顎矯正手術前後のQOLに関連する因子

Factors associated with quality of life before and after orthognathic surgery.

抄録

目的:

顎矯正手術を受けた患者の術前術後2年間のQOLを低下させる因子を評価する。

PURPOSE: Evaluate which factors compromise patients' quality of life who have undergone orthognathic surgery in the pre and postoperative period of 2 years.

研究デザイン:

この縦断的前向き研究では、顎矯正手術を受けた成人患者46人を評価した。主要アウトカム変数はQOLで、術前および術後2年間の顎矯正QOL質問票（OQLQ）の総合スコアで評価した。予測変数は、術前および術後2年に評価したaxis I（顎関節機能障害）およびaxis II（心理社会的）のRDC/TMD診断、術前の横顔、非対称性、開咬、術後2年の矯正治療の有効性とした。共変数は年齢と性別とした。OQLQスコアは、Wilcoxon検定を用いて術前と術後で比較し、Mann-Whitney検定およびKruskall-Wallis検定を用いて他の変数と比較した。

STUDY DESIGN: In this longitudinal prospective study, 46 adult patients undergoing orthognathic surgery were evaluated. The primary outcome variable was quality of life, assessed using the overall score of the orthognathic quality of life questionnaire (OQLQ) in the pre and 2-year postoperative periods. The predictor variables were axis I (temporomandibular dysfunction) and axis II (psychosocial) RDC/TMD diagnoses, assessed preoperatively and 2 years postoperatively; profile, asymmetry, and open bite preoperatively; and orthodontic treatment active 2 years postoperatively. The covariables were age and sex. The OQLQ score was compared preoperatively and postoperatively using the Wilcoxon test and with the other variables using the Mann-Whitney and Kruskall-Wallis tests.

結果:

術前、高いOQLQ得点は筋筋膜痛（P = 0.012）および重度の抑うつ（P = 0.030）と関連していた。術後2年では、OQLQ全体（P < 0.001）、筋筋膜性疼痛（P = 0.012）、慢性疼痛（P = 0.001）に改善がみられた。しかし、筋筋膜性疼痛（P = 0.012）、積極的な矯正治療（P = 0.007）、および疼痛を含むその他の非特異的身体症状（NSPSIP）（P = 0.049）を有する人ほど、OQLQスコアが高かった。

RESULTS: Preoperatively, higher OQLQ scores were associated with myofascial pain (P = .012) and severe depression (P = .030). Two years after surgery, there was an improvement in overall OQLQ (P < .001), myofascial pain (P = .012) and chronic pain (P = .001). However, higher OQLQ scores were associated with individuals who had myofascial pain (P = .012), active orthodontic treatment (P = .007), and other nonspecific physical symptoms including pain (NSPSIP) (P = .049).

結論:

QOLは、術前に筋筋膜性疼痛とうつ病の影響を受け、術後2年で有意に改善したものの、筋筋膜性疼痛、NSPSIP、積極的矯正治療の影響を受け続けた。

CONCLUSION: Quality of life was affected preoperatively by myofascial pain and depression, and although it improved significantly 2 years after surgery, it continued to be affected by myofascial pain, NSPSIP, and active orthodontic treatment.