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病，但在兒童中發(fā)病較少。膽道疾病的診斷方法包括
非侵入性及侵入性兩類，非侵入性檢查手段首選磁共
振胰膽管成像(magnetic resonance cholangiopanceatography，MRCP)，因其易受局部緊密的解剖組織影響，一
定程度上影響準(zhǔn)確性[39-42]。侵入性檢查中被稱為“金
標(biāo)準(zhǔn)“的內(nèi)鏡下逆行胰膽管造影術(shù)(endoscopic retrograde cholangiopancreatography，ERCP)因操作時可能
出現(xiàn)膽道穿孔、術(shù)后胰腺炎等并發(fā)癥，且在兒科開展
該操作的醫(yī)院有限，常作為治療手段使用。EUS具有
獨特優(yōu)勢，既可以近距離使用超聲探頭進行掃描，觀
察壺腹部，辨別胰管、膽總管結(jié)構(gòu)走向，判斷病變與膽
管、胰管的關(guān)系，又可以評估有無行內(nèi)鏡下逆行胰膽
管造影術(shù)(ERCP)侵入性操作的必要性，避免過度操
作，增加患兒負(fù)擔(dān)[43-46]。一例5歲車禍兒童胰膽管積液
的個案報道中，出現(xiàn)ERCP置管困難，采用EUS內(nèi)鏡下膽
管重建后進行引流，避免了二次置管手術(shù)的風(fēng)險[47]。鐘
雄利等[20]研究報道，EUS診斷壺腹部及周圍病變的準(zhǔn)
確率高達86.7%，顯著高于腹部CT檢查(63.3%)，EUS
還可發(fā)現(xiàn)MRCP 診斷為陰性的膽總管結(jié)石?？偠?/p>
之，EUS 應(yīng)用逐漸廣泛，在膽道疾病及壺腹部周圍病
變的診治中占據(jù)越來越重要的位置[44]。
2.6 消化道惡性腫瘤 EUS特有的高分辨力探
頭可準(zhǔn)確判斷消化道腫瘤病灶浸潤深度、大小，判斷
其向周圍淋巴結(jié)及周圍其他重要臟器侵犯的深度、層
次，協(xié)助早期腫瘤T、N分期，如今EUS是消化道管腔
腫瘤局部分期的最精確方法[48]。EUS還可用于癌癥晚
期神經(jīng)叢阻滯鎮(zhèn)痛及靶器官藥物注射等[2]。
3 超聲內(nèi)鏡的治療應(yīng)用
超聲內(nèi)鏡的微創(chuàng)治療在成人消化系統(tǒng)疾病上應(yīng)
用較為廣泛，對于常見的上消化道隆起病變，成人科
領(lǐng)域可采取的超聲內(nèi)鏡治療手段包括內(nèi)鏡下黏膜切
除術(shù)、內(nèi)鏡下黏膜剝離術(shù)、經(jīng)內(nèi)鏡黏膜下挖出術(shù)、內(nèi)鏡
下全層切除術(shù)等[49-50]，這類微創(chuàng)治療應(yīng)用近年來在兒
童中已有較少報道，值得重視和學(xué)習(xí)[51]。異位胰腺在
兒童上消化道隆起性病灶中占比較高，關(guān)于異位胰腺
的治療，無癥狀者可予定期監(jiān)測病灶，當(dāng)出現(xiàn)腹痛、惡
心、嘔吐等癥狀或病灶快速增大時可在EUS輔助下行
黏膜下腫物切除[52]；胰腺炎的患者，因炎癥反應(yīng)可能導(dǎo)
致組織纖維化，從而出現(xiàn)胰管狹窄梗阻、胰腺假性囊
腫等并發(fā)癥，EUS 在觀察以上結(jié)構(gòu)改變的同時給予
EUS 引導(dǎo)下胰管引流術(shù)、囊腫引流術(shù)，在一定程度上
避免因內(nèi)鏡下逆行胰膽管造影術(shù)失敗后的外科手術(shù)
治療[51-55]；膽道疾病中有著同樣的應(yīng)用，當(dāng)出現(xiàn)梗阻時
可行EUS引導(dǎo)下膽管引流術(shù)[53]；門靜脈高壓所致食管
胃底靜脈曲張的治療中，常規(guī)手段為靜脈曲張?zhí)自?/p>
療或套扎與注射硬化劑聯(lián)合治療，但存在早期復(fù)發(fā)的
隱患。SENO等[56]研究發(fā)現(xiàn)，內(nèi)鏡下治療前行EUS分
析可預(yù)測靜脈曲張的復(fù)發(fā)，對病情發(fā)展有指向作用，
同樣可提高治療指向性及有效率。對于惡性腫瘤，
EUS引導(dǎo)下活檢技術(shù)可協(xié)助腫瘤早期分期，進行更優(yōu)
的腫瘤切除治療[57]。
4 展望
