生长发育期骨性Ⅱ类错畸形儿童上气道矢状径主要影响因素分析

doi:10.13481/j.1671-587X.20210527

摘要/Abstract

摘要： 目的

探讨影响生长发育期骨性Ⅱ类错畸形儿童上气道矢状径的相关因素，为临床包含气道预测的正畸方案的制定提供思路。

方法

选取2017—2018年就诊于本院正畸科9~15岁生长发育期骨性Ⅱ类错畸形儿童共100例，进行回顾性研究。收集患儿一般信息（性别、身高和体质量）、牙弓测量数据和X线头影测量分析数据，分析生长发育期骨性Ⅱ类错畸形儿童上气道矢状径情况，通过逐步回归分析得出影响上气道各段矢状径大小的相关因素。

结果

在喉咽段，与QCVMⅠ-Ⅱ期比较，喉咽段气道矢状径（V-LPW）在QCVMⅡ-Ⅲ期、Ⅲ-Ⅳ期明显增大；在鼻咽段，与QCVMⅠ-Ⅱ期、Ⅲ-Ⅳ期比较，鼻咽腔气道矢状径（PNS-UPW）在QCVMⅡ-Ⅲ期增大（P<0.05）。在喉咽段，喉咽腔气道矢状径（V-LPW）随体质量指数（BMI）的增大而增大，在低体质量组与正常组、低体质量组与超重组间比较差异有统计学意义（P<0.05）。低体质量组患儿鼻咽腔和下口咽腔气道段矢状径（PNS-UPW和U-MPW）低于正常组（P<0.05）。在鼻咽气道，蝶鞍点-鼻根点-下齿槽座点（SNB）和患儿是否处于QCVMⅡ期是PNS-UPW的影响因素（P<0.05）；在口咽气道，舌骨前下点距第三颈椎前下点距离（H-C3）、上齿槽座点-鼻根点-下齿槽座点（ANB）和软腭长度（SPL）是U-MPW的影响因素（P<0.05）；在喉咽气道，H-C3和患儿是否为低体质量是V-LPW的影响因素（P<0.05）；在下口咽气道间隙，H-C3、ANB和患儿是否为低体质量是下口咽气道间隙（PAS）的影响因素（P<0.05）。

结论

生长发育期骨性Ⅱ类错畸形儿童上气道矢状径与周围软硬组织关系密切，在制定临床正畸治疗方案时需要全面评估上气道与患儿自身状况，避免医源性因素造成患儿上气道阻塞，同时为预后提供参考依据。

关键词: 上气道, 头影测量分析, 多元回归分析, 生长发育期, 骨性Ⅱ类

Abstract: Objective

To explore the related factors that affects the sagittal diameter of upper airway of the children with skeletal class Ⅱ malocclusion during the growth and development period， and to provide ideas for the formulation of clinical orthodontic programs that includes airway prediction.

Methods

A total of 100 children with skeletal class Ⅱ malocclusion during the growth and development period aged 9－15 years old from 2017－2018 in the Department of Orthodontics in our hospital were selected for retrospective study. The patients’ general information （gender，height， body mass），dental arch measurement data， and X-ray cephalometric analysis data were collected， and the upper airway sagittal diameters of the children with skeletal class Ⅱ malocclusion during the growth and development period were analyzed. Through the results obtained by multiple regression analysis， the related factors affecting the size of the sagittal diameter of each segment of the upper airway were obtained.

