唇腭裂出生节律性研究及经缝牵引成骨矫正唇腭裂患者面中部发育不全的临床与实验研究
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摘要
[目的]
1.唇腭裂患儿的出生存在季节性差异,不同的地区、人群季节性差异不同,那么中国人群中,唇腭裂患儿的出生是否存在季节性差异,本课题给予初步探讨。
2.观察记录分析经缝牵引成骨技术在唇腭裂面中部发育不全患儿中的临床治疗过程,探讨牵引力与患者年龄的关系,经缝牵引成骨的稳定性和回缩率,对牙弓宽度、腭穹高度、语音清晰度及腭咽闭合的影响,进一步指导临床治疗。
3.以SD雄性大鼠颧上颌缝为研究对象,探讨面缝增龄性生物学变化,为研究经缝牵引促进上颌骨复合体的生长发育提供生物学基础。
[方法]
1.收集2002.1至2011.12月在我院接受唇腭裂相关治疗的患者资料,对照组是北京大学附属第三医院产科2002.1至2011.12月正常出生的婴儿数据。采用X2检验分析唇腭裂出生的季节性差异。
2.分析2005年以来在我院接受经缝牵引成骨术治疗的65例唇腭裂面中部发育不全患儿,研究①面型、咬关系的变化②测量术前、拆架子时及随访期的头颅侧位片,观察缝牵引成骨的稳定性和回缩率③将石膏牙模转成三维数字牙模,测量术前、拆架子时及随访期的牙弓宽度及腭穹高度的变化④通过主观语音评价、鼻咽纤维镜及X线头颅侧位片评价术前及拆架子时语音清晰度及腭咽闭合的变化。
3.SD雄性大鼠分4周龄、3月龄及13月龄三组,各20只,观察记录身体、头面颅骨膜及颅面缝的大体变化；Elisa检测血浆中RANKL/OPG/ALP/OC的蛋白量及增龄性变化；RT-PCR检测局部组织中RANKL/OPG/ALP/OC/OX62/CD25的mRNA表达量及增龄性变化；同时采用组织学和MicroCT的方法观察缝及周围骨组织的增龄性变化。
[结果]
一.节律性研究
收集6193名唇腭裂患者及13254名正常新生儿的出生资料。研究发现,唇腭裂患者的出生高峰期在秋季和冬季,尤其是10月和1月,出生率最低的是在夏季(P<0.05)。男性患者出生高峰期在秋季和冬季,尤其是10月、2月和1月,女性患者出生高峰期也在秋季和冬季,尤其是1月、10月和11月。在女性患者中不同月份及季节出生率之间有统计学差异(P<0.05),但男性患者没有发现类似结果(P>0.05)。
二.临床研究
1.65例患儿顺利完成了缝牵引治疗。面型得到显著改善,面中部凹陷畸形消失,前牙反(?)得到矫正,未发生严重并发症。
2.低于11岁年龄组与高于11岁年龄组相比,牵引力无明显差异(P>0.05),但后者潜伏期明显延长。
3.拆架子时,A点平均前移13.48mm, SNA角度平均增加9.65。；拆架子后6个月内,73%的患者A点后退22%,27%的患者A点前移13%,82%的患者SNA角度减少20%,18%的患者角度增加9.6%；拆架子后26.75个月,83%的患者A点后退23%,92%的患者SNA角度减小24.6%。
4.未做正畸的单侧完全性唇腭裂的患儿,行RED缝牵引后其牙弓宽度增加最明显的是前段,其次是中段,再次是后段；同步正畸的单侧完全性唇腭裂的患儿,牙弓宽度增加最明显的是中段,其次是后段,再次是前段；同步正畸治疗的患者拆架子后随访,前段、中段牙弓宽度继续增加,后段牙弓宽度缩小；未正畸组患儿腭穹高度降低,正畸组患儿腭穹高度稍有增加。
5.38%的患儿语音清晰度增加,54%的患儿语音清晰度变差；69%的患者腭咽闭合状态未发生变化,31%的患者腭咽闭合状态有恶化；92%的患者软腭长度/咽腔深度减少。
三.实验研究
1.SD雄性大鼠从4周到13月龄,体重增加345%,体长增加65%,躯干增加61%。成年后,体长和躯干增加不再明显,体重依然可明显增加。
2.从4周到13月龄,血浆中RANKL, OPG的数值有降低的趋势,RANKL/OPG的数值有增高的趋势,但没有统计学意义。ALP和OC的数值降低,且有统计学意义(P<0.05)。
3.在组织水平,从4周到13月龄,RANKL, OPG的基因表达量有降低趋势,RANKL/OPG的数值有增加的趋势,ALP的数值有降低的趋势,但无统计学意义。OC的数值降低,且有统计学意义(P<0.05)；从4周到3月龄,integrin alpha E2(OX62),CD25的数值均呈增高趋势,但均无统计学意义。
4. MicroCT检测大鼠颧上颌缝,从4周到13月龄其骨缝的密度增加8倍,同期骨密度增加2倍。缝与骨的密度比从4周龄的0.14：1上升到13月龄的0.54：1。
[结论]
1.在中国人群中唇腭裂患儿的出生存在季节性差异,且性别不同差异不同,通过倡导减少吸烟、酗酒以及增加日晒时间可能对降低唇腭裂的出生率有益。
