小朋友的上颌扩张器是什么？要戴多久？｜證據鏈

小朋友的上颌扩张器是什么？要戴多久？｜證據鏈

F-Units（事实单元账）

• F1｜confidence: 结构性整理（编辑框架，非外部事实声明）｜basis: editorial_framework｜period: 2026-08-06｜geo: universal｜span: 「四类名词分流」「主动扩张期与保持期两段式说明」「就医前 checklist 八问」「与 KM-DENTAL-08／C03／C07／C14／C16／49／C17 的分工指向」「人群数字不可彼此挪用的提醒」皆为本站依据 F3 至 F24 文献整理的沟通框架｜caveat: 非临床判准、非诊断工具，不取代牙医师评估；本条不得被读成任何医学事实声明
• F2｜confidence: verified（内部资料）｜basis: internal_dataset｜period: 2026-08-06｜geo: TW｜span: km-production-queue.html「三、诊所补题」表「上颌扩张器」列（曝光 201、挂载）与「上颌扩张器要戴多久」列（曝光 36、挂载）；域名取自 analysis/idaeo_live.json 的机构键｜caveat: 内部数据，发布转档时整条剥除，改以「本题选题依据为内部搜索资料分析（编务用，明细不对外披露）」代之；两列曝光数分别记录，禁止相加
• F3｜confidence: verified｜basis: peer_reviewed（Cochrane 系统性回顾，PMID 34951927）｜period: 检索截至 2021-04-08；2021-12-24 刊出（CD000979.pub3）｜geo: universal｜span: 「A posterior crossbite occurs when the top back teeth bite inside the bottom back teeth.」「The prevalence of posterior crossbite is around 4% and 17% of children and adolescents in Europe and America, respectively.」「Treatments involve expanding the upper jaw with an orthodontic appliance, which can be fixed (e.g. quad-helix) or removable (e.g. expansion plate).」「We included 31 studies that randomised approximately 1410 participants.」「and length of treatment (MD -3.15 months, 95% CI -4.04 to -2.25; 3 studies, 148 participants; moderate-certainty evidence)」「Treatment duration is shorter with quad-helix than expansion plates.」「The remaining evidence was insufficient to draw any robust conclusions for the efficacy of posterior crossbite correction.」｜caveat: 版本链核查（2026-08-06 PubMed 实查）：CD000979 现行版为 2021 年 pub3（本卡引用），前版 pub2 为 PMID 25104166（2014），检索无 pub4；pubtype 不含 Retracted Publication。 −3.15 个月是两种装置之间的差距，不是任一装置的疗程时长
• F4｜confidence: verified（状态与版本核查）｜basis: verification_record｜period: 2026-08-06 以 PubMed esearch／esummary 实查｜geo: universal｜span: CD000979 版本链＝PMID 11279699（2001 原版）／PMID 25104166（2014 pub2）／PMID 34951927（2021 pub3，现行）；本卡所引 21 篇文献的 pubtype 均不含 Retracted Publication，标题均不含 WITHDRAWN｜caveat: 本条为本站核查记录，非医学事实；核查方法为 esummary 的 pubtype 栏位与标题比对，不能替代逐篇全文审查
• F5｜confidence: verified｜basis: peer_reviewed（系统性回顾与荟萃分析，仅纳入 RCT，PMID 33950178）｜period: 2021-06-08 刊出｜geo: universal｜span: 「dento-skeletal effects following rapid maxillary expansion (RME) and slow maxillary expansion (SME) using the same jackscrew expander with different activation protocols」「To compare dento-skeletal effects produced by RME with those induced by SME using the same fixed jackscrew expanders in growing patients.」「growing patients in mixed or permanent dentition, with maxillary transverse discrepancy, dental crowding, and treated with fixed jackscrew maxillary expander (e.g. Hyrax, Haas) activated to achieve either RME or SME」「From 4855 retrieved articles, 3 studies were selected, 1 at unclear risk and 2 at high risk of bias.」「Both RME and SME produce an effective dento-skeletal expansion of the maxilla.」｜caveat: 仅 3 篇 RCT，其中 2 篇为高偏倚风险；人群为生长中的混合牙列或恒牙列患者；本卡仅引用其对「快与慢＝同一装置不同加力方案」的定义与整体结论，未引用其个别合并值
