均角型骨性Ⅲ类患者拔牙掩饰性或手术治疗后上气道容积和舌骨位置的比较

doi:10.7518/hxkq.2025.2024184

华西口腔医学杂志 ›› 2025, Vol. 43 ›› Issue (1): 53-62.doi: 10.7518/hxkq.2025.2024184

均角型骨性Ⅲ类患者拔牙掩饰性或手术治疗后上气道容积和舌骨位置的比较

徐景胙¹(), 刘浩洁¹^,²^,³, 林成钊¹, 刘振浩⁴, 翟烨¹, 郭舒瑜¹^,²^,³, 徐荣耀¹^,²^,³^,⁵()

^1.南京医科大学口腔医学院，南京 210029
^2.口腔疾病研究与防治国家级重点实验室培育建设点，南京 210029
^3.江苏省口腔转化医学工程研究中心，南京 210029
^4.徐州医科大学口腔医学院，徐州 221004
^5.南京医科大学附属口腔医院口腔颌面外科，南京 210029

收稿日期:2024-05-10 修回日期:2024-11-14 出版日期:2025-02-01 发布日期:2025-01-22
通讯作者: 徐荣耀 E-mail:cchsu@stu.njmu.edu.cn;rongyaoxu@njmu.edu.cn
作者简介:徐景胙，本科，E-mail：cchsu@stu.njmu.edu.cn
基金资助:
国家自然科学基金(82270943)

Comparison of upper airway volume and hyoid position after camouflage orthodontic or orthodontic-orthognathic treatment in patients with skeletal class Ⅲ malocclusion with normal-angle vertical pattern

ChingCho Hsu¹(), Liu Haojie¹^,²^,³, Lin Chengzhao¹, Liu Zhenhao⁴, Zhai Ye¹, Guo Shuyu¹^,²^,³, Xu Rongyao¹^,²^,³^,⁵()

^1.Stomatological College of Nanjing Medical University, Nanjing 210029, China
^2.State Key Laboratory Cultivation Base of Research, Prevention and Treatment for Oral Diseases, Nanjing 210029, China
^3.Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing 210029, China
^4.School of Stomatology, Xuzhou Medical University, Xuzhou 221004, China
^5.Dept. of Oral and Maxillofacial Surgery, the Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing 210029, China

Received:2024-05-10 Revised:2024-11-14 Online:2025-02-01 Published:2025-01-22
Contact: Xu Rongyao E-mail:cchsu@stu.njmu.edu.cn;rongyaoxu@njmu.edu.cn
Supported by:
The National Natural Science Foundation of China(82270943)

摘要/Abstract

摘要：

目的比较2种矫治方式对骨性Ⅲ类错畸形治疗的气道影响差异，尤其关注气道容积、形态、腭角、下颌旋转及骨位移等方面的具体改变，并通过寻找可能具有临床意义的气道指标，以期为预防OSAHS提供新的监测依据。方法选取2018年9月—2023年12月在南京医科大学附属口腔医院口腔正畸科临床诊断为骨性Ⅲ类错畸形患者36例，按照治疗方法不同，分为正畸正颌联合治疗组（n=18）和掩饰性治疗（n=18）组。通过比较术前、术后锥形束CT及三维头影测量分析气道容积、横径、腭角、下颌骨及舌骨等变化。结果掩饰性治疗后鼻咽容积、舌咽容积均有增大趋势，且差异有统计学意义（P<0.05）。正畸正颌联合治疗后鼻咽容积、气道鼻咽段和舌咽段横径、腭角、下颌旋转及舌骨位移的改变均有统计学意义（P<0.05）。2组患者治疗后比较，舌咽段横径、腭角及舌骨至蝶鞍点距离等变化具有统计学意义（P<0.05）。结论正畸正颌联合治疗组的患者在舌咽段截面积、腭角及舌骨的改变较掩饰性治疗组明显。OSAHS的易感人群多出现舌骨下移及气道最小截面积减小，因此在采取正畸正颌联合治疗方案时应格外注意其气道形态的改变，以避免造成不良后果。