2.经缝牵引成骨治疗唇腭裂面中部发育不全可取得良好效果,随着年龄的增长,其牵引的难度有增大的趋势。拆架子后半年内A点平均会有20%的回缩,在前期超量牵引时,可以根据此值计算超量牵引的距离。术后A点的回缩主要发生在拆架子后的半年内,所以缝牵引患儿拆架子后需常规夜间佩戴面弓,最好能坚持半年左右,当然面弓的佩戴与超量牵引的回缩需协同处理,以达到最佳的面型和咬合功能改善。从三维牙模分析可知未同步正畸的患者牙弓宽度增加和腭穹高度降低,说明作用于上颌骨的前向牵引力可促进硬腭的三维生长,硬腭的缝组织和骨组织均发生了重塑。由于未同步正畸的患儿牙弓扩张较同步正畸的显著,所以对于牙弓缩窄较为严重的患者,建议暂不同步正畸治疗。如果患儿牙弓缩窄并不严重,则可以术前开始同步正畸。缝牵引上颌骨前移后,到拆架子时,38%的患者语音清晰度出现改善,但多数患儿语音清晰度与术前相比轻度下降,69%的患者腭咽闭合与术前相比无明显变化。
3.SD雄性大鼠,从4周到13月龄,颅面部骨膜增厚,骨质增厚,颜色变白,颧上颌缝变窄,缝间纤维母细胞减少,缝旁骨板增厚,骨质变的更为致密,代表成骨活性的及破骨活性的的血浆蛋白量与缝及其周围组织内对应的基因表达量有着较好的一致性,至13月龄时破骨细胞的活性未发现有统计学意义的变化,但成骨细胞的活性已经降低。MicroCT显示至13月龄,骨缝的密度增加8倍,同期骨密度增加2倍,骨缝密度与骨密度比从0.14：1增长到0.54：1。以上缝的增龄性变化,为临床患者增龄性经缝牵引难度增加提供了生物学依据。从4周龄到3月龄,局部组织中DC细胞的活化标记及T细胞的活化标记未发现明显的变化,说明在此年龄段骨缝及其周围骨组织的骨免疫处于平衡状态。在此年龄段进行经缝牵引成骨可能会获得较好的缝组织和骨组织的重塑平衡,有利于新骨组织的形成。
[objective]
1. The research will determine whether births of patients with oral-facial clefts follow a seasonal pattern in a native Chinese population.
2. To study the relationship between the distraction force and the age of the patients.To study postoperative maxillary stability and retraction rate. The impact on dental arch width, palate height,speech articulation and velopharyngeal closure status will also be determined.
3. We use the zygomaticomaxillary suture of the male rat as the research object. We hope to find some age related biological changes which is related to the age related difficulty in maxillary complex distraction.
[Methods]
1. Patients with oral-facial clefts treated at the Plastic Surgery Hospital between2002.01-2011.12were retrospectively investigated. The controls consisting of all living births from the obstetric department of the third affiliated hospital of Peking university during2002.01-2011.12.Seasonal variations in months of births were analyzed by using χ2test.
2.65patients were treated with trans-sutural distraction osteogenesis technique. To study①the change of face contour and occluding relation②maxillary stability and retraction rate with cephalometric mesurement③the change of dental arch width and palatal height with digital dental wax mesurement④the change of speech articulation and velopharyngeal closure status with the methods of subjective speech evaluation, nasopharynx fiber microscopy examination and X ray of lateral projection of cranium measurement.