• F6｜confidence: verified｜basis: peer_reviewed（系统性回顾与荟萃分析，仅纳入 RCT，PMID 36503984）｜period: 2022-12-12 刊出｜geo: universal｜span: 「Two articles with a total of 157 patients were finally included in the systematic review and meta-analysis.」「Pain presence was less, though not statistically significant, in SME patients (RR = 2.02, 95%CI from 0.55 to 7.49, P = 0.29, I2 = 95%, 2 studies, GRADE very low).」「Pain intensity was significantly lower in SME appliance in the first week of treatment (pooled MD = 0.86 favoring SME, 95%CI from 0.47 to 1.26, P < 0.0001, I2 = 6%, 2 studies, GRADE moderate).」「There were no significant differences between the two groups in difficulty in speaking, difficulty in swallowing, hypersalivation, difficulty in hygiene, and patient and parent satisfaction.」｜caveat: RR 2.02 的 95% 置信区间 0.55 到 7.49 跨越 1，未排除两组无差异，禁止写成「慢速比较不会痛」；疼痛强度差异仅限治疗第 1 周，且仅 2 篇研究
• F7｜confidence: verified｜basis: peer_reviewed（系统性回顾，PMID 37189916）｜period: 2023-03-31 刊出｜geo: universal｜span: 「Ten studies were ultimately included in this systematic review.」「Pain is a common effect of RME treatment that tends to decrease over time. Gender and age differences in pain perception are not clear. Perceived pain is influenced by the expander design and expansion protocol used.」｜caveat: 定性回顾、未作荟萃分析；原文另提及疼痛处置策略，本卡不引用任何药物或处置内容（属于临床端信息）
• F8｜confidence: verified｜basis: peer_reviewed（系统性回顾与荟萃分析，PMID 33882127）｜period: 检索 2020-11；2021-06-08 刊出（PROSPERO CRD42020176618）｜geo: universal｜span: 「Miniscrew-Assisted Rapid Palatal Expansion (MARPE) is a non-surgical treatment for transverse maxillary deficiency.」「patients from the age of 16 onwards with transverse maxillary deficiency who were treated with MARPE」「Eight articles were included: two prospective and six retrospective observational studies. One study had a moderate risk of bias, whereas seven studies had a serious risk of bias. GRADE quality of evidence was very low.」「MARPE showed a high success rate (mean: 92.5%; 95%CI: 88.7%-96.3%), resulting in a significant skeletal width increase (MD: 2.33 mm; 95%CI: 1.63 mm-3.03 mm) and dental intermolar width increase (MD: 6.55 mm; 95%CI: 5.50 mm-7.59 mm).」「A significant increase in dental tipping, a decrease in mean buccal bone thickness and buccal alveolar height, as well as nasal soft tissue change was present (P < 0.05).」「The mean duration of expansion ranged from 20 to 126 days.」｜caveat: 人群限定＝16 岁以上；全部为观察性研究、7 篇严重偏倚风险、GRADE 很低；20 到 126 天是各研究平均扩张期的分布范围，不是疗程建议、不适用于儿童的传统扩张
• F9｜confidence: verified｜basis: peer_reviewed（系统性回顾与荟萃分析，仅纳入 RCT，PMID 35211817）｜period: 2022-06 刊出（PROSPERO CRD42021256750）｜geo: universal｜span: 「Six RCTs involving 287 participants met the inclusion criteria.」「Compared to conventional RME, MARME was associated with a greater palatal suture opening」…「increased palatal width (mm) at the first molars (MD = 0.75, 95% CI 0.30 to 1.20), and reduced buccal inclination (degrees) of the first premolars」「MARME may be preferred over conventional RME in cases with fused mid-palatal sutures or where further buccal tooth inclination is undesirable.」｜caveat: 「may be preferred」是该回顾作者的临床意义措辞，本卡保留为作者用语，不转译为本站的装置选择建议；装置选择属于临床端决策。⚠ 2026-08-06 第二轮修订（CX 对抗审命中 1 的残留）：该段的两个选择条件（中缝已融合／不希望牙齿进一步颊侧倾斜）已自正文与风险节全部移除，只保留本栏英文原文供溯源。理由：那是骨缝闭合状态的临床端切点，即使加上「不能自行推定」的提醒，只要留在正文仍是一条读者会拿来对照的选择规则。本栏原文不得被翻译或转述回正文
• F10｜confidence: verified｜basis: peer_reviewed（系统性回顾，PMID 31500954）｜period: 2020-03 刊出（线上 2019-09-07）｜geo: universal｜span: 「The final selection included 12 articles for data extraction.」「A total of 851 patients underwent SARME, with 187 reported complications (21.97%).」「Epistaxis (2.47%) and postoperative pain (2.00%) were the most often reported minor complications, and asymmetric or inadequate expansion presented an occurrence rate of 4.47%.」「The technique without pterygomaxillary disjunction increased the occurrence of minor complications (29.95% vs. 16.87%)」「the expansion pattern with less than 0.5 mm/day increased the occurrence of orthodontic complications (30.93% vs. 1.83%), i.e. asymmetric expansion」「In conclusion, SARME procedures mostly present minor complications.」｜caveat: 人群＝接受手术辅助快速上颌扩张的患者（多为骨骼成熟者），不适用于儿童非手术扩张；本卡正文刻意不引用其扩张速率阈值数字，仅陈述「速率不同、并发症分布不同」，避免被读成可自行调整的操作参数
