口腔医学研究

口腔医学研究 ›› 2025, Vol. 41 ›› Issue (9): 806-813.DOI: 10.13701/j.cnki.kqyxyj.2025.09.012

• 口腔颌面外科学研究 • 上一篇    下一篇

骨性Ⅲ类错牙合畸形手术设计中上颌骨矢状向位置参考基准的对比研究

李婧怡, 万淑筠, 吕欣, 章茜, 王育新*   

  1. 南京大学医学院附属口腔医院,南京市口腔医院口腔颌面创伤正颌整形外科,南京大学口腔医学研究所 江苏 南京 210008
  • 收稿日期:2025-03-21 出版日期:2025-09-28 发布日期:2025-09-24
  • 通讯作者: * 王育新,E-mail: wangyuxin0212@126.com
  • 作者简介:李婧怡(1999~ ),女,乌鲁木齐人,硕士在读,主要从事口腔颌面外科相关临床研究。
  • 基金资助:
    南京市口腔医院高水平医院建设科研项目(编号:0224C039)

Comparative Analysis of Sagittal Maxillary Positioning Reference in Orthognathic Surgical Design of Skeletal Class Ⅲ Malocclusion

LI Jingyi, WAN Shujun, LV Xin, ZHANG Qian, WANG Yuxin*   

  1. Department of Oral and Maxillofacial Trauma Orthognathic Plastic Surgery, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Research Institute of Stomatology, Nanjing University, Nanjing 210008, China
  • Received:2025-03-21 Online:2025-09-28 Published:2025-09-24

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摘要： 目的: 对比骨性Ⅲ类错牙合畸形手术设计中,上颌骨矢状向位置参考基准与面中部软组织的相关性。方法: 收集2022年3月~2024年12月在南京市口腔医院口腔颌面外科就诊的骨性Ⅲ类错牙合畸形患者82例。收集术前1周和术后6月以上的螺旋CT影像资料,通过Mimics和ProPlan CMF行三维重建,测量颅面骨及面部软组织在水平向线距、矢状向线距、角度、鼻部相关指标等28项数据。使用GraphPad Prism对SNA、上颌深度(a-point-nasion vert distance,A-N)和GALL与28项面部测量指标行t检验和相关性分析。结果: 不同SNA分组(SNA<80°和SNA≥80°)的骨性Ⅲ类患者中,有4项面中部测量指标(鼻唇上角、双侧∠1与左侧∠3)存在统计学差异(P<0.05)。不同上颌深度(A-N<0和A-N≥0)的骨性Ⅲ类患者中,有9项面中部测量指标(鼻尖高度、鼻唇上角、左脸颊凸度、鼻下深度、双侧鼻翼深度、右侧∠1、双侧∠2)存在统计学差异(P<0.05)。不同GALL距离下(上切牙点距GALL<-2和上切牙点距GALL≥-2)骨性Ⅲ类患者中,有3项面中部测量指标(双侧脸颊凸度、右侧∠1)存在统计学差异(P<0.05)。A-N与13项面中部软组织参数呈显著相关(P<0.05),明显多于SNA(10项)和GALL(9项);在相关性参数中,A-N相关性最强。收集19例术后A-N为正常范围(0±2) mm患者进行术后验证,结果示术后A-N正常患者不同SNA分组间(80°≤SNA≤85°,n=11;SNA>85°或SNA＜80°,n=8)面中部软组织测量数据无显著统计学差异。结论: 与SNA和GALL相比, A-N与更多面中部软组织测量指标存在强相关性,能更敏感地反映面中部软组织的形态变化,可以在正颌设计中辅助确认上颌骨矢状向位置。

关键词: 正颌外科手术, 骨性Ⅲ类错牙合畸形, 上颌骨矢状向参数, 面部美学

Abstract: Objective: To compare the correlation between sagittal position reference of the maxilla and midfacial soft tissues in surgical design for skeletal Class Ⅲ malocclusion patients. Methods: Eighty-two patients of skeletal Class Ⅲ malocclusion were included in this study. They were treated at the Department of Oral and Maxillofacial Trauma Orthognathic Plastic Surgery, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Research Institute of Stomatology, Nanjing University from March 2022 to December 2024. The spiral computed tomography (SCT) were taken before and 6 months after surgery. The Mimics and ProPlan CMF were applied to perform three-dimensional reconstruction. Twenty-eight parameters of craniofacial bones and soft tissues, including horizontal/sagittal linear distances, angular measurements, and nasal-related indices were measured. The statistical analysis was performed between twenty-eight facial parameters and Sella-Nasion-A point angle (SNA), A-point-Nasion vert distance (A-N) and Goal Anterior Limit Line (GALL) by the GraphPad Prism. Results: In two SNA groups (SNA< 80° and SNA≥80° ), there were statistical differences in four indexes (superior nasolabial angle, bilateral ∠1, and left ∠3) (P<0.05). There were statistical differences in nine indexes (tip height, superior nasolabial angle, left cheek convexity, subnasal depth, bilateral nasal alar depth, right ∠1, bilateral ∠2) in two A-N groups (A-N<0 and A-N≥0) (P<0.05). The three indexes (bilateral cheek convexity, right ∠1) had statistical differences in two GALL groups (upper incisor point to GALL <-2 and upper incisor point to GALL ≥-2) (P<0.05). Compared with the SNA angle (10 parameters) and GALL (9 parameters), the amount and intensity of correlation between A-N and the midfacial soft tissue parameters were best (P <0.05). Furthermore, the nineteen postoperative patients which the A-N was in the normal range (0±2) mm were included and divided into two groups according SNA (80°≤SNA≤85°, n=11; SNA>85° or <80°, n=8). The results showed that there was no significant statistical difference in the midface soft tissue measurement between the two groups. Conclusion: Compared with SNA and GALL, the A-N had higher correlation with most midface soft tissue parameters, and could more sensitively reflect the profile changes of midface soft tissue.

Key words: orthognathic surgical procedures, skeletal Class Ⅲ malocclusion, maxillary sagittal parameters, esthetics