3. The SD male rats were divided into3groups (n=20),the age of each group is4week old(4w),3months old(3m) and13months old(13m). The age related changes of body, cranial facial sutures and periosteum were recorded. The age related changes of plasma amount of RANKL/OPG/ALP/OC were detected with Elisa and local tissue RANKL/OPG/ALP/OC/OX62/CD25mRNA were detected with RT-PCR. We also use histology and MicroCT to study age related changes of the zygomaticomaxillary suture.
[results]
1. seasonal research
A total of6193patients with oral-facial clefts and13254normal living newborns were included in this study. Birth time peaks of the patients occurred in autumn and winter,especially in October and January,compared with the nadir in the summer(P<0.05). The birth time peaks of male patients occurred in autumn and winter, especially in October, February and January. The birth time peaks of female occurred in autumn and winter,, especially in January, October and November. There was statistical difference in birth distribution in the different months (P<0.05) or four seasons (P<0.05) in females,No statistical difference was found in males (P>0.05).
2. clinical research
I) All patients'face contour and occluding relation improved after treatment. No severe complications were found.
II) There is no statistically significant difference of distraction force was found between the age below and more than11years old, but in older group the latency time is longer.
III) From preoperative to the removal of RED,the A point average forward13.48mm and the SNA angle increased by an average of9.65°;within6months after the removal of RED,73%of patients with A point retreat22%,83%of patients with SNA angle decreased20%;within26.75months after the removal of RED,83%of patients with A point retreat23%,92%of patients with SNA angle decreased24.6%.
IV) Dental arch width increased most obviously of UCLP without orthodontic treatment is the anterior segment,followed by the medial segment, and again posterior segment. Dental arch width increased most obviously of UCLP with orthodontic treatment is medial segment followed by posterior segment, and again the anterior segment. In the follow-up period, the UCLP with orthodontic treatment whose anterior and medial segment of dental arch width continue to increase,but the posterior segment narrowing. The palatal height of the UCLP without orthodontic treatment reduced,but the orthodontic group slightly increased.
V)38%of patients increased speech articulation,54%of patients deteriorated speech articulation.69%of patients with velopharyngeal closure status have no change,31%of patients with velopharyngeal closure status deteriorated.92%of patients with soft palate length/pharyngeal depth ratio reduced.
3. Animal experiment
1) From4w to3m old,the body weight,body and trunk length of the SD male rats increased345%,65%,61%respectively. When the rats were in adult,the length of the body and trunk will not increase obviously, but body weight still can significantly increased.
2) From4w to13m old,the plasma amount of RANKL and OPG tend to decrease, but RANKL/OPG ratio tends to increase, both of them have no statistically significant. The value of plasma ALP and OC decreased and have statistically significant (P<0.05)
3) From4w to13m old,At the tissue level the mRNA expression of RANKL and OPG tend to decrease,but the RANKL/OPG ratio and the amount of ALP tend to decrease,all of above have no statistically significant. The value of OC decreased and have statistically significant.;From4w to3m old,the amount of0X62and CD25tend to increase,but have no statistically significant.
4) From4w to13m old, MicroCT shows the density of zygomaticomaxillary suture increased by8times and the density of bone increased by2times at the same time. The suture/bone density ratio increase from0.14:1in4w old to0.54:1in13m old.
[conclusions]
1. The data indicate that there is a possible seasonality in months of births of patients with oral-facial clefts in a native Chinese population and a difference between the genders. This approach could be useful for the study of the etiology and pathogenesis of oral-facial clefts.
2. To treat midface hypoplasia with the technique of SDO have been achieved good results. With the patient's age grows, the treatment will have more difficulty. After the removal of the RED, the maxillary complex will have an tendency to retreat, especially in the first six months, synchronizing orthodontic treatment is not helpful to the lateral expansion of the dental arch, but its long-term effect is better, and also beneficial to the palate height maintainment.38%of patients increased speech articulation,69%of patients with velopharyngeal closure status have no change, there is certain guiding significance of the soft palate length/pharyngeal depth ratio in judgment of postoperative velopharyngeal status.
3. From4w to13m old,the body weight, body and trunk length significantly increased, but when the rats were in adult,only body weight increased obviously. The amount of plasma osteoblasts and osteoclasts related protein have a good consistency with mRNA quantitative in the local tissue. Till13months old,we didn't found any sign of bone loss,but the activity of osteoblasts have been reduced. From4w to3m old, the amout of DC and activated T cell did not change significantly in local tissue. With the age increasing,the difference of the density between the suture and bone are getting smaller and smaller. Its texture and link is more close. And all of above can be the biological evidence to the age related difficulty with SDO technique.