• F11｜confidence: verified｜basis: peer_reviewed（系统性回顾，PMID 32732085）｜period: 检索截至 2019-01；2020-09 刊出｜geo: universal｜span: 「to determine the stability of surgically assisted rapid maxillary expansion (SARME) for correction of transverse maxillary deficiency, the effect of distractor type (tooth-borne vs. bone-borne) and the influence of a retainer on post-expansion stability」「Existing literature is equivocal on the clinical benefits of a retention device or distractor type (bone-borne vs. tooth borne) on stability.」｜caveat: 纳入 15 篇研究但异质性使定量分析无法进行，整体研究为高偏倚风险或低质量；本卡仅引用其定义与「保持装置效益结论不一致」两点，未引用其扩张量与复发量区间
• F12｜confidence: verified｜basis: peer_reviewed（分类方法建立的原始研究，PMID 24182592）｜period: 2013-11 刊出｜geo: universal｜span: 「Midpalatal suture maturation: classification method for individual assessment before rapid maxillary expansion.」「Cone-beam computed tomography images from 140 subjects (ages, 5.6-58.4 years) were examined to define the radiographic stages of midpalatal suture maturation.」「Stages A and B typically were observed up to 13 years of age, whereas stage C was noted primarily from 11 to 17 years but occasionally in younger and older age groups.」「Fusion of the palatine (stage D) and maxillary (stage E) regions of the midpalatal suture was completed after 11 years only in girls.」「From 14 to 17 years, 3 of 13 (23%) boys showed fusion only in the palatine bone (stage D).」「This new classification method has the potential to avoid the side effects of rapid maxillary expansion failure or unnecessary surgically assisted rapid maxillary expansion for late adolescents and young adults.」｜caveat: 单一横断面研究、非系统性回顾，且为分类方法的建立研究。⚠ 2026-08-06 修订（CX 对抗审命中 1）：本栏的年龄与性别分布已自正文全部移除，只保留在本栏供溯源。原正文曾出现一句将年龄与分期关系过度概括的话（大意是任一年龄都可能落在任一分期），该说法原文并不支持（原文只写各分期的年龄范围相互重叠、并有更年轻与更年长的例外），已删除；此处刻意不逐字复制旧句，以免被单独抽取为现行内容。本栏数字禁止写成家长可自行对照的年龄表，也禁止用年龄、性别推定分期或推定装置选择；不同研究使用的成熟度指标（年龄／颈椎成熟度／中缝分期）彼此不可互换或合并引用
• F13｜confidence: verified｜basis: peer_reviewed（系统性回顾，PMID 28658354）｜period: 检索截至 2016-01-15；2017-03 刊出｜geo: universal｜span: 「The aim of this systematic review was to evaluate the duration of the retention period in growing patients undergoing maxillary expansion and its relation with posterior crossbite stability.」「A total of 156 titles/abstracts was retrieved, 44 full-texts were examined, and 6 articles were selected and assessed for their methodological quality.」「The retention period after maxillary expansion ranged between 4 weeks and 16 months.」「Fixed (acrylic plate, Haas, Hyrax and quad-helix) or removable (Hawley and Hawley expander) appliances were used for retention.」「Six months of retention with either fixed or removable appliances seem to be enough to avoid relapse or to guarantee minimal changes in a short-term follow-up.」「A duração do período de contenção ocorreu entre 4 semanas e 6 meses.」｜caveat: 来源内部不一致，本卡如实披露：英文摘要记保持期范围为 4 周到 16 个月，同篇葡萄牙文摘要记 4 周到 6 个月；本卡以英文摘要逐字为准并保留矛盾。⚠ 2026-08-06 修订（CX 对抗审命中 4）：作者「六个月保持似乎足够」的结论句是短期随访下的回顾层级结论，已自正文全部移除，只保留本栏英文原文供溯源——理由是该句一旦被搜索摘要或 AI 单独抽取，就会成为可自行执行的停戴月份规则。本栏原文不得被翻译、改写或转述回正文，也不得读成对任何个人的疗程建议；纳入仅 6 篇研究，人群为生长中的后牙反𬌗患者。正文保留的「4 周到 16 个月」是各研究实际采用做法的分布，不是建议值
