手术优先模式治疗骨性III类错颌畸形的研究进展

Research Progress of Surgical Priority Model in the Treatment of Bone Class III Malocclusion

摘要: 正畸–正颌联合治疗是矫正严重牙颌面畸形的主要方法，包括传统正畸–正颌治疗和手术优先方案(surgical first approach, SFA)。常规正畸–正颌治疗包括3个不同的治疗阶段：术前正畸去代偿、正颌手术矫正骨骼和术后正畸调整咬合。为了防止术前正畸引起的面部畸形进一步恶化，缩短整体治疗时间以及提高患者满意度，研究者们提出了手术优先入路。即患者术前不进行正畸治疗，直接进行手术截骨，再术后正畸改良咬合关系。与传统的正畸–正颌联合治疗相比，SFA具有明显的优势，但同时适应病例的选择也更为严格。SFA作为传统正畸治疗的替代方案，近年来已成为研究热点之一，为了达到更完美的效果，其对数字化的应用，术前手术设计和操作者能力的要求不断增加。本文就手术优先方式的发展、适应证、非适应症、优缺点、数字化技术的应用进行综述，希望能为临床医生在选择治疗方式时提供一定的参考价值。

Abstract: Combined orthodontic-orthognathic treatment is the primary method for correcting severe occlusal facial deformities, including the traditional orthodontic-orthognathic treatment and surgical first approach (SFA). Conventional orthodontic-orthognathic treatment consists of three different stages of treatment: preoperative orthodontic decompensation, orthognathic bone correction, and post-operative orthodontic occlusal adjustment. In order to prevent the further deterioration of facial deformities caused by preoperative orthodontics, shorten the overall treatment time and improve patient satisfaction, the researchers proposed a surgical priority approach. That is, patients do not undergo orthodontic treatment before surgery, or try to use the shortest time before surgery to fi-ne-tune the orthodontic, directly perform surgical osteotomy, and then orthodontic improvement of the occlusal relationship after surgery. Compared with the traditional orthodontic-orthognathic combined treatment, SFA has obvious advantages, but at the same time, the selection of adaptive cases is stricter. As an alternative to traditional orthodontic treatment, SFA has become one of the research hotspots in recent years, and in order to achieve more perfect results, its requirements for digital application, preoperative surgical design and operator ability are increasing. In this paper, the development, indications, off-indications, advantages and disadvantages, and the application of digital technology of surgical priority methods are reviewed, hoping to provide certain reference value for clinicians when choosing treatment methods.