错颌畸形正颌术患者生活质量变化轨迹及其术前影响因素分析

Trajectory of quality-of-life changes and preoperative predictors in patients undergoing orthognathic surgery for malocclusion

摘要:

目的 探讨错颌畸形正颌术患者的生活质量变化轨迹及其术前影响因素。方法 选取2022年9月—2024年7月华中科技大学同济医学院附属协和医院口腔颌面外科收治的错颌畸形78例患者作为研究对象。评价术前和术后第1、3、6个月的生活质量得分，观察其变化特征，并基于多因素一般回归模型分析，明确其术前影响因素。结果 术前、术后1个月、术后3个月和术后6个月生理机能、生理职能、一般健康状态状况的36项健康调查简表（SF-36）评分和SF-36评分总分比较，差异均有统计学意义（P <0.05）。术后3、6个月生理机能的SF-36 评分较术前和术后1个月高（P <0.05）。术后3、6个月生理职能的SF-36评分较术前高（P <0.05）。术后6个月生理职能的SF-36评分较术后1个月高（P <0.05）。术后3、6个月一般健康状况的SF-36评分较术前和术后1个月高（P <0.05）。术后6个月一般健康状况的SF-36评分较术后1个月高（P <0.05）。术后3、6个月SF-36评分总分较术前和术后1个月高（P <0.05）。术后6个月SF-36评分总分较术后1个月高（P <0.05）。男性术后6个月SF-36评分高于女性（P <0.05），错颌畸形Ⅰ级、Ⅱ级、Ⅲ级患者SF-36评分依次降低（P <0.05）。而不同经济水平、教育水平患者的术后6个月SF-36评分比较，差异无统计学意义（P >0.05）。错颌畸形Ⅱ、Ⅲ级术后6个月SF-36评分较Ⅰ级低，错颌畸形Ⅲ级较Ⅱ级低（P <0.05）。多元线性回归分析结果显示：女性、错颌畸形分类是影响正颌术后6个月SF-36总分的独立危险因素（P <0.05）；而患者对手术结果的期望值是影响正颌术后6个月SF-36总分的独立保护因素（P <0.05）。结论 正颌术能够显著改善错颌畸形患者的远期生活质量，并受性别、错颌畸形分类及手术期望值的影响。

Abstract:

Objective To explore the trajectory of quality-of-life changes and preoperative predictors in patients undergoing orthognathic surgery for malocclusion.Methods Between September 2022 to July 2024, the 78 patients undergoing orthognathic surgery for malocclusion were selected from the Department of Oral and Maxillofacial Surgery at Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology. The quality-of-life scores were assessed preoperatively and at 1, 3, and 6 months postoperatively to observe their change patterns. A multiple linear regression model was applied to identify preoperative factors influencing postoperative quality-of-life outcomes.Results SF-36 scores for physical functioning, physical role functioning, general health perceptions, and the total SF-36 scores were compared across the preoperative period, and at 1, 3, and 6 months postoperatively, and the one-way ANOVA revealed statistically significant differences across all time points (P < 0.05). At 3 and 6 months postoperatively, SF-36 scores for physical functioning were significantly higher than those at baseline and 1 month postoperatively. SF-36 scores for physical role functioning at 3 and 6 months postoperatively were significantly higher than preoperative values, with scores at 6 months postoperatively also significantly higher than those at 1 month postoperatively. SF-36 scores for general health perceptions at 3 and 6 months postoperatively were significantly higher than both preoperative and 1-month postoperative scores, and the 6-month score was significantly higher than the 1-month score postoperatively. Total SF-36 scores at 3 and 6 months postoperatively were significantly higher than those at baseline and 1 month postoperatively, with the 6-month score also significantly exceeding the 1-month score postoperatively. Additionally, male patients had higher SF-36 scores at 6 months postoperatively compared to female patients. Among patients with Class I, II, and III malocclusion, total SF-36 scores decreased progressively across the severity levels. However, no statistically significant differences were found in SF-36 scores at 6 months postoperatively among patients with different economic or educational levels, as determined by one-way ANOVA (P > 0.05). At 6 months postoperatively, patients with Class II and Class III malocclusion had lower SF-36 scores compared to those with Class I malocclusion, and patients with Class III malocclusion had lower scores than those with Class II. Multiple linear regression analysis showed that female sex and higher malocclusion classification were independent risk factors for the total SF-36 score at 6 months postoperatively (P < 0.05), while higher expectations regarding surgical outcomes were identified as an independent protective factor (P < 0.05).Conclusion Orthognathic surgery can significantly improve the long-term quality of life of patients with malocclusion, and this improvement is affected by factors such as sex, malocclusion classification, and preoperative expectations of surgical outcomes.