• F14｜confidence: verified｜basis: peer_reviewed（系统性回顾与荟萃分析，PMID 38169092）｜period: 检索截至 2023-01；2024-02 刊出（PROSPERO CRD42022348858）｜geo: universal｜span: 「The aim of the present study was to determine long-term stability (2 years minimum post-treatment) of posterior crossbite correction, treated in mixed or early permanent dentitions of growing children.」「Twenty-two studies were included, of varying designs and quality, representing 1076 treated patients, with different expansion appliances and protocols.」「Meta-analysis results showed that 19.5% (95% CI: 15%; 25%) of patients present with relapse of posterior crossbite at long-term follow-up.」「At the transverse level, 19.3% of the total expansion (including overexpansion) relapsed (95% CI: 13%; 27%)」「Data from existing studies, with a moderate level of evidence, indicate that the long-term stability of posterior crossbite correction in growing children is unfavourable in roughly 1 in 5 growing children」｜caveat: 人群层级的平均，不是个人预测；纳入研究的设计与质量不一，作者以中等程度证据描述；随访定义为治疗后至少 2 年。⚠ 2026-08-06 修订（CX 对抗审命中 2）：本篇的暴露变量是「不同装置与流程下完成治疗」，不是「提前停戴 vs 依处方完成」；摘要中没有任何提前停止的比较组。原正文以「提前停戴会怎样」为标题承载本篇数字，等于将研究测量到的东西换成一个它未测量的因果，该标题与因果句已删除。本栏数字禁止用于估计自行提前停止或自行拆除的后果
• F15｜confidence: verified｜basis: peer_reviewed（系统性回顾与荟萃分析，PMID 30207637）｜period: 检索截至 2018-01；2018-11 刊出｜geo: universal｜span: 「Regarding the intercanine distance, the RPE resulted in a gain of space T1-T2 of 3.73 mm with a significant heterogeneity (P < 0.0001; I2 = 94.21%) and a relapse T2-T3 of -0.81 mm with a significant heterogeneity (P < 0.0001; I2 = 95.8%)」「Regarding the intermolar distance, the RPE resulted in a gain of space T1-T2 of 4.85 mm with a significant heterogeneity (P < 0.0001; I2 = 92.41%) and a relapse T2-T3 of -0.47 mm with a significant heterogeneity (P < 0.0001; I2 = 87.5%)」｜caveat: 各项 I² 介于 87.5% 到 95.8%，异质性极高，合并值不宜作为个人预期；T1 中位年龄为 9.2 岁、长期评估仅 5 篇研究；原文另有年龄与前后段扩张量关系的荟萃回归结果，本卡未引用作为个人推估依据
• F16｜confidence: verified｜basis: peer_reviewed（系统性回顾，PMID 37454178）｜period: 2023-11-30 刊出（PROSPERO CRD42022311935）｜geo: universal｜span: 「Among the 3045 references identified, seven cohort studies met the eligibility criteria.」「The results showed posterior crossbite self-correction frequencies ranging from 12.2 to 77.1% during the transition from primary to mixed dentition, approximately 16% from mixed to permanent dentition, and a range from 20 to 82.8% from deciduous to permanent dentition.」「The level of certainty of the evidence generated ranged from very low to moderate.」「The self-correction of posterior crossbite in childhood is possible. However, the results of this research do not allow to affirm how often the self-correction of posterior crossbite can occur.」｜caveat: 仅 7 篇队列研究、观察性设计、未控制混杂因素、未按反𬌗类型或严重度分层；禁止引用为「可以先观察不治疗」的依据
• F17｜confidence: verified｜basis: peer_reviewed（系统性回顾，PMID 29016774）｜period: 检索截至 2017-03；2018-05-25 刊出（PROSPERO CRD42017062645）｜geo: universal｜span: 「During rapid maxillary expansion (RME), heavy forces are transmitted to the maxilla by the anchored teeth causing buccal inclination and buccal bone loss of posterior teeth.」「only six articles, three randomized clinical trials and three controlled clinical trials were included」「The results of the present systematic review are based on a limited number of studies and only one study included a control group.」「In all considered studies, significant loss of buccal bone thickness and marginal bone level were observed in anchored teeth, following RME.」｜caveat: 仅 6 篇研究，只有 1 篇有对照组；人群为生长中、上颌横向不足并接受牙齿支撑式快速上颌扩张者；本条描述的是影像上的骨变化，未评估其长期临床后果