1.唇腭裂患儿的出生存在季节性差异,不同的地区、人群季节性差异不同,那么中国人群中,唇腭裂患儿的出生是否存在季节性差异,本课题给予初步探讨。
2.观察记录分析经缝牵引成骨技术在唇腭裂面中部发育不全患儿中的临床治疗过程,探讨牵引力与患者年龄的关系,经缝牵引成骨的稳定性和回缩率,对牙弓宽度、腭穹高度、语音清晰度及腭咽闭合的影响,进一步指导临床治疗。
3.以SD雄性大鼠颧上颌缝为研究对象,探讨面缝增龄性生物学变化,为研究经缝牵引促进上颌骨复合体的生长发育提供生物学基础。
[方法]
1.收集2002.1至2011.12月在我院接受唇腭裂相关治疗的患者资料,对照组是北京大学附属第三医院产科2002.1至2011.12月正常出生的婴儿数据。采用X2检验分析唇腭裂出生的季节性差异。
2.分析2005年以来在我院接受经缝牵引成骨术治疗的65例唇腭裂面中部发育不全患儿,研究①面型、咬关系的变化②测量术前、拆架子时及随访期的头颅侧位片,观察缝牵引成骨的稳定性和回缩率③将石膏牙模转成三维数字牙模,测量术前、拆架子时及随访期的牙弓宽度及腭穹高度的变化④通过主观语音评价、鼻咽纤维镜及X线头颅侧位片评价术前及拆架子时语音清晰度及腭咽闭合的变化。
3.SD雄性大鼠分4周龄、3月龄及13月龄三组,各20只,观察记录身体、头面颅骨膜及颅面缝的大体变化；Elisa检测血浆中RANKL/OPG/ALP/OC的蛋白量及增龄性变化；RT-PCR检测局部组织中RANKL/OPG/ALP/OC/OX62/CD25的mRNA表达量及增龄性变化；同时采用组织学和MicroCT的方法观察缝及周围骨组织的增龄性变化。
[结果]
一.节律性研究
收集6193名唇腭裂患者及13254名正常新生儿的出生资料。研究发现,唇腭裂患者的出生高峰期在秋季和冬季,尤其是10月和1月,出生率最低的是在夏季(P<0.05)。男性患者出生高峰期在秋季和冬季,尤其是10月、2月和1月,女性患者出生高峰期也在秋季和冬季,尤其是1月、10月和11月。在女性患者中不同月份及季节出生率之间有统计学差异(P<0.05),但男性患者没有发现类似结果(P>0.05)。
二.临床研究
1.65例患儿顺利完成了缝牵引治疗。面型得到显著改善,面中部凹陷畸形消失,前牙反(?)得到矫正,未发生严重并发症。
2.低于11岁年龄组与高于11岁年龄组相比,牵引力无明显差异(P>0.05),但后者潜伏期明显延长。
3.拆架子时,A点平均前移13.48mm, SNA角度平均增加9.65。；拆架子后6个月内,73%的患者A点后退22%,27%的患者A点前移13%,82%的患者SNA角度减少20%,18%的患者角度增加9.6%；拆架子后26.75个月,83%的患者A点后退23%,92%的患者SNA角度减小24.6%。
4.未做正畸的单侧完全性唇腭裂的患儿,行RED缝牵引后其牙弓宽度增加最明显的是前段,其次是中段,再次是后段；同步正畸的单侧完全性唇腭裂的患儿,牙弓宽度增加最明显的是中段,其次是后段,再次是前段；同步正畸治疗的患者拆架子后随访,前段、中段牙弓宽度继续增加,后段牙弓宽度缩小；未正畸组患儿腭穹高度降低,正畸组患儿腭穹高度稍有增加。
5.38%的患儿语音清晰度增加,54%的患儿语音清晰度变差；69%的患者腭咽闭合状态未发生变化,31%的患者腭咽闭合状态有恶化；92%的患者软腭长度/咽腔深度减少。
三.实验研究
1.SD雄性大鼠从4周到13月龄,体重增加345%,体长增加65%,躯干增加61%。成年后,体长和躯干增加不再明显,体重依然可明显增加。
2.从4周到13月龄,血浆中RANKL, OPG的数值有降低的趋势,RANKL/OPG的数值有增高的趋势,但没有统计学意义。ALP和OC的数值降低,且有统计学意义(P<0.05)。
3.在组织水平,从4周到13月龄,RANKL, OPG的基因表达量有降低趋势,RANKL/OPG的数值有增加的趋势,ALP的数值有降低的趋势,但无统计学意义。OC的数值降低,且有统计学意义(P<0.05)；从4周到3月龄,integrin alpha E2(OX62),CD25的数值均呈增高趋势,但均无统计学意义。
4. MicroCT检测大鼠颧上颌缝,从4周到13月龄其骨缝的密度增加8倍,同期骨密度增加2倍。缝与骨的密度比从4周龄的0.14：1上升到13月龄的0.54：1。
[结论]
1.在中国人群中唇腭裂患儿的出生存在季节性差异,且性别不同差异不同,通过倡导减少吸烟、酗酒以及增加日晒时间可能对降低唇腭裂的出生率有益。