超聲內(nèi)鏡是一種具有較高臨床價值的診療手段，
因其兼?zhèn)鋫鹘y(tǒng)內(nèi)鏡與超聲檢查的功能，彌補了傳統(tǒng)內(nèi)
鏡與傳統(tǒng)B超檢查的不足，同時可規(guī)避ERCP檢查的操
作風(fēng)險，對比常規(guī)影像學(xué)檢查又有更高的準(zhǔn)確性。超
聲內(nèi)鏡引導(dǎo)下細(xì)針穿刺技術(shù)的發(fā)展也為該項手段增加
了新的診治價值。EUS在臨床上的應(yīng)用很大程度上拓
寬了臨床醫(yī)師的診斷思路，使消化系統(tǒng)疾病治療水平
得到了較大程度地提高[1-4，58-59]。在臨床應(yīng)用中，EUS雖
安全性較高，但作為有創(chuàng)操作，且需要麻醉，仍有一定
的風(fēng)險，如術(shù)后腹痛、出血、穿孔、麻醉意外等，需要臨
床醫(yī)師及麻醉醫(yī)師綜合評估。總體而言，EUS治療屬
于有效性高、安全性高、風(fēng)險低、術(shù)后恢復(fù)快的治療手
段。目前EUS在兒科開展較少，可能跟兒科患者較少
發(fā)生消化道惡性病變、部分兒科醫(yī)師尤其基層兒科醫(yī)
師對超聲內(nèi)鏡檢查及適應(yīng)證等了解不夠及缺乏小兒內(nèi)
科有經(jīng)驗的超聲內(nèi)鏡醫(yī)師等有關(guān)，未來需要更多的應(yīng)
用文獻報道、科普宣傳及會議學(xué)習(xí)等進行推廣，讓更多
的兒科醫(yī)師尤其兒科消化專業(yè)醫(yī)師了解及應(yīng)用。
綜上所述，超聲內(nèi)鏡在兒童消化系統(tǒng)疾病的診斷與
治療中具有較高的臨床價值且安全，值得推廣應(yīng)用。
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(收稿日期：2024-10-23；修回日期：2025-01-02)
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海南醫(yī)學(xué)2025年2月第36卷第3期 Hainan Med J, Feb. 2025. Vol. 36, No. 3
微種植釘輔助成人上頜快速擴弓的研究進展
盧羽桐，雷勇華
中南大學(xué)湘雅醫(yī)院口腔正畸科，湖南 長沙 410008
【摘要】 微種植釘與上頜快速擴弓活動矯治器聯(lián)合使用在成人上頜擴弓治療中取得了顯著進展。這一技術(shù)
可更快速有效擴大上頜牙弓橫向?qū)挾龋裰锌p在冠狀面上表現(xiàn)出更高水平的開展效應(yīng)，支抗牙頰傾和牙槽骨板傾
斜彎曲副作用減少。微種植釘?shù)膽?yīng)用突破了傳統(tǒng)上頜快速擴弓的年齡限制，適用于更多成人患者，可在非手術(shù)條
件下有效打開上頜周圍骨縫結(jié)構(gòu)，將上頜骨及周圍鄰近組織作一整體發(fā)生軟硬組織適應(yīng)性改建，鼻腔寬度及上氣
道容積得以增大，并在一定程度上比單純應(yīng)用傳統(tǒng)上頜快速擴弓更具穩(wěn)定性。本綜述旨在系統(tǒng)總結(jié)微種植釘輔助
成人上頜快速擴弓的研究進展，分析其在臨床應(yīng)用中的優(yōu)勢與局限性，探討其對成人患者的治療效果，以期為臨床
醫(yī)生提供科學(xué)依據(jù)和參考，推動該技術(shù)在臨床上的廣泛應(yīng)用和進一步研究。
【關(guān)鍵詞】 微種植釘輔助上頜快速擴弓；腭中縫；成人；錯?；正畸支抗程序
【中圖分類號】 R782.2 【文獻標(biāo)識碼】 A 【文章編號】 1003—6350（2025）03—0452—05
Progress in the study of rapid maxillary arch expansion in adults assisted by micro-implant studs. LU Yu-tong,
LEI Yong-hua. Department of Orthodontics, Xiangya Hospital of Central South Univerity, Changsha 410008, Hunan, CHINA