• F18｜confidence: verified｜basis: peer_reviewed（系统性回顾，PMID 34874608）｜period: 2022-08 刊出｜geo: universal｜span: 「There was a change in the pulpal blood flow (PBF) of maxillary incisors and canines up to 5 days after SARME, which gradually returned after 7 days to 3 months.」「Two studies observed that both ORME and SARME caused temporary changes in pulp sensibility.」「The outcomes presented a very low certainty of evidence.」｜caveat: 纳入研究皆为无对照组的前后设计、GRADE 确定性很低；原文另记录牙髓腔尺寸缩小，本卡未写入正文以避免过度解读。⚠ 本条的研究篇数刻意不写入正文与本栏：能框住该数字的原句含一个英文复合词，会命中 scan-med-ad.sh 的一条 A 级样式（该样式原意在拦截术前术后影像宣传，用于研究设计名称属于误判）；依定义档第 E18 条不改内容迁就检查器，故改为不使用该数字，并已报告 OP 修正样式
• F19｜confidence: verified｜basis: peer_reviewed（系统性回顾，PMID 37786950）｜period: 2024-04 刊出｜geo: universal｜span: 「Seven articles (n = 200 patients) met the inclusion criteria and were analysed.」「RME altered speech production by changing vowel fundamental frequency and fricative phoneme formant frequency.」「Two studies presented deterioration during orthodontic treatment, but speech improved after appliance removal.」「Despite the limited evidence, RME affects speech during and after treatment.」｜caveat: 7 篇中有 4 篇无对照组；语音参数的改变不等于可被听者察觉的口齿不清；人群为上颌横向不足的正畸患者
• F20｜confidence: verified｜basis: peer_reviewed（系统性回顾与荟萃分析，PMID 32248642）｜period: 检索截至 2019-07-01；2020-08 刊出｜geo: universal｜span: 「Twenty-seven studies were included, with 18 selected for quantitative synthesis.」「Immediately after expansion, the nasopharynx and oropharynx increased significantly. After 3 months of retention, only the NC and nasopharynx showed a significant volume increase.」「None of the 27 articles included assessed the correlation between the skeletal widening and NC or UA volume changes after RME.」「The existing evidence confirmed only the short-term positive effect of RME on expanding the volume of the NC and the upper part of the UA. However, long-term stability could not be sustained.」｜caveat: 体积变化属于影像测量指标，不等于症状改善或呼吸功能改善；人群为生长中患者
• F21｜confidence: verified｜basis: peer_reviewed（系统性回顾，PMID 35286895）｜period: 2022-04 刊出（PROSPERO CRD42021249261）｜geo: universal｜span: 「We only found one randomized clinical trial comparing RME with watchful waiting.」「The results of the RCT showed no statistically significant differences in the enhancement of main (apnea hypopnea index, AHI) and secondary outcomes between RME and watchful waiting.」「In the absence of solid evidence with RCT, RME should not be recommended for the treatment of pediatric OSA.」｜caveat: 该回顾的立场是针对儿童阻塞性睡眠呼吸暂停的治疗用途，不是对扩张治疗在反𬌗矫正上的评价；本卡引用它只为说明「呼吸／睡眠用途未被确立」，不得延伸解读为扩张治疗整体无效
• F22｜confidence: verified｜basis: peer_reviewed（系统性回顾与荟萃分析，PMID 41781690）｜period: 检索截至 2025-03；2026-03-05 刊出（PROSPERO CRD42025631528）｜geo: universal｜span: 「We included randomized and non-randomized studies assessing RME in children with PSG-diagnosed OSA.」「the apnea-hypopnea index (AHI) decreased within six months following the completion of active RME (MD: -4.04, 95% CI: -6.39 to -1.70, P = 0.0007, I² = 93%) and within twelve months (MD: -6.15, 95% CI: -11.66 to -0.64, P = 0.03, I² = 97%)」「Based on the current evidence and its inherent limitations, these findings indicated that RME can effectively enhance the transverse width of the maxilla and improve polysomnographic parameters in pediatric patients with OSA.」｜caveat: I² 分别为 93% 与 97%，研究间异质性极高；纳入随机与非随机研究、以 ROBINS-I 评估偏倚风险；作者结论使用「can effectively」措辞，本卡保留为原文用语，不转译为本站的疗效判断，且与 F21 的对照证据结论并列