关键词: 掩饰性正畸治疗, 正畸正颌联合治疗, 骨性Ⅲ类错牙合畸形, 气道容积, 舌骨位移, 阻塞性睡眠呼吸暂停低通气综合征

Abstract:

Objective This study aims to compare the effects of two orthodontic treatment modalities for skeletal class Ⅲ malocclusion on specific changes in airway volume, morphology, palatal angle, mandibular rotation, and bone displacement. Results provide scientific evidence for the selection of orthodontic treatment plans and reduce the risk of developing obstructive sleep apnea hypopnea syndrome (OSAHS). Methods Thirty-six patients diagnosed with skeletal class Ⅲ malocclusion at the Department of Orthodontics, the Affiliated Stomatological Hospital of Nanjing Medical University from September 2018 to December 2023 were divided into two groups: orthodontic-orthognathic treatment group (18 patients) and camouflage orthodontic treatment group (18 patients). Changes in airway volume, cross-sectional area, palatal angle, mandibular, and tongue positions were observed through pre- and post-operative cone beam computed tomography and 3D cephalometric measurements. Results In the camouflage orthodontic treatment group, nasopharyngeal volume and oropharyngeal volume statistically increased after treatment (P<0.05). In the orthodontic-orthognathic treatment group, changes in nasopharyngeal volume, nasopharyngeal airway, distance from posterior tongue to pharyngeal wall, palatal angle, mandibular rotation, and hyoid bone displacement were statistically significant after surgery (P<0.05). In the comparison between the two groups after treatment, changes in the distance from posterior tongue to pharyngeal wall, palatal angle, and distance from hyoid bone to sella turcica point were statistically significant (P<0.05). Conclusion Patients in the orthodontic-orthognathic treatment group showed significantly greater changes in oropharyngeal cross-sectional area, palate angle, and tongue position compared with patients in the camouflage orthodontic treatment group. As individuals susceptible to OSAHS often exhibit mandibular retrusion and decreased minimum airway cross-sectional area, special attention should be paid to airway morphology changes when adopting orthodontic-orthognathic treatment to avoid adverse consequences.

Key words: camouflage orthodontic treatment, orthodontic-orthognathic treatment, skeletal class Ⅲ malocclusion, airway volume, hyoid bone displacement, obstructive sleep apnea hypopnea syndrome

中图分类号:

R783.5

徐景胙, 刘浩洁, 林成钊, 刘振浩, 翟烨, 郭舒瑜, 徐荣耀. 均角型骨性Ⅲ类患者拔牙掩饰性或手术治疗后上气道容积和舌骨位置的比较[J]. 华西口腔医学杂志, 2025, 43(1): 53-62.

ChingCho Hsu, Liu Haojie, Lin Chengzhao, Liu Zhenhao, Zhai Ye, Guo Shuyu, Xu Rongyao. Comparison of upper airway volume and hyoid position after camouflage orthodontic or orthodontic-orthognathic treatment in patients with skeletal class Ⅲ malocclusion with normal-angle vertical pattern[J]. West China Journal of Stomatology, 2025, 43(1): 53-62.

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测量标志点	定义
后鼻棘点（PNS）	硬腭后部骨棘的顶端
颅底点（BA）	枕骨大孔前缘最低点
上牙槽座点（A）	前鼻棘与上牙槽缘间的弧形骨像最凹点
下牙槽座点（B）	下牙槽缘点与颏前点间的骨部最凹点
下颌角点（Go）	下颌角向外、后方最突出的点
舌根点（V）	舌根最靠后的点
H	舌骨最前上的点
蝶鞍点（S）	垂体窝中心
下颌平面（MP）	通过颏下点（Me）与下颌角下缘相切的线条
颏下点（Me）	下颌体（颏部）的最下点
鼻根点（N）	鼻额缝阴影的最前点
颏前点（Pog）	下颌颏部最前突点
颏后点（RGN）	下颌内侧最后点
前鼻棘点（ANS）	前鼻棘的顶端