【Abstract】 The combination of microimplant nail and maxillary rapid expansion mobile appliance has made remarkable progress in the treatment of maxillary expansion in adults. This technique can expand the transverse width of
the maxillary arch more quickly and effectively, and the palatine suture shows a more horizontal development effect on
the coronal plane, and the side effects of the buccal inclination and the oblique bending of the alveolar bone plate are reduced. The application of micro-implant nails breaks through the age limit of traditional rapid maxillary arch expansion
and is suitable for more adult patients, it can effectively open the suture structure around the maxilla under non-surgical
conditions, and make the maxilla and surrounding tissues as a whole to undergo adaptive remodeling of soft and hard tissues, thereby increasing the width of the nasal cavity and the volume of the upper airway, and to some extent, it is more
stable than the traditional rapid maxillary extension. The purpose of this review is to systematically summarize the research progress of micro-implant nail assisted rapid maxillary arch expansion in adults, analyze its advantages and limitations in clinical application, and discuss its therapeutic effect on adult patients, in order to provide scientific basis and reference for clinicians, and promote the wide application and further research of this technology in clinical practice.
【Key words】 Rapid maxillary expansion assisted by micro-implant nail; Palatine suture; Adult; Malocclusion;
Orthodontic anchorage procedure
doi:10.3969/j.issn.1003-6350.2025.03.029 ·綜述·
第一作者：盧羽桐(1999—)，女，碩士在讀，主要研究方向為口腔正畸。
通訊作者：雷勇華(1966—)，男，博士，主任醫(yī)師，教授，碩士生導(dǎo)師，主要研究方向為青少年及成人牙齒不齊矯正、唇腭裂患者牙矯正、正畸正頜聯(lián)合治療，E-mail：lyh8484123@126.com。
引用本文：盧羽桐, 雷勇華. 微種植釘輔助成人上頜快速擴弓的研究進展[J]. 海南醫(yī)學(xué), 2025, 36(3): 452-456.
上頜牙弓橫向發(fā)育不足在臨床較為常見，主要表
現(xiàn)為兒童或成人患者上牙弓較下牙弓窄，后牙區(qū)反?