2.经缝牵引成骨治疗唇腭裂面中部发育不全可取得良好效果,随着年龄的增长,其牵引的难度有增大的趋势。拆架子后半年内A点平均会有20%的回缩,在前期超量牵引时,可以根据此值计算超量牵引的距离。术后A点的回缩主要发生在拆架子后的半年内,所以缝牵引患儿拆架子后需常规夜间佩戴面弓,最好能坚持半年左右,当然面弓的佩戴与超量牵引的回缩需协同处理,以达到最佳的面型和咬合功能改善。从三维牙模分析可知未同步正畸的患者牙弓宽度增加和腭穹高度降低,说明作用于上颌骨的前向牵引力可促进硬腭的三维生长,硬腭的缝组织和骨组织均发生了重塑。由于未同步正畸的患儿牙弓扩张较同步正畸的显著,所以对于牙弓缩窄较为严重的患者,建议暂不同步正畸治疗。如果患儿牙弓缩窄并不严重,则可以术前开始同步正畸。缝牵引上颌骨前移后,到拆架子时,38%的患者语音清晰度出现改善,但多数患儿语音清晰度与术前相比轻度下降,69%的患者腭咽闭合与术前相比无明显变化。
3.SD雄性大鼠,从4周到13月龄,颅面部骨膜增厚,骨质增厚,颜色变白,颧上颌缝变窄,缝间纤维母细胞减少,缝旁骨板增厚,骨质变的更为致密,代表成骨活性的及破骨活性的的血浆蛋白量与缝及其周围组织内对应的基因表达量有着较好的一致性,至13月龄时破骨细胞的活性未发现有统计学意义的变化,但成骨细胞的活性已经降低。MicroCT显示至13月龄,骨缝的密度增加8倍,同期骨密度增加2倍,骨缝密度与骨密度比从0.14：1增长到0.54：1。以上缝的增龄性变化,为临床患者增龄性经缝牵引难度增加提供了生物学依据。从4周龄到3月龄,局部组织中DC细胞的活化标记及T细胞的活化标记未发现明显的变化,说明在此年龄段骨缝及其周围骨组织的骨免疫处于平衡状态。在此年龄段进行经缝牵引成骨可能会获得较好的缝组织和骨组织的重塑平衡,有利于新骨组织的形成。
[objective]
1. The research will determine whether births of patients with oral-facial clefts follow a seasonal pattern in a native Chinese population.
2. To study the relationship between the distraction force and the age of the patients.To study postoperative maxillary stability and retraction rate. The impact on dental arch width, palate height,speech articulation and velopharyngeal closure status will also be determined.
3. We use the zygomaticomaxillary suture of the male rat as the research object. We hope to find some age related biological changes which is related to the age related difficulty in maxillary complex distraction.
[Methods]
1. Patients with oral-facial clefts treated at the Plastic Surgery Hospital between2002.01-2011.12were retrospectively investigated. The controls consisting of all living births from the obstetric department of the third affiliated hospital of Peking university during2002.01-2011.12.Seasonal variations in months of births were analyzed by using χ2test.
2.65patients were treated with trans-sutural distraction osteogenesis technique. To study①the change of face contour and occluding relation②maxillary stability and retraction rate with cephalometric mesurement③the change of dental arch width and palatal height with digital dental wax mesurement④the change of speech articulation and velopharyngeal closure status with the methods of subjective speech evaluation, nasopharynx fiber microscopy examination and X ray of lateral projection of cranium measurement.