Results

In the laryngopharyngeal airway， compared with QCVM stages Ⅰ to Ⅱ，the laryngopharyngeal airway sagittal diameter （V-LPW） in QCVM stages Ⅱ to Ⅲ，and Ⅲ to Ⅳ were increased significantly.In the nasopharyngeal airway， compared with QCVM Ⅰ to Ⅱ stages and Ⅲ to Ⅳ stages， the PNS-UPW from stage Ⅱ to stage Ⅲ was significantly increased（P<0.05）. In the laryngopharyngeal airway， the sagittal diameter （V-LPW） was increased with the increase of the body mass index（BMI），and there were statistically significant differences between low-weight group and normal-weight group，low-weight group and overweight group （P<0.05）.The sagittal diameters （PNS-UPW and U-MPW） in low-weight group were lower than those in normal weight group （P<0.05）. In the nasopharyngeal airway， SNB and whether the patient was in QCVM stage Ⅱ were the influencing factors of the sagittal diameter PNS-UPW （P<0.05）. In the oropharyngeal airway， H-C3， ANB and soft palate length （SPL） were the influencing factors of U-MPW （P<0.05）. In the laryngopharyngeal airway， H-C3 and whether the patient was in low-weight were the influencing factors of V-LPW （P<0.05）. In the pharyngeal airway space， H-C3，ANB and whether the patient was in low-weight were the influencing factors of PAS （P<0.05）.

Conclusion

The sagittal diameter of the upper airway in the children with skeletal class Ⅱ malocclusion during the growth and development period is closely related to the surrounding soft and hard tissues. When formulating a clinical orthodontic treatment plan， it is necessary to comprehensively evaluate the upper airway and the patient’s own condition to avoid the iatrogenic factor-caused upper airway obstruction in the patients， and to provide a reference for the prognosis.

Key words: upper airway, cephalometric analysis, multi-parameter regressive, growth and development period, skeletal class Ⅱ malocclusion

中图分类号:

R783.5

陆晨萌,张祎,尹茂运,米合日扎提·买买提,刘新煜,胡敏. 生长发育期骨性Ⅱ类错畸形儿童上气道矢状径主要影响因素分析[J]. 吉林大学学报(医学版), 2021, 47(5): 1273-1280.

Chenmeng LU,Yi ZHANG,Maoyun YIN,Mamat MIHRIZAT,Xinyu LIU,Min HU. Analysis on main factors affecting sagittal diameter of upper airway in children with skeletal class Ⅱ malocclusion during growth and development period[J]. Journal of Jilin University(Medicine Edition), 2021, 47(5): 1273-1280.

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Group	n	PNS-UPW	U-MPW	V-LPW	PAS
Male	52	20.85±4.04	9.02±2.84	15.58±4.18	12.39±3.50
Female	48	21.13±3.25	8.58±2.61	14.79±3.14	12.31±3.22
t		－0.370	0.808	1.064	0.113
P		0.712	0.421	0.290	0.910

Segmented airway（l/mm）	(I) QCVM classification	(J) QCVM classification	Difference	Standard coefficient	P
PNS-UPW	Ⅰ stage	Ⅱ stage	－0.058	1.350	0.966
		Ⅲ stage	－2.620	1.380	0.060
		Ⅳ stage	－1.890	1.330	0.157
	Ⅱ stage	Ⅰ stage	0.058	1.350	0.966
		Ⅲ stage	－2.560	0.950	0.009^*
		Ⅳ stage	－1.840	0.880	0.041^*
	Ⅲ stage	Ⅰ stage	2.620	1.380	0.060
		Ⅱ stage	2.560	0.950	0.009^*
		Ⅳ stage	0.720	0.920	0.435
	Ⅳ stage	Ⅰ stage	1.890	1.330	0.157
		Ⅱ stage	1.840	0.880	0.041^*
		Ⅲ stage	－0.720	0.920	0.435
U-MPW	Ⅰ stage	Ⅱ stage	0.570	1.030	0.585
		Ⅲ stage	－0.760	1.050	0.472
		Ⅳ stage	－0.360	1.020	0.725
	Ⅱ stage	Ⅰ stage	－0.570	1.030	0.585
		Ⅲ stage	－1.330	0.730	0.072
		Ⅳ stage	－0.920	0.680	0.175
	Ⅲ stage	Ⅰ stage	0.760	1.050	0.472
		Ⅱ stage	1.330	0.730	0.072
		Ⅳ stage	0.400	0.700	0.570
	Ⅳ stage	Ⅰ stage	0.360	1.010	0.725
		Ⅱ stage	0.920	0.680	0.175
		Ⅲ stage	－0.400	0.700	0.570
V-LPW	Ⅰ stage	Ⅱ stage	0.790	1.360	0.564
		Ⅲ stage	－1.060	1.390	0.249
		Ⅳ stage	－1.750	1.340	0.194
	Ⅱ stage	Ⅰ stage	－0.790	1.360	0.564
		Ⅲ stage	－2.400	0.960	0.014^*
		Ⅳ stage	－2.550	0.890	0.005^*
	Ⅲ stage	Ⅰ stage	1.610	1.390	0.249
		Ⅱ stage	2.400	0.960	0.014^*
		Ⅳ stage	－0.150	0.930	0.876
	Ⅳ stage	Ⅰ stage	1.760	1.340	0.194
		Ⅱ stage	2.550	0.890	0.005^*
		Ⅲ stage	0.150	0.930	0.876
PAS	Ⅰ stage	Ⅱ stage	－0.860	1.260	0.501
		Ⅲ stage	－2.200	1.290	0.091
		Ⅳ stage	－1.550	1.240	0.216
	Ⅱ stage	Ⅰ stage	0.860	1.270	0.501
		Ⅲ stage	－1.350	0.890	0.135
		Ⅳ stage	－0.700	0.830	0.404
	Ⅲ stage	Ⅰ stage	2.200	1.290	0.091
		Ⅱ stage	1.350	0.890	0.135
		Ⅳ stage	0.650	0.860	0.451
	Ⅳ stage	Ⅰ stage	1.550	1.250	0.216
		Ⅱ stage	0.700	0.830	0.404
		Ⅲ stage	－0.650	0.860	0.451