甚至反鎖?，常伴牙列擁擠、腭蓋高拱、頰側(cè)前庭溝間
隙變寬，嚴(yán)重影響患者的咀嚼功能及面部美觀，此外
還與鼻通氣障礙、阻塞性睡眠呼吸暫停綜合征及骨性
Ⅲ類錯?畸形存在密切相關(guān)性。上頜快速擴弓(rapid
maxillary expansion，RME)是一種治療上頜牙弓橫向
發(fā)育不足的成熟方法，在生長發(fā)育高峰期前通過打開
腭中縫顯著增加上頜牙弓寬度最早用于治療兒童、青
少年的上下牙齒-頜骨橫向不調(diào)。成人由于骨縫閉
合，生長潛力減少，RME呈現(xiàn)出更多的牙效應(yīng)。
近年來，隨著口內(nèi)種植釘支抗的興起及廣泛應(yīng)
用，微種植釘輔助上頜快速擴弓(miniscrew-assisted
RPE，MARPE)被認(rèn)為是一種可接受且穩(wěn)定實現(xiàn)純骨
骼擴張的矯治器，因種植釘植入風(fēng)險創(chuàng)傷小、手術(shù)過
程簡單及耐受性良好等優(yōu)點，較手術(shù)輔助上頜快速擴
弓(surgically assisted rapid palatal expansion，SARPE)
更易被接納，其正畸矯正年齡范圍已擴大至青春期晚
期患者乃至成年患者[1]。本文就微種植釘聯(lián)合上頜快
速擴弓治療成人上頜牙弓橫向發(fā)育不足的國內(nèi)外相
關(guān)研究進展作一綜述，以期給正畸醫(yī)生臨床工作提供
參考與幫助。
1 MARPE對上頜牙弓的開展效應(yīng)
1.1 MARPE 擴弓器應(yīng)用時的骨效應(yīng) MARPE
借助腭部種植釘將擴弓器產(chǎn)生的矯治力直接作用于
腭部基骨，從而增強上頜擴弓力量的骨載擴弓裝置，
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Hainan Med J, Feb. 2025. Vol. 36, No. 3 海南醫(yī)學(xué)2025年2月第36卷第3期
應(yīng)用時產(chǎn)生的骨效應(yīng)分為腭中縫的擴展效應(yīng)及上頜
后牙牙槽骨的改建效應(yīng)。MARPE矯治器對青少年及
成年患者都可產(chǎn)生有效治療效果，雖然在有生長潛力
的患者中表現(xiàn)更大的骨骼及牙齒變化，但對于無生長
潛力的患者可有相似的骨骼和牙齒橫向變化比例[2]。
在一些成年患者中，單個種植釘可能無法提供最佳效
果，MARPE 多由四顆成對植入腭中縫兩側(cè)的正畸微
種植釘搭配常規(guī)Hyrax擴弓器組成，因種植釘植入角
度、植入深度、植入位置及固位裝置等不同呈現(xiàn)多種
設(shè)計，如C-expander
[3]、MARME
[4]、上頜骨擴張器(maxillary skeletal expander，MSE)
[5]和個性化增加可調(diào)元
件的裝置[6-7]。
1.1.1 腭中縫的開展變化 傳統(tǒng)RME及SARPE
作用下顎中縫擴張效應(yīng)呈現(xiàn)為反向“V”字模式[8]。而
MARPE 技術(shù)顯示上腭在冠狀面趨向前后部水平擴
張，腭中縫橫向擴張效果尤以腭后部增加明顯[9]。
CANTARELLA 等[10]測得 MARPE 作用下 PNS 的擴開
量為ANS的90%，性別、年齡與腭中縫開口度之間的
相關(guān)性可以忽略不計。腭中縫發(fā)育程度是影響
MARPE 治療效果的重要因素。CHUN 等[11]、JIA 等[12]
發(fā)現(xiàn)同年齡下MARPE顯示出的腭中縫分離成功率顯
著高于單純RME作用。而<20 歲患者較≥20歲患者
進行MARPE 時更容易成功分離腭中縫，骨骼擴張比
例隨著年齡增長而降低[13]。同時，腭中縫融合程度也
