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目的:研究强支抗结合拔牙矫治而产生的大幅度切牙后移对年轻成年错畸形患者上气道大小的影响,探讨牙齿位置及颌面形态变化与上气道大小之间的相关性。方法:随机选择31例拔除4个第一前磨牙并使用强支抗(种植支抗或口外弓加TPA)和21例非拔牙的错畸形矫治完成病例,测量矫治前后的X线头颅定位侧位片,将测量数据进行配对t检验,单因素相关分析及多因素回归分析。结果:非拔牙组患者矫治前后牙颌面及上气道测量参数均无显著性变化(P>0.05)。强支抗拔牙组患者矫治前后,上下切牙明显后移(U1-Y、L1-Y,P<0.01),而上下磨牙无明显前移(U6-Y、L6-Y,P>0.05);软腭后气道间隙(SPAS,P<0.01)、软腭尖后气道间隙(MAS,P<0.05)及舌根后气道间隙(IAS,P<0.01)均显著减小。单因素相关分析结果显示,SPAS及IAS改变量与L1-Y距改变量呈正相关(P<0.05),MAS改变量与U1-Y距改变量呈正相关(P<0.05)。多因素回归分析结果显示,SPAS改变量与L1-Y及SNA改变量呈正相关(P<0.05);MAS改变量与U1-Y及SNB改变量呈正相关(P<0.05);IAS改变量与U1-Y及L1-Y改变量呈正相关(P<0.05)。结论:因拔牙矫治结合强支抗而产生的大幅度切牙后移会引起上气道各水平前后径减小,切牙前后向位置的明显改变与上气道大小改变相关。
OBJECTIVE: To study the effect of maxillary incisors and posterior approach on the size of upper airways in young adult patients with malocclusion, and to explore the correlation between tooth position, maxillofacial morphology and upper airway size . Methods: Totally 31 cases were enrolled in this study. Four cases of first premolar removal were treated with strong support (implanting support or extra-corporeal arch plus TPA) and 21 cases of non-extracranial malformation. The X-ray cranial positioning Bit-slice, the measured data were paired t-test, single factor correlation analysis and multivariate regression analysis. Results: There was no significant difference in maxillofacial and upper airway parameters before and after treatment in non-extractive group (P> 0.05). Before and after the treatment, the upper and lower incisors were significantly displaced (U1-Y, L1-Y, P <0.01), while the upper and lower molar did not significantly advance (U6-Y, L6-Y, P> 0.05). The posterior airway clearance (SPAS, P <0.01), the posterior airway clearance (MAS, P <0.05) and the posterior lingual airway clearance (IAS, P <0.01) were significantly reduced after soft palate. The result of univariate analysis showed that the change of SPAS and IAS was positively correlated with the change of L1-Y (P <0.05), and the change of MAS was positively correlated with the change of U1-Y (P <0.05). Multivariate regression analysis showed that the changes of SPAS were positively correlated with the changes of L1-Y and SNA (P <0.05); the changes of MAS were positively correlated with the changes of U1-Y and SNB (P <0.05); the changes of IAS and U1 -Y and L1-Y changes were positively correlated (P <0.05). CONCLUSION: The large posterior incisor displacement caused by extraction combined with strong support will result in a decrease in anteroposterior diameter of the upper airway. The significant change of the anterior and posterior incisors to the position of the upper airway may be related to the size of the upper airway.