Segmented airway（l/mm）	(I)BMI classification	(J)BMI classification	Difference	Standard coefficient	P
PNS-UPW	Low-weight	Normal-weight	－2.17	0.92	0.021^*
		Overweight	－1.04	1.25	0.409
	Normal-weight	Low-weight	2.17	0.92	0.021^*
		Overweight	1.12	1.06	0.292
	Overweight	Low-weight	1.04	1.25	0.409
		Normal-weight	－1.12	1.06	0.292
U-MPW	Low-weight	Normal-weight	－1.10	0.69	0.115
		Overweight	－1.26	0.95	0.186
	Normal-weight	Low-weight	1.10	0.69	0.115
		Overweight	－0.16	0.80	0.845
	Overweight	Low-weight	1.26	0.95	0.186
		Normal-weight	0.16	0.80	0.845
V-LPW	Low-weight	Normal-weight	－3.17	0.89	0.001^*
		Overweight	－4.02	1.22	0.001^*
	Normal-weight	Low-weight	3.17	0.89	0.001^*
		Overweight	－0.84	1.03	0.414
	Overweight	Low-weight	4.02	1.22	0.001^*
		Normal-weight	0.84	1.03	0.414
PAS	Low-weight	Normal-weight	－1.98	0.84	0.020^*
		Overweight	－2.02	1.14	0.081
	Normal-weight	Low-weight	1.98	0.84	0.020^*
		Overweight	－0.04	0.97	0.969
	Overweight	Low-weight	2.02	1.14	0.081
		Normal-weight	0.04	0.97	0.969

Variable（l/mm）	Factor	β	S.E.	Standad coefficient	t	P
PNS-UPW	SNB（θ/°）	0.238	0.086	0.262	2.752	0.007^*
PNS-UPW	Whether in QCVM Ⅱ stage	－1.843	0.757	－0.231	－2.433	0.017^*
U-MPW	ANB（θ/°）	－0.267	0.090	－0.268	－2.971	0.004^*
	H-C3（l/mm）	0.156	0.047	0.291	3.296	0.001^*
	SPL （l/mm）	－0.245	0.080	－0.277	－3.068	0.003^*
V-LPW	H-C3（l/mm）	0.313	0.062	0.428	5.034	<0.01
V-LPW	Whether in low-weight group	－2.849	0.786	－0.308	－3.625	<0.01
PAS	ANB（θ/°）	－0.429	0.110	－0.350	－3.901	<0.01
	H-C3（l/mm）	0.142	0.059	0.215	2.385	0.019^*
	Whether in low-weight group	－1.681	0.750	－0.202	－2.240	0.027^*
^*P<0.05.

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