测量指标		定义
上气道横径/mm	鼻咽段横径（NOP）	与咽壁相交的ANS-PNS平面
	腭咽段横径（UOP）	悬雍垂至咽后壁的距离
	舌咽段横径（TOP）	舌后至咽后壁的最短距离
	喉咽段横径（EOP）	会咽到咽后壁的最短距离
上气道容积/mm³	鼻咽容积	腭平面向咽后壁延长线、后鼻棘点、蝶鞍点所围成的容积
	腭咽容积	腭平面向咽后壁延长线与悬雍垂尖水平面间气道容积
	舌咽容积	悬雍垂尖水平面与会厌尖水平面间容积
	上气道总容积	鼻咽、腭咽、舌咽3个部分的总体容积
腭角/°	U-PNS-ANS	U-PNS、ANS-PNS两线夹角（钝角）
下颌平面角/°	SN-MP	前颅底平面（SN）与MP形成的夹角
舌骨位置/mm	H-FH	H与FH的垂直距离
	H-S	H与蝶鞍点（S）连线的垂直距离
	H-MP	H与MP的垂直距离
	H-PNS	H与PNS连线距离
	H-RGN	H与RGN连线距离
切牙内收量/mm	U1 tip dx	重叠治疗前后颅底平面，测量右上颌中切牙切缘的水平移动距离
	U1 root dx	重叠治疗前后颅底平面，测量右上颌中切牙牙根的水平移动距离
	U1 root dy	重叠治疗前后颅底平面，测量右上颌中切牙牙根的垂直移动距离
	U1 root dt	重叠治疗前后颅底平面，测量右上颌中切牙牙根的移动距离
	L1 tip dx	重叠治疗前后颅底平面，测量右下颌中切牙切缘的水平移动距离
	L1 root dx	重叠治疗前后颅底平面，测量右下颌中切牙牙根的水平移动距离
	L1 root dy	重叠治疗前后颅底平面，测量右下颌中切牙牙根的垂直移动距离
	L1 root dt	重叠治疗前后颅底平面，测量右下颌中切牙牙根的移动距离

测量指标		术前	术后	P值
上气道横径/mm	NOP	23.54±2.54	24.56±3.48	0.131 7
	UOP	10.36±3.03	10.16±2.21	0.628 7
	TOP	10.69±3.97	11.08±3.61	0.520 9
	EOP	5.79±2.38	5.89±2.47	0.848 8
上气道容积/mm³	鼻咽容积	6 088.61±1 848.89	6 790.17±1 740.99	0.009 0*
	腭咽容积	7 867.06±2 294.06	8 057.33±2 703.66	0.577 8
	舌咽容积	6 116.83±2 338.46	7 064.17±2 356.21	0.035 2*
	上气道总容积	20 072.50±4 833.42	21 911.67±5 231.83	0.154 2
腭角/°	U-PNS-ANS	123.64±6.42	125.27±7.96	0.306 0
下颌平面角/°	SN-MP	26.62±6.11	25.37±8.28	0.354 6
舌骨位置/mm	H-FH	-154.76±15.38	-138.97±78.36	0.167 4
	H-S	111.83±8.71	111.42±9.43	0.800 2
	H-MP	10.61±5.50	10.24±6.78	0.756 4
	H-PNS	53.91±5.44	52.82±5.29	0.083 4
	H-RGN	38.69±6.00	38.52±7.23	0.914 6

测量指标		术前	术后	P值
上气道横径/mm	NOP	23.24±2.92	25.51±2.60	0.002 2*
	UOP	12.06±2.99	11.38±3.70	0.352 8
	TOP	13.04±3.28	11.97±2.84	0.003 7*
	EOP	7.45±3.67	7.54±2.66	0.184 4
上气道容积/mm³	鼻咽容积	6 387.33±1 655.65	7 236.89±2 058.89	0.001 9*
	腭咽容积	8 792.33±3 274.72	8 646.44±4 018.97	0.865 0
	舌咽容积	6 032.83±2 303.77	5 992.83±2 592.99	0.902 4
	上气道总容积	21 212.50±5 411.63	21 876.17±6 980.94	0.639 7
腭角/°	U-PNS-ANS	116.88±9.44	122.18±7.98	0.001 4*
下颌平面角/°	SN-MP	32.39±5.50	29.41±5.48	0.004 9*
舌骨位置/mm	H-FH	-119.77±106.50	-114.44±105.65	0.617 0
	H-S	109.53±11.19	114.25±13.27	0.005 4*
	H-MP	6.66±4.72	7.73±6.96	0.403 6
	H-PNS	55.66±5.15	56.97±6.56	0.282 2
	H-RGN	39.38±6.34	37.53±6.58	0.157 3

