HRP	-0.11±1.15	-0.35±0.86	0.24 (-0.47, 0.95)	0.502
ZMM-HRP	-0.01±1.45	-0.36±1.37	0.35 (-0.64, 1.33)	0.477
ZFM-HRP	0.56±1.78	0.05±1.08	0.51 (-0.52, 1.53)	0.322
Transverse
ZTM width	1.49±1.14	2.11±1.26	-0.62 (-1.46, 0.22)	0.143
ZMM width	2.74±1.11	2.65±1.10	0.09 (-0.68, 0.86)	0.813
ZFM width	1.55±1.00	1.67±0.69	-0.12 (-0.72, 0.49)	0.699

表3

表4

表5

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Source of variation		Sum of squares	Mean square	F value	P value
A-CRP	Treatment	6.97	6.97	4.28	0.047
	ZMS stage	0.23	0.23	0.14	0.709
	Treatment×ZMS stage	3.15	3.15	1.94	0.174
ZTM-CRP	Treatment	4.06	4.06	6.30	0.018
	ZMS stage	3.02	3.02	4.68	0.039
	Treatment×ZMS stage	2.08	2.08	3.22	0.083
ZMM-CRP	Treatment	3.82	3.82	6.73	0.015
	ZMS stage	0.56	0.56	0.98	0.330
	Treatment×ZMS stage	0.63	0.63	1.11	0.302
ZFM-CRP	Treatment	9.64	9.64	8.94	0.006
	ZMS stage	2.49	2.49	2.31	0.139
	Treatment×ZMS stage	0.03	0.03	0.03	0.871
A-HRP	Treatment	4.56	4.56	1.37	0.251
	ZMS stage	0.37	0.37	0.11	0.742
	Treatment×ZMS stage	0.99	0.99	0.30	0.590
ZTM-HRP	Treatment	1.84	1.84	1.77	0.194
	ZMS stage	0.48	0.48	0.46	0.502
	Treatment×ZMS stage	0.00	0.00	0.00	0.952
ZMM-HRP	Treatment	3.65	3.65	1.85	0.184
	ZMS stage	0.93	0.93	0.47	0.497
	Treatment×ZMS stage	0.64	0.64	0.32	0.574
ZFM-HRP	Treatment	2.73	2.73	1.28	0.266
	ZMS stage	1.92	1.92	0.90	0.350
	Treatment×ZMS stage	2.44	2.44	1.15	0.293
ZTM width	Treatment	0.12	0.12	0.08	0.783
	ZMS stage	3.42	3.42	2.25	0.144
	Treatment×ZMS stage	0.60	0.60	0.40	0.533
ZMM width	Treatment	2.34	2.34	1.97	0.171
	ZMS stage	0.11	0.11	0.09	0.766
	Treatment×ZMS stage	1.14	1.14	0.96	0.335
ZFM width	Treatment	0.22	0.22	0.29	0.592
	ZMS stage	0.16	0.16	0.21	0.649
	Treatment×ZMS stage	1.11	1.11	1.49	0.232

Items	Pearson correlation coefficient of A-CRP	P
ZTM-CRP	0.026	0.924
ZMM-CRP	0.652	0.006
ZFM-CRP	0.083	0.761