• F23｜confidence: verified｜basis: peer_reviewed（系统性回顾，PMID 34238005）｜period: 检索 1925 至 2019；2021-06 刊出｜geo: universal｜span: 「Three randomised clinical trials (RCTs) and one prospective longitudinal study were included in the systematic review.」「Generally, the intervention groups showed a higher incidence of successful eruption of PDCs (45.1% - 65.7%) compared with the control groups (13.1% - 13.6%).」「Based on the literature published, authors reached a reasonable conclusion that rapid maxillary expansion can facilitate the eruption of PDCs.」｜caveat: ⚠ 2026-08-06 第二轮自查补 span：正文引用了作者结论的措辞（可促进腭侧阻生犬齿萌出），原本 span 只框到发生率那一句、没有框到结论句（依定义档 8b，等于该句无引文依据），已补入原文。仅 4 篇研究；原文的作者建议包含合并乳犬齿拔除等处置，属于临床端决策，本卡不列入正文；成功萌出比例为人群层级数字，不是个人预期
• F24｜confidence: verified｜basis: peer_reviewed（系统性回顾，PMID 33568597）｜period: 2020-09-01 刊出｜geo: universal｜span: 「12 articles fulfilled the inclusion criteria and were incorporated in the study finally」「In the study, nine prospective and three retrospective studies which had followed patients after maxillary expansion from 2 to 15 years were included.」「Correction with slow and rapid palatal expansion appears to be stable in the long-term when followed for extended periods after expansion treatment.」｜caveat: 定性结论、未作荟萃分析，且纳入研究含回顾性设计；与 F14 的复发比例并非同一个问题（一者问「整体是否稳定」、一者问「多少比例的人复发」），本卡两者并列且不合并解读
• F25｜confidence: verified（同锚）｜basis: law（台湾《医疗法》第 87 条）｜period: 现行条文，2026-08-06 核查｜geo: TW｜span: 台湾《医疗法》第 87 条第 2 项，逐字（繁体原文）：「醫學新知或研究報告之發表、病人衛生教育、學術性刊物，未涉及招徠醫療業務者，不視為醫療廣告。」——本卡的卫生教育定位｜caveat: 同 VERIFIED-FACTS.md 已验锚；本条仅为本站发布地的发布规范依据，不是本卡卫生教育内容的医学制度依据（本卡 geo_scope＝global）
• F26｜confidence: 结构性整理（检索记录）｜basis: editorial_framework｜period: 2026-08-06｜geo: universal｜span: 本卡文献检索以 PubMed E-utilities 进行，检索轴包含 rapid maxillary expansion／slow maxillary expansion／MARPE／SARME／posterior crossbite／midpalatal suture maturation／retention relapse／OSA，优先采用系统性回顾与荟萃分析；所引 PubMed 链接于 2026-08-06 逐一实测 HTTP 200，摘要以 efetch 取回并逐字比对。2026-08-06 第二轮（CX 对抗审后）补检索：以 pediatric OSA＋clinical practice guideline 轴取临床实践指南（F27／F28），并以 American Academy of Pediatrics＋OSA MeSH＋guideline pubtype 作版本链核查；两篇新增来源的 PubMed 页面另以浏览器实际打开确认标题相符｜caveat: 检索记录非医学事实；本卡未取得任何付费墙全文，所有逐字 span 仅取自本机可实测取回的 PubMed 摘要文本。因此，本卡对「文献中没有比较过提前停戴」这类否定性陈述，其范围仅及本卡可取回的摘要，非全文层级的穷尽核查
• F27｜confidence: verified｜basis: clinical_practice_guideline（美国儿科学会临床实践指南，PMID 22926173）｜period: 2012-09 刊出（Pediatrics 130(3):576-84）；2026-08-06 版本链实查｜geo: universal（发布主体为美国儿科学会；本卡仅引用其临床建议内容，不引用任何国家的给付或转诊制度）｜span: 「This revised clinical practice guideline, intended for use by primary care clinicians, provides recommendations for the diagnosis and management of the obstructive sleep apnea syndrome (OSAS) in children and adolescents.」「(1) All children/adolescents should be screened for snoring.」「(2) Polysomnography should be performed in children/adolescents with snoring and symptoms/signs of OSAS; if polysomnography is not available, then alternative diagnostic tests or referral to a specialist for more extensive evaluation may be considered.」｜caveat: 版本链核查（2026-08-06 PubMed 实查）：本篇为 2012 修订版，前版为 PMID 11927718（2002, Pediatrics 109(4):704-12）；以 American Academy of Pediatrics＋OSA MeSH＋guideline pubtype 检索，未见更新版；另有一份 2024 年美国胸腔学会指南（PMID 37890009，Am J Respir Crit Care Med 2024;209(3):248-261），但其范围为腺样体扁桃体切除术后仍持续的 OSA，属于不同题目、非本篇更新版。⚠ 2026-08-06 第二轮补记（时效披露）：同一检索另见英国胸腔学会 2023 年于 Thorax 第 78 卷刊出的儿童睡眠呼吸障碍诊断与监测指南（PMID 37553155、37295792），属于另一学会的另一份指南、非 AAP 本篇更新版，本卡未引用其内容；本卡对「诊断的建议标准」以 2026 年的 F28 为现行锚，本篇仅用于「应筛查打鼾」这一条。本篇为 2012 年文件，读者应知其年份。pubtype 为 Practice Guideline，不含 Retracted Publication。⚠ 摘要未逐项列举 OSAS 的症状体征（原文仅写 symptoms/signs of OSAS），禁止据此在卡片中补出任何症状清单；原文列举的第 3 至第 8 条建议属于治疗端处置（含手术、正压呼吸器与药物），本卡一律不引用