测量指标		掩饰性治疗组	正畸正颌联合治疗组	P值
上气道横径/mm	dNOP	1.02±2.72	2.27±2.67	0.173 6
	dUOP	-0.21±1.77	-0.68±3.03	0.567 8
	dTOP	0.39±2.52	-1.08±1.36	0.036 7*
	dEOP	0.11±2.25	0.09±1.92	0.690 0
上气道容积/mm³	d鼻咽容积	701.56±991.83	849.56±1 176.55	0.685 8
	d腭咽容积	190.28±1 422.57	-145.89±2 700.58	0.643 3
	d舌咽容积	947.33±1 756.02	-40.00±1 364.04	0.191 6
	d上气道总容积	1 839.17±2 799.52	663.67±4 035.73	0.317 1
腭角/°	dU-PNS-ANS	1.63±6.29	5.31±5.92	0.037 1*
下颌平面角/°	dSN-MP	-1.24±5.55	-2.98±3.58	0.275 1
舌骨位置/mm	dH-FH	15.79±83.14	5.33±21.66	0.311 7
	dH-S	-0.41±6.69	4.72±6.28	0.023 7*
	dH-MP	-0.37±4.93	1.07±5.28	0.919 0
	dH-PNS	-1.09±2.86	1.31±4.99	0.358 9
	dH-RGN	-0.17±6.71	-1.85±5.31	0.132 0
切牙内收量/mm	U1 tip dx	3.42±3.16	4.68±4.09	0.350 8
	U1 root dx	3.06±2.99	3.86±3.21	0.254 5
	U1 root dy	2.78±2.49	3.10±1.99	0.466 2
	U1 root dt	4.70±3.14	5.40±3.07	0.375 8
	L1 tip dx	3.85±3.10	7.13±5.19	0.013 8*
	L1 root dx	4.85±4.06	8.22±5.44	0.077 5
	L1 root dy	4.34±4.02	4.34±3.85	0.869 7
	L1 root dt	6.93±5.18	9.91±5.69	0.149 2

均角型骨性Ⅲ类患者拔牙掩饰性或手术治疗后上气道容积和舌骨位置的比较

Comparison of upper airway volume and hyoid position after camouflage orthodontic or orthodontic-orthognathic treatment in patients with skeletal class Ⅲ malocclusion with normal-angle vertical pattern

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测量指标	掩饰性治疗组			正畸正颌联合治疗组
测量指标	切牙内收量/mm	d舌咽体积/mm³	P值	切牙内收量/mm	d舌咽体积/mm³	P值
L1 tip dx	3.9±3.1	947.3±1 756.0	0.347 0	7.1±5.2	-40.0±1 364.0	0.772 3
L1 root dx	4.9±4.1		0.157 3	8.2±5.4		0.698 7
L1 root dy	4.3±4.0		0.413 6	4.3±3.9		0.612 7
L1 root dt	6.9±5.2		0.158 4	9.9±5.7		0.957 9

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[2]	刘奕陈燕包扬. 正畸正颌联合治疗颜面不对称患者头颅定位后前位片的非对称性分析[J]. 华西口腔医学杂志, 2014, 32(2): 138-145.
[3]	杨随兴封净张佐曲爰丽龚淼唐洁范俊恒李松青赵燕玲. 下颌逐步前伸对阻塞性睡眠呼吸暂停低通气综合征患者舌咽部影响的三维有限元研究[J]. 华西口腔医学杂志, 2013, 31(2): 150-153.