三维评估上颌骨矢状向旋转对骨性Ⅲ类错畸形鼻唇软组织的影响

doi:10.19439/j.sjos.2026.04.014

摘要/Abstract

摘要： 目的: 通过对小样本同质患者群三维CT影像的精准测量,探讨骨性Ⅲ类错畸形患者在双颌正颌手术中,上颌骨矢状向旋转与面部鼻唇软组织形态变化的相关性,为正颌手术方案设计及术后软组织形态预判提供临床依据。方法: 纳入2017年1月—2024年12月于大连医科大学附属第一医院接受双颌正颌手术的骨性Ⅲ类错畸形患者21例,分别采集患者术前1周、术后3~5天撤除引流装置后（记为术后短期）及术后12个月的颌面部CT数据,导入Mimics 21.0软件,构建三维模型。创新性引入APP平面[在三维模型上,选择上牙槽座点（A）点与双侧上颌腭板后缘中点PNS（l,r）为基准点建立],以量化上颌骨矢状向旋转程度,并测量软、硬组织标志点的三维位移。观察上颌骨矢状向旋转与鼻唇部软组织变化的整体相关性,并按术后APP-FH角的变化情况,再将患者分为顺时针及逆时针旋转组。采用SPSS 27.0软件包进行配对t检验、Pearson/Spearman相关分析及偏相关分析,通过控制下颌平面角（MPA）与下颌体长度（Go-Gn）,排除下颌骨移动对软组织的干扰。结果: APP 平面在术后不同时间点表现出良好的稳定性,可准确反映上颌骨矢状向旋转量。上颌旋转量（ΔAPP-FH）与AI（鼻翼点）及Cm（鼻小柱点）的水平向位移呈中度负相关（P<0.05）。偏相关分析显示,该效应受下颌骨前后向移动的共同影响。上颌骨顺时针旋转独立影响AI点垂直向、Ch（口角点）及LL'（下唇缘点）矢状向位移（P<0.05）,上颌骨逆时针旋转与软组织变化无显著相关性（P>0.05）。结论: APP平面是评估上颌骨矢状向旋转的可靠骨性参考平面。上颌骨顺时针旋转对鼻唇软组织影响显著,且该影响独立于下颌移动,逆时针旋转则对软组织无影响。

关键词: 正颌手术, APP平面, 骨性Ⅲ类错, 鼻唇软组织, 三维测量

Abstract: PURPOSE: To investigate the correlation between maxillary sagittal rotation and nasolabial soft tissue morphological changes during bimaxillary orthognathic surgery in patients with skeletal Class III malocclusion through accurate three-dimensional CT measurements in a small homogeneous patient cohort, so as to provide clinical evidence for surgical planning and postoperative soft tissue prediction. METHODS: A retrospective study was conducted on 21 patients with skeletal Class III malocclusion who underwent bimaxillary orthognathic surgery at our hospital from January 2017 to December 2024. Maxillofacial CT data were collected at 1 week preoperatively, 3-5 days postoperatively (after removal of drainage devices, defined as short-term postoperatively), and 12 months postoperatively, and imported into Mimics 21.0 software for three-dimensional reconstruction. The APP plane [constructed based on point A and the midpoints of the posterior edges of bilateral maxillary palatal plates PNS(l, r) on three-dimensional models] was innovatively introduced to quantify maxillary sagittal rotation, and three-dimensional displacements of hard and soft tissue landmarks were measured. The overall correlation between maxillary sagittal rotation and nasolabial soft tissue changes was observed. The patients were further divided into clockwise rotation group and counterclockwise rotation group according to postoperative changes in the APP-FH angle. Paired t test, Pearson/Spearman correlation analysis, and partial correlation analysis were performed using SPSS 27.0 software package. The confounding influence of mandibular movement on soft tissue was eliminated by controlling mandibular plane angle(MPA) and mandibular body length (Go-Gn). RESULTS: The APP plane showed favorable stability at different postoperative time points and could accurately reflect the magnitude of maxillary sagittal rotation. The maxillary rotation amount (ΔAPP-FH) was moderately negatively correlated with the horizontal displacement of Point AI(alar point) and Point Cm (columella point)(P<0.05). Partial correlation analysis indicated that this effect was jointly influenced by anteroposterior mandibular movement. Clockwise maxillary rotation independently affected the vertical displacement of point AI and the sagittal displacement of point Ch (cheilion) and point LL' (lower lip edge) (P<0.05). No significant correlation was found between counterclockwise maxillary rotation and soft tissue changes(P>0.05). CONCLUSIONS: The APP plane is a reliable osseous reference plane for evaluating maxillary sagittal rotation. Clockwise maxillary rotation exerts significant influence on nasolabial soft tissue independent of mandibular movement, whereas counterclockwise rotation shows no significant effect on soft tissue.

Key words: Orthognathic surgery, APP plane, Skeletal Class Ⅲ malocclusion, Nasolabial soft tissue, Three-dimensional measurement

中图分类号:

R782.2

权慧欣, 黄岳飞, 乃毕·马吾买尔, 肖迪. 三维评估上颌骨矢状向旋转对骨性Ⅲ类错畸形鼻唇软组织的影响[J]. 上海口腔医学, 2026, 35(4): 433-439.

Quan Huixin, Huang Yuefei, Naibi Mawumaier, Xiao Di. Three-dimensional evaluation of the effects of maxillary sagittal rotation on nasolabial soft tissue in skeletal Class Ⅲ malocclusion[J]. Shanghai Journal of Stomatology, 2026, 35(4): 433-439.

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