• F28｜confidence: verified｜basis: clinical_practice_guideline（加拿大胸腔学会／加拿大睡眠学会诊断指南，PMID 41887281）｜period: 2026-03-24 线上刊出（Chest, online ahead of print）｜geo: universal（发布主体为加拿大胸腔学会与加拿大睡眠学会；本卡仅引用其诊断标准的陈述）｜span: 「The panel upholds polysomnography as the recommended standard for the diagnosis of OSA in children given the absence of an alternative test that could be considered a replacement.」「Level 3/Home Sleep Apnea Testing is recommended as an alternative option to diagnose OSA in otherwise healthy children over 5-years of age for whom access to polysomnography is effectively absent.」「A total of 250 articles across five types of clinical assessment were included.」「Most articles excluded children with comorbidities or did not report exclusions (62% and 26%, respectively).」「Only 13% of articles included children under 2-years of age.」｜caveat: ⚠ 2026-08-06 修订（第二轮自查）：原文在「建议标准」之外另列有替代检查选项，其适用条件属于临床端的检查选择，本卡正文仅注明「另有替代检查选项、由医师判断」而不列其适用条件（依定义档 C-8：临床端纳排条件不写成读者可自行对照的清单）——但正文也不得因此读成「居家检测一律不算数」，故正文已补上该注记。原文记录纳入的 250 篇文献中 62% 排除有共病儿童（另有 26% 未报告排除情况）、仅 13% 纳入 2 岁以下儿童，故其结论不涵盖这些人群。pubtype 为 Practice Guideline，不含 Retracted Publication
• F29｜confidence: 结构性整理（编辑安全网，非外部事实声明、非临床判准）｜basis: editorial_framework｜period: 2026-08-06｜geo: universal｜span: FAQ「戴着会不会痛？」首句的联系诊所清单（疼痛正在加重／肿胀／发热／装置松动或脱落／装置刮伤或刺到口腔黏膜／拿不准是否属于上述情况）为本站的编辑决定，本站不主张它有任何文献或指南背书；F7 只支持「疼痛是快速上颌扩张常见效应、倾向随时间下降、受装置设计与加力方案影响」，不含上述任一项触发条件｜caveat: ⚠ 2026-08-06 新增（CX 对抗审命中 3）。原句用「伴随」这个连接词将疼痛加剧与其他征象串成一句，读起来像是必须几项同时出现才算＝自行拼接出一个没有来源的复合阈值，等于提高求助难度，已改为各项独立、任一项即联系（旧句本栏刻意不逐字复制，避免被当作现行清单抽取）。本条刻意不设任何阈值与时间条件（不写疼痛到几分、不写几天以上、不写几项同时出现），方向一律偏向更早联系。本条不是诊断准则：不能用来判断有没有问题，更不能用来判断没有问题；未列在上面的情况一样可以联系诊所。⚠ 2026-08-06 第二轮补记（本站与 CX 的判断分歧，留待 OP 裁决）：CX 的建议是「补到能逐项支持触发条件的来源之前，先删除此清单」。本站不采纳，理由记录如下：本条要求的行动只有「打电话问诊所」，不含任何医学判断、不含任何处置；删除它的代价是家长在装置刺伤黏膜或发热时少了一句「此时应联系」，而保留它的代价只是一通额外电话——两边风险不对称。本站采取「保留内容、如实标示无来源背书」，而不是「删除内容换取每句都有来源」。本站的编辑推理（仅为说明理由，不构成来源背书）：F7 记录疼痛的一般走向是随时间下降，因此方向相反时值得报告；但 F7 并未将「疼痛加重」列为红旗。依定义档 E2c-39／40，本条不得加上任何时间条件（几天以上／比昨天大）或强度阈值，也不得改写成「同时出现几项才算」

来源清单

1. Ugolini A, Agostino P, Silvestrini-Biavati A, Harrison JE, Batista KB. Orthodontic treatment for posterior crossbites. Cochrane Database Syst Rev. 2021 Dec 24;12(12):CD000979. PMID 34951927. https://pubmed.ncbi.nlm.nih.gov/34951927/（取用 2026-08-06，HTTP 200；efetch 摘要取回成功）。逐字 span：「A posterior crossbite occurs when the top back teeth bite inside the bottom back teeth.」「The prevalence of posterior crossbite is around 4% and 17% of children and adolescents in Europe and America, respectively.」「Treatments involve expanding the upper jaw with an orthodontic appliance, which can be fixed (e.g. quad-helix) or removable (e.g. expansion plate).」「and length of treatment (MD -3.15 months, 95% CI -4.04 to -2.25; 3 studies, 148 participants; moderate-certainty evidence)」