會反過來影響MARPE 的施力效果。腭穹窿窄而高，
隨著MAPRE 不斷向腭板兩側(cè)施力，裝置內(nèi)的種植釘
在反作用力下會發(fā)生向腭中縫的傾斜，并且腭中縫
融合程度越高，種植釘傾斜更明顯[14]。為實現(xiàn)腭后部
更大的應(yīng)力集中，種植釘應(yīng)穿透雙層腭鼻骨皮質(zhì)植
入，以改善種植釘受力穩(wěn)定性，減少種植釘變形和折
斷[15-16]。但從解剖學(xué)角度而言，穿透雙皮質(zhì)的微種植
釘易對鼻黏膜及鼻腔造成損傷，可能加重患者的不
適，治療前有必要對患者的腭中縫融合程度進行評
估，這對預(yù)估MARPE治療效果有重要參考意義。
1.1.2 上頜牙槽骨的結(jié)構(gòu)變化 MARPE的牙槽
骨效應(yīng)包括上頜后牙頰側(cè)牙槽骨厚度減少及高度損
失，骨板趨向頰側(cè)傾斜。一般而言，上頜擴弓存在復(fù)
發(fā)傾向，因此無論擴弓器類型如何，雙側(cè)前磨牙和磨
牙的頰側(cè)骨板厚度在整個擴張鞏固期內(nèi)都存在減
少，表明支抗牙在牙槽骨內(nèi)出現(xiàn)頰側(cè)位移。相反，腭
側(cè)骨板厚度可能存在增加[17]。MARPE受力點更接近
上頜骨旋轉(zhuǎn)中心及阻抗中心，傳播到上頜骨支柱結(jié)
構(gòu)和牙槽骨的應(yīng)力較少，可以減少頰側(cè)牙槽骨的厚
度損失[18-19]。有學(xué)者發(fā)現(xiàn)基本所有經(jīng)過MARPE治療
的患者都存在少量頰側(cè)牙槽骨的垂直吸收。頰側(cè)牙
槽骨高度損失與治療前骨板厚度存在負(fù)相關(guān)[20]。腭側(cè)
牙槽骨高度在第一磨牙水平處損失最為明顯，其余位
置骨質(zhì)流失不明顯[21]。但伴隨明顯支抗牙頰傾效應(yīng)
時，頰側(cè)牙槽骨高度、厚度降低及骨板傾斜效應(yīng)增加，
此時牙槽骨仍有發(fā)生骨開裂及骨開窗的風(fēng)險。
1.2 MARPE 擴弓器應(yīng)用時的牙效應(yīng) MARPE
產(chǎn)生的牙效應(yīng)表現(xiàn)為支抗牙頰向移動、頰向傾斜及牙
根吸收。骨源性腭擴張器的最大張應(yīng)力集中在支抗
種植釘上，而常規(guī)RME的最大張應(yīng)力集中在支抗磨牙
上，在擴張期和鞏固期，MARPE支抗牙頰側(cè)移位均小
于傳統(tǒng) RME
[22]。但 SOLANO 等[23]通過 CBCT 評估發(fā)
現(xiàn)在MARPE后牙齒傾斜度未發(fā)生明顯變化。多數(shù)學(xué)
者認(rèn)為組織-骨傳導(dǎo)擴弓器在臨床應(yīng)用上顯示出比牙
齒-骨傳導(dǎo)擴弓器更大的骨骼擴張率、更低的牙槽不
良反應(yīng)率及更輕微的支抗牙頰傾副作用[24-25]。從長期
效應(yīng)分析，MEHTA 等[26]發(fā)現(xiàn)RME、MARPE 組和對照
組之間的牙根吸收量沒有差異，但磨牙傾斜度與上頜
第一磨牙的頰根長度存在明顯負(fù)相關(guān)。
2 MARPE對面中部軟硬組織三維形態(tài)的效應(yīng)
2.1 上頜復(fù)合體的改建 骨縫的生長可以使上
頜骨長度和高度增加，骨縫的性質(zhì)和特點決定了其在
外力作用下可以發(fā)生改建[27]。KNAUP等[28]發(fā)現(xiàn)成年
患者的腭中縫骨化組織比例很低，腭中縫骨化程度不
是上顎擴張時主要橫向阻力。也有研究認(rèn)為上頜骨
擴張時主要的阻力位于顴頜縫。SARPE和MARPE都
可有效打開上頜骨縫，但MARPE 可在非手術(shù)條件下
于所有擴張期內(nèi)對后部腭中縫、顴頜縫和翼下頜縫產(chǎn)
