探討正顎手術患者生活品質之影響

目的:本研究目的探討正顎手術患者，使用 OHIP-14T(Oral Health Impact Profile，口腔健康相關生活品質量表)和OQLQ(Orthognathic Quality of Life Questionnaire，正顎生活品質問卷)，比較手術前、手術後，生活品質及各健康層面改善之狀況。將勒福式一型(Le Fort I)截骨術和雙側矢狀劈開截骨術(Bilateral Sagittal Split Osteotomy，BSSO)、口內下顎直枝垂直截骨術(Intraoral Vertical Ramus Osteotomy IVRO)合併下頦成形術 (Genioplasty，Gep)，進行手術矯正，探討與OHIP-14T、OQLQ的關係，對手術前與手術後生活品質差異的影響。及探討將性別、年齡及二種不同手術方式分組與OHIP-14T、OQLQ的關係，對不同時間點口腔健康相關問題及生活品質的影響。方法: 本研究追蹤訪查高雄某醫學中心接受正顎手術治療，年滿20歲以上，共收集45位接受正顎手術患者，以OHIP-14T及 OQLQ量表測量患者口腔及整體性健康相關生活品質，以卡方檢定(Chi-square test)分析基本人口學與手術方式比較差異，並用獨立樣本t 檢定，分析平均數、標準差描述基本人口學資料，與OHIP-14T及OQLQ各量表前測之相關性，及性別與手術方式在三個時間點之組間差異，以及分析二種手術方式在三個時間點與OHIP-14T及OQLQ各構面的差異分析。以配對t檢定(Paired-t test)及Effect Size(ES)分析兩種手術方式在三個時間點對各量表改變之情形。使用迴歸統計方法調整量表及基本人口學變項，比較二種手術方式對OHIP-14T及OQLQ改變量之差異。使用廣義方程式（generalized estimating equation，GEE）進行統計分析，在整個觀察期內，比較了各年齡組和性別及手術方式對生活質量的影響。結果: 二種手術方式在術後三個月Le Fort I術式於OQLQ構面之社交方面與OQLQ整體p<0.05，有顯著改善；在IVRO+Gep 或 BSSO+Gep術式於OHIP-14T構面之身體疼痛及OQLQ構面之面部美學有明顯改善，p<0,05，達統計學顯著差異。在OQLQ量表，年齡在20-30歲的患者的生活品質明顯優於31-40歲患者。用廣義方程式（GEE）分析年齡、性別和手術方式及不同時間點的差異，結果時間點有顯著差異，p <0.05為統計學顯著性差異，表示隨時間越久逐漸理想。結論: 本研究評估正顎手術後的生活品質，使用OHIP-14T及OQLQ證明了生活品質隨時間有顯著改善，且更長時間的追蹤是有助於確定結果是否一致，本研究已確定正顎手術需長期的追蹤評估，才有顯著改善。

關鍵字

正顎手術；生活品質；口腔健康相關生活品質；牙顎畸形

並列摘要

Purpose : The purpose of this study is to compare preoperative and postoperative quality of life and all aspects of health condition using OHIP-14T or OQLQ in orthognathic surgery patients. We are going to explore the connection between OHIP and OQLQ, furthermore, we also explored preoperative and postoperative quality of life in patients who underwent Le Fort I Osteotomy,BSSO and IVRO combined genioplasty. We will get the result that oral hygiene related problems affecting quality of life in preoperative patients by studying the relationship between grouping,gender, different surgical methods and OHIP, OQLQ and the condition of one month postoperative, and three months postoperative. Method: Our study prospectively followed 45 patients who were 20 years old and above, and underwent orthognathic surgery in a medical center in Kaohsiung. Those who used using OHIP and OQLQ scaling their oral and integrity quality of life. Researchers used three scaling systems, Chi square test, independent sample t test and paired-t test to analyze basic demographics. Except the Chi square test, independent sample t test and paired-t test, researchers will also use the group who underwent differences in two surgical methods at three different times and the group using effect size (ES) to calculate before and after OHIP and OQLQ scaling differences. ES smaller than 0.2 was definite to no difference, ES between 0.2 to 0.8 was definite to moderate difference, and ES larger than 0.8 was definite to large difference. The final method generalized estimating equation (GEE) was used for statistical analysis. During the entire observation period, the effects of age groups, gender and surgical methods on the quality of life were compared. Result: About the two surgical methods, Le Fort I method greatly improved the social aspect in OQLQ and in OQLQ overall in three months post-operation, P<0.05; In the Bilateral IVRO+Gep or BSSO+Gep method also showed a significant improvement in body pain score aspect in OHIP and facial cosmetic score in OQLQ, p<0.05, which was statistically significant. All subjects over twenty years old had obviously better QoL than older aged groups in OQLQ score. Using generalized estimating equation (GEE) to analyze difference in age, gender, surgical method, with three different time points, the results showed different time point had statistically significant differences, P<0.05, implying the longer recovery period, the better condition you will have. Conclusion: Our study using OHIP and OQLQ score to assess the quality of life after orthognathic surgery significantly improved with time. The effect is clearly seen with longer time. This study has proved that post-orthognathic surgery, is able to change patients quality of life with time.

並列關鍵字

Orthognathic surgery ； quality of life ； oral health related life quality ； dentofacial deformity

參考文獻

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探討正顎手術患者生活品質之影響

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