骨性Ⅲ类错正畸-正颌联合治疗前后温度感觉功能的定量评价

上海口腔医学 ›› 2016, Vol. 25 ›› Issue (5): 583-587.

骨性Ⅲ类错正畸-正颌联合治疗前后温度感觉功能的定量评价

顾鑫宇¹, 张静露², 吕冬³, 陈文静³

1.南通市口腔医院正畸科,江苏南通 226000；
2.南京医科大学口腔医学院口颌面疼痛与颞下颌关节病研究中心,江苏南京 210029；
3.南京医科大学口腔医学研究所·附属口腔医院正畸科,江苏南京 210029

收稿日期:2015-11-18 修回日期:2016-03-20 出版日期:2016-10-25 发布日期:2016-11-10
通讯作者: 陈文静,E-mail: chenwenjing_orth@163.com
作者简介:顾鑫宇（1989-）,女,硕士,住院医师,E-mail：xiaoyu07110126@126.com

Partial recovery of thermal sensory functions in skeletal Class Ⅲ patients undergoing orthognathic surgery

GU Xin-yu¹, ZHANG Jing-lu², LV Dong³, CHEN Wen-jing³

1.Department of Orthodontics, Nantong Stomatological Hospital. Nantong 226000;
2.Orofacial Pain & TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University. Nanjing 210029;
3.Institute of Stomatology & Department of Orthodontics,Affiliated Hospital of Stomatology,Nanjing Medical University. Nanjing 210029, Jiangsu Province, China

Received:2015-11-18 Revised:2016-03-20 Online:2016-10-25 Published:2016-11-10

摘要/Abstract

摘要： 目的观察正畸治疗和正颌手术后三叉神经分布区域温度感觉功能的变化。方法选取20例平均年龄在20.9±1.74岁的骨性Ⅲ类错患者,进行温度觉的定量感觉检查（quantitative sensory tests, QST）。检查部位在双侧眶下孔（V2L、V2R）、双侧颏孔（V3L、V3R）和左手大鱼际。检测时间分别在正畸治疗前（T0）、正颌手术前（T1）、正颌手术后2个月（T2）和正颌手术后6个月（T3）。检查项目包括冷感阈值（cold detection threshold, CDT）、温感阈值（warm detection threshold, WDT）、冷痛阈值(cold pain threshold, CPT)和热痛阈值(hot pain threshold,HPT)4项指标。采用SPSS16.0软件包对数据进行统计学分析。结果T1与T0相比,V2L(P=0.006)和V2R (P=0.017) 的温感阈值降低（敏感性增高）,V2L (P=0.028)的冷感阈值增加（敏感性降低）, V2R (P=0.028) 和V3R (P=0.017)的热痛阈值增加（敏感性降低）。T3与T0相比,V3L (P=0.024)的温感阈值增加（敏感性降低）,V2R (P=0.036)、V3L (P=0.012) 和 V3R (P=0.044)的冷痛阈值降低（敏感性增高）,V2L (P=0.009)、V2R (P=0.034)、V3L (P=0.032) 和V3R (P=0.001)的热痛阈值增加（敏感性降低）。T2期的麻木症状在是T0期的93.3%,T3期的麻木症状在是T0期的20%。有无颏成形术对患者在T2期（P=0.303）和T3期（P=0.530）的感觉变化无影响。结论正畸治疗和正颌手术均会影响三叉神经分布区域的温度感觉功能,各个阶段手部的感觉功能无改变。但大多数患者的温度感觉功能在半年后会部分恢复。

关键词: 定量感觉测试, 正颌手术, 正畸治疗, 三叉神经

Abstract: PURPOSE: To clarify whether trigeminal somatosensory function will be changed after orthodontic treatment as well as after orthognathic surgery. METHODS: A series of 20 patients with a mean age of 20.9±1.74 years were recruited. Thermal quantitative sensory tests were conducted before orthodontic treatment (T0), before orthognathic surgery (T1), 2 months after orthognathic surgery (T2), and 6 months after orthognathic surgery (T3). The cold detection threshold (CDT), cold pain threshold (CPT), warm detection threshold (WDT) and heat pain threshold (HPT) were determined. SPSS 16.0 software package was used for statistical analysis. RESULTS: There were significant differences with lower threshold (higher sensitivity) in V2L (P=0.006) and V2R (P=0.017) for WDT at T1 compared to T0. A significantly higher threshold (lower sensitivity) was detected for CDT in V2L (P=0.028) at T1 compared to T0. A significantly higher threshold (lower sensitivity) was detected for HPT in V2R (P=0.028) and V3R (P=0.017) at T1 compared to T0. There were significant differences with higher threshold (lower sensitivity) V3L (P=0.024) for WDT at T3 compared to T0. A significantly lower threshold (higher sensitivity) was detected for CPT in V2R (P=0.036), V3L (P=0.012) and V3R (P=0.044) at T3 compared to T0. There were significant differences with higher threshold (lower sensitivity) in V2L (P=0.009), V2R (P=0.034), V3L (P=0.032) and V3R (P=0.001) for HPT at T3 compared to T0.Numbness was reported most frequently at T2 (93.33%), but this symptom tended to decrease with time (T3-20%).Fisher's exact test showed that there was no significant difference at T2(P=0.303) and T3(P=0.530) between participates who underwent genioplasty or not. CONCLUSIONS: The results indicated that thermal somatosensory function was altered after initial orthodontic treatment and orthognathic surgery. However, partial recovery of thermal sensory function can be expected in the majority of patients.