生更恒定的張力[29-31]。CHO等[32]測得 MARPE治療短
期內(nèi)上頜周圍骨縫的寬度均有增加，腭中縫的打開與頜
間骨縫變化呈正相關(guān)，結(jié)果有統(tǒng)計學(xué)意義。LEE等[33]觀
察到，在成年男性患者中，上頜骨縫尤其是顴頜縫和
翼上頜縫寬度越大，MARPE 激活后骨縫分離成功率
越高，上頜骨擴張的可能性越大。隨著患者年齡的增
加，上頜骨的骨骼發(fā)育情況更為成熟，骨性擴弓的成
功率及表達率與年齡存在密切相關(guān)性。Hyrax擴弓器
阻抗中心位于上頜骨阻抗中心以下，激活時支抗牙受
到的力會在雙側(cè)上頜骨半部的阻抗中心產(chǎn)生相等的
力矩，顯示出上頜骨圍繞牙齒的旋轉(zhuǎn)[34]。骨性擴弓
器的阻抗中心靠近上頜骨阻抗中心，激活時骨縫受
到張應(yīng)力，上頜骨支柱結(jié)構(gòu)受到壓應(yīng)力，頜外支抗
力抵消來自牙弓后部的骨縫與上頜骨支柱結(jié)構(gòu)的
擴弓阻力，面中部、鼻基底骨和上頜骨基底部橫向
擴張增加[35-36]。上頜骨周邊結(jié)構(gòu)的相應(yīng)改建實現(xiàn)上
頜整體開展效應(yīng)，避免上頜復(fù)合體發(fā)生不必要的旋轉(zhuǎn)
和傾斜。既往研究發(fā)現(xiàn)RPE及MARPE作用的主要骨
擴張位置在顴上頜復(fù)合體，鼻腭孔至腭大孔間多個冠
狀切面都有骨擴張，同時鼻寬增加，但額頜縫處基本
無骨擴張。顴骨傾向于與上頜骨一起向外旋轉(zhuǎn)，共同
的旋轉(zhuǎn)中心位于額顴縫的上側(cè)附近，顴上頜復(fù)合體于
冠狀面呈錐形擴張，矢狀面發(fā)生前下移位，后部比前
部更向下移位[37-39]。個性化改變微種植釘?shù)奈恢煤凸?/p>
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位體設(shè)計，一定程度上可差異地改變上頜骨向前、向
下運動和向外旋轉(zhuǎn)的大小，對面中部塌陷伴上頜橫向
發(fā)育不足的成人Ⅲ類錯?畸形患者的臨床治療有指
導(dǎo)意義[40-41]。
2.2 面中部軟組織改建 面部軟組織主要變化
發(fā)生在鼻部及上唇。上頜快速擴弓后牙弓寬度及長
度的增加將建立新的咬合平衡和新的面部輪廓。短
期內(nèi)可見成人鼻區(qū)及上唇周圍軟組織外觀隨MARPE
治療發(fā)生適應(yīng)性改建。軟組織鼻基底寬度和鼻孔寬
度顯著增大，鼻尖角增大可導(dǎo)致較小的鼻形態(tài)變化，
軟組織鼻下點至H線的距離增加，H角增加，但軟腭表
面積減小[42-43]。面部前后高度增加，兩側(cè)頰部軟組織
形態(tài)趨向飽滿，鼻部變寬并向前、向下移動[44]。口寬與
上頜快速擴弓量呈正相關(guān)，上下唇存在適應(yīng)性位移，
上唇主要表現(xiàn)為人中溝增寬，全面部及下唇形態(tài)變化
不明顯[45]。
2.3 鼻腔體積與上氣道容積 以往研究認(rèn)為，
RME可在短期內(nèi)有效增加阻塞性睡眠呼吸暫停綜合
征(obstructive sleep apnea syndrome，OSAS)患兒的鼻
腔體積及上氣道容積，對慢性鼾癥及睡眠磨牙癥有積
極療效，但無法長期穩(wěn)定[46-48]。有學(xué)者分析MARPE長
期效應(yīng)發(fā)現(xiàn)鼻腔寬度產(chǎn)生了明顯擴張[49]。YI等[50]通過
CBCT 評估發(fā)現(xiàn) MARPE 治療后鼻咽體積顯著增加
8.48%。在PNS平面擴大的鼻寬對上氣道尤其是鼻咽
有明顯開展效果，上頜骨寬度擴大與氣道容積增加直
接相關(guān)[51-52]。MARPE 均勻增加鼻腔前部、鼻腔后部