3. The SD male rats were divided into3groups (n=20),the age of each group is4week old(4w),3months old(3m) and13months old(13m). The age related changes of body, cranial facial sutures and periosteum were recorded. The age related changes of plasma amount of RANKL/OPG/ALP/OC were detected with Elisa and local tissue RANKL/OPG/ALP/OC/OX62/CD25mRNA were detected with RT-PCR. We also use histology and MicroCT to study age related changes of the zygomaticomaxillary suture.
[results]
1. seasonal research
A total of6193patients with oral-facial clefts and13254normal living newborns were included in this study. Birth time peaks of the patients occurred in autumn and winter,especially in October and January,compared with the nadir in the summer(P<0.05). The birth time peaks of male patients occurred in autumn and winter, especially in October, February and January. The birth time peaks of female occurred in autumn and winter,, especially in January, October and November. There was statistical difference in birth distribution in the different months (P<0.05) or four seasons (P<0.05) in females,No statistical difference was found in males (P>0.05).
2. clinical research
I) All patients'face contour and occluding relation improved after treatment. No severe complications were found.
II) There is no statistically significant difference of distraction force was found between the age below and more than11years old, but in older group the latency time is longer.
III) From preoperative to the removal of RED,the A point average forward13.48mm and the SNA angle increased by an average of9.65°;within6months after the removal of RED,73%of patients with A point retreat22%,83%of patients with SNA angle decreased20%;within26.75months after the removal of RED,83%of patients with A point retreat23%,92%of patients with SNA angle decreased24.6%.
IV) Dental arch width increased most obviously of UCLP without orthodontic treatment is the anterior segment,followed by the medial segment, and again posterior segment. Dental arch width increased most obviously of UCLP with orthodontic treatment is medial segment followed by posterior segment, and again the anterior segment. In the follow-up period, the UCLP with orthodontic treatment whose anterior and medial segment of dental arch width continue to increase,but the posterior segment narrowing. The palatal height of the UCLP without orthodontic treatment reduced,but the orthodontic group slightly increased.
V)38%of patients increased speech articulation,54%of patients deteriorated speech articulation.69%of patients with velopharyngeal closure status have no change,31%of patients with velopharyngeal closure status deteriorated.92%of patients with soft palate length/pharyngeal depth ratio reduced.
3. Animal experiment
1) From4w to3m old,the body weight,body and trunk length of the SD male rats increased345%,65%,61%respectively. When the rats were in adult,the length of the body and trunk will not increase obviously, but body weight still can significantly increased.
2) From4w to13m old,the plasma amount of RANKL and OPG tend to decrease, but RANKL/OPG ratio tends to increase, both of them have no statistically significant. The value of plasma ALP and OC decreased and have statistically significant (P<0.05)
3) From4w to13m old,At the tissue level the mRNA expression of RANKL and OPG tend to decrease,but the RANKL/OPG ratio and the amount of ALP tend to decrease,all of above have no statistically significant. The value of OC decreased and have statistically significant.;From4w to3m old,the amount of0X62and CD25tend to increase,but have no statistically significant.
4) From4w to13m old, MicroCT shows the density of zygomaticomaxillary suture increased by8times and the density of bone increased by2times at the same time. The suture/bone density ratio increase from0.14:1in4w old to0.54:1in13m old.
[conclusions]
1. The data indicate that there is a possible seasonality in months of births of patients with oral-facial clefts in a native Chinese population and a difference between the genders. This approach could be useful for the study of the etiology and pathogenesis of oral-facial clefts.
2. To treat midface hypoplasia with the technique of SDO have been achieved good results. With the patient's age grows, the treatment will have more difficulty. After the removal of the RED, the maxillary complex will have an tendency to retreat, especially in the first six months, synchronizing orthodontic treatment is not helpful to the lateral expansion of the dental arch, but its long-term effect is better, and also beneficial to the palate height maintainment.38%of patients increased speech articulation,69%of patients with velopharyngeal closure status have no change, there is certain guiding significance of the soft palate length/pharyngeal depth ratio in judgment of postoperative velopharyngeal status.
3. From4w to13m old,the body weight, body and trunk length significantly increased, but when the rats were in adult,only body weight increased obviously. The amount of plasma osteoblasts and osteoclasts related protein have a good consistency with mRNA quantitative in the local tissue. Till13months old,we didn't found any sign of bone loss,but the activity of osteoblasts have been reduced. From4w to3m old, the amout of DC and activated T cell did not change significantly in local tissue. With the age increasing,the difference of the density between the suture and bone are getting smaller and smaller. Its texture and link is more close. And all of above can be the biological evidence to the age related difficulty with SDO technique.
引文
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