Key words: Quantitative sensory testing, Orthognathic surgery, Orthodontic treatment, Trigeminal nerve

中图分类号:

R783.5

顾鑫宇, 张静露, 吕冬, 陈文静. 骨性Ⅲ类错正畸-正颌联合治疗前后温度感觉功能的定量评价[J]. 上海口腔医学, 2016, 25(5): 583-587.

GU Xin-yu, ZHANG Jing-lu, LV Dong, CHEN Wen-jing. Partial recovery of thermal sensory functions in skeletal Class Ⅲ patients undergoing orthognathic surgery[J]. Shanghai Journal of Stomatology, 2016, 25(5): 583-587.

参考文献

[1] Jacobson A, Evans WG, Preston CB, et al. Mandibular prognathism [J]. Am J Orthod ,1974, 66(2): 140-171.
[2] Espeland L, Hogevold HE, Stenvik A. A 3-year patient-centred follow-up of 516 consecutively treated orthognathic surgery patients [J]. Eur J Orthod, 2008, 30(1): 24-30.
[3] Steel BJ, Cope MR. Unusual and rare complications of orthognathic surgery: a literature review [J]. J Oral Maxillofac Surg, 2012, 70(7): 1678-1691.
[4] Baron R, Wasner G. Quantitative thermotest-investigations of thermal and nociceptive afferents in neuropathy. Is a multicentric approach useful to investigate rare painful neuropathies? [J]. Schmerz, 1998, 12(3): 209-211.
[5] Fruhstorfer H, Lindblom U, Schmidt WC. Method for quantitative estimation of thermal thresholds in patient [J]. J Neurol Neurosurg Psychiatry, 1976, 39(11): 1071-1075.
[6] Jensen TS, Baron R. Translation of symptoms and signs into mechanisms in neuropathic pain [J]. Pain, 2003, 102(1-2): 1-8.
[7] Kelly KG, Cook T, Backonja MM. Pain ratings at the thresholds are necessary for interpretation of quantitative sensory testing [J]. Muscle Nerve, 2005, 32(2): 179-184.
[8] Klein T, Magerl W, Rolke R, et al. Human surrogate models of neuropathic pain [J]. Pain, 2005, 115(3): 227-233.
[9] LaMotte RH, Campbell JN. Comparison of responses of warm and nociceptive C-fiber afferents in monkey with human judgments of thermal pain [J]. J Neurophysiol, 1978, 41(2): 509-528.
[10] Verdugo R, Ochoa JL. Quantitative somatosensory thermotest. A key method for functional evaluation of small calibre afferent channels [J]. Brain, 1992, 115(Pt 3): 893-913.
[11] Dougher MJ, Crossen JR, Ferraro DP, et al. The effects of covert sensitization on preference for sexual stimuli: a preliminary analogue experiment[J]. J Behav Ther Exp Psychiatry, 1987, 18(4): 337-348.
[12] Yarnitsky D. Quantitative sensory testing [J]. Muscle Nerve, 1997, 20(2): 198-204.
[13] Rosenberger PH, Jokl P, Ickovics J. Psychosocial factors and surgical outcomes: an evidence-based literature review [J]. J Am Acad Orthop Surg, 2006, 14(7): 397-405.
[14] Matos R, Wang K, Jensen JD, et al. Quantitative sensory testing in the trigeminal region: site and gender differences [J]. J Orofac Pain, 2011, 25(2): 161-169.
[15] Van Sickels JE, Hatch JP, Dolce C, et al. Effects of age, amount of advancement, and genioplasty on neurosensory disturbance after a bilateral sagittal split osteotomy [J]. J Oral Maxillofac Surg, 2002, 60(9): 1012-1017.
[16] de Santana Santos T, Albuquerque KM, Santos ME, et al. Survey on complications of orthognathic surgery among oral and maxillofacial surgeons [J]. J Craniofac Surg, 2012, 23(5): e423-430.
[17] Tung TC, Chen YR, Bendor-Samuel R. Surgical complications of the Le Fort I osteotomy-a retrospective review of 146 cases [J]. Changgeng Yi Xue Za Zhi, 1995, 18(2): 102-107.