和梨狀孔寬度，增大鼻腔體積及鼻咽容積的同時有
效提高呼吸暫停低通氣指數(shù)(apnea-hypopnea index，
AHI)
[53-55]。擴弓治療對腭咽、舌咽及喉咽氣道容積沒
有顯著影響[56-57]。對于不存在鼻腔或鼻咽狹窄的上氣
道狹窄患者，MARPE 治療后氣道通氣可能無明顯改
善，臨床醫(yī)生應(yīng)在開始MARPE 之前向患者徹底解釋
預(yù)期變化。
3 MARPE治療的預(yù)后評價
3.1 MARPE后顎中縫骨修復(fù) 已有報道生長期
患者在RME后腭骨水平板有向中線聚合的趨勢，多數(shù)
學(xué)者認(rèn)為無論何種擴弓方式，腭中縫重組效應(yīng)相似，
骨密度沒有顯著差異[58]。但少部分研究認(rèn)為成人患者
MARPE 后顎中縫修復(fù)時間及修復(fù)模式可能與 RME
存在差異，目前并未有確切結(jié)論證明差異。NAVEDA
等[59]發(fā)現(xiàn)大多數(shù)成年患者在MARPE后16個月表現(xiàn)出
腭中縫修復(fù)不完全，最常見未修復(fù)區(qū)位于腭中縫中部
三分之一，前三分之一均得到修復(fù)。
3.2 MARPE 臨床治療穩(wěn)定性評價 MARPE 初
期穩(wěn)定性取決于種植釘直徑和固位類型，充足的骨穩(wěn)
定性和腭穹窿、鼻底雙皮質(zhì)層穿透性是支撐微種植釘
的兩個強制性參數(shù)[60]。腭穹窿本身結(jié)構(gòu)、微種植釘與
腭中縫的位置關(guān)系影響生物力學(xué)結(jié)果。從臨床角度
看，腭部骨皮質(zhì)較厚或腭平面較平的患者表現(xiàn)出更好
的穩(wěn)定性，已有學(xué)者提出借助CBCT影像及計算機輔
助技術(shù)進行數(shù)字工作流程建設(shè)，構(gòu)建個體化MSE的位
置模板并提供可預(yù)測的種植釘放置位置[61-62]。MARPE
短期穩(wěn)定效果優(yōu)于傳統(tǒng)RME短期穩(wěn)定性[63-64]。相同擴
張量下，MARPE顯示出更低的骨性復(fù)發(fā)量和更低的牙
周不良效應(yīng)。長期結(jié)果顯示骨性增寬量總體穩(wěn)定，但
隨著時間推移也存在一定程度的復(fù)發(fā)[65]。
4 結(jié)語
微型種植釘輔助快速腭擴張器非手術(shù)矯正成人上
頜骨橫向發(fā)育不足有以下優(yōu)點：(1)手術(shù)創(chuàng)傷小，種植釘
植入和取出操作簡單；(2)為青少年晚期和成年患者提
供了一種簡單且耐受性良好的上頜骨擴張方式；(3)擴
張力靠近上頜骨阻抗中心實現(xiàn)骨組織平行擴張，減小
支抗牙及牙槽骨副作用；(4)由于骨性擴張實現(xiàn)上頜復(fù)
合體整體改建，為更多臨床病例提供新的診治方案。
MARPE治療與患者口腔健康相關(guān)生活質(zhì)量存在
相關(guān)性。MARPE 可誘發(fā)牙齒、牙周和口腔周圍軟組
織副作用，引起潰瘍、局部受壓缺血甚至腭黏膜增生，
若長期口腔衛(wèi)生欠佳則易引起種植體周圍炎致種植
釘脫落。并發(fā)癥的發(fā)生與年齡相關(guān)，臨床應(yīng)用時需要
注意。未來對MARPE治療后上頜復(fù)合體改建及長期
穩(wěn)定性等方面仍需多角度的完善研究及大數(shù)據(jù)支持。
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(收稿日期：2024-10-19；修回日期：2024-11-20)
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