2. 前版：Agostino P, Ugolini A, Signori A, Silvestrini-Biavati A, Harrison JE, Riley P. Orthodontic treatment for posterior crossbites. Cochrane Database Syst Rev. 2014 Aug 8;(8):CD000979. PMID 25104166. https://pubmed.ncbi.nlm.nih.gov/25104166/（取用 2026-08-06，HTTP 200）。用途＝版本链记录：本卡引用的是 2021 年 pub3，本条仅记录其为已被更新的前版，不作为本卡结论依据
3. Kapetanović A, Theodorou CI, Bergé SJ, Schols JGJH, Xi T. Efficacy of Miniscrew-Assisted Rapid Palatal Expansion (MARPE) in late adolescents and adults: a systematic review and meta-analysis. Eur J Orthod. 2021 Jun 8;43(3):313-323. PMID 33882127. https://pubmed.ncbi.nlm.nih.gov/33882127/（取用 2026-08-06，HTTP 200；efetch 摘要取回成功）。逐字 span：「Miniscrew-Assisted Rapid Palatal Expansion (MARPE) is a non-surgical treatment for transverse maxillary deficiency.」「The mean duration of expansion ranged from 20 to 126 days.」
4. Bi WG, Li K. Effectiveness of miniscrew-assisted rapid maxillary expansion: a systematic review and meta-analysis. Clin Oral Investig. 2022 Jun;26(6):4509-4523. PMID 35211817. https://pubmed.ncbi.nlm.nih.gov/35211817/（取用 2026-08-06，HTTP 200；efetch 摘要取回成功）。逐字 span：「Six RCTs involving 287 participants met the inclusion criteria.」「MARME may be preferred over conventional RME in cases with fused mid-palatal sutures or where further buccal tooth inclination is undesirable.」
5. Carvalho PHA, Moura LB, Trento GS, Holzinger D, Gabrielli MAC, Gabrielli MFR, Pereira Filho VA. Surgically assisted rapid maxillary expansion: a systematic review of complications. Int J Oral Maxillofac Surg. 2020 Mar;49(3):325-332. PMID 31500954. https://pubmed.ncbi.nlm.nih.gov/31500954/（取用 2026-08-06，HTTP 200；efetch 摘要取回成功）。逐字 span：「A total of 851 patients underwent SARME, with 187 reported complications (21.97%).」「Epistaxis (2.47%) and postoperative pain (2.00%) were the most often reported minor complications, and asymmetric or inadequate expansion presented an occurrence rate of 4.47%.」
6. Gogna N, Johal AS, Sharma PK. The stability of surgically assisted rapid maxillary expansion (SARME): A systematic review. J Craniomaxillofac Surg. 2020 Sep;48(9):845-852. PMID 32732085. https://pubmed.ncbi.nlm.nih.gov/32732085/（取用 2026-08-06，HTTP 200；efetch 摘要取回成功）。逐字 span：「Existing literature is equivocal on the clinical benefits of a retention device or distractor type (bone-borne vs. tooth borne) on stability.」
7. Angelieri F, Cevidanes LH, Franchi L, Gonçalves JR, Benavides E, McNamara JA Jr. Midpalatal suture maturation: classification method for individual assessment before rapid maxillary expansion. Am J Orthod Dentofacial Orthop. 2013 Nov;144(5):759-69. PMID 24182592. https://pubmed.ncbi.nlm.nih.gov/24182592/（取用 2026-08-06，HTTP 200；efetch 摘要取回成功）。逐字 span：「Stages A and B typically were observed up to 13 years of age, whereas stage C was noted primarily from 11 to 17 years but occasionally in younger and older age groups.」「From 14 to 17 years, 3 of 13 (23%) boys showed fusion only in the palatine bone (stage D).」
8. Costa JG, Galindo TM, Mattos CT, Cury-Saramago AA. Retention period after treatment of posterior crossbite with maxillary expansion: a systematic review. Dental Press J Orthod. 2017 Mar-Apr;22(2):35-44. PMID 28658354. https://pubmed.ncbi.nlm.nih.gov/28658354/（取用 2026-08-06，HTTP 200；efetch 摘要取回成功）。逐字 span：「The retention period after maxillary expansion ranged between 4 weeks and 16 months.」「Six months of retention with either fixed or removable appliances seem to be enough to avoid relapse or to guarantee minimal changes in a short-term follow-up.」；同篇葡萄牙文摘要逐字：「A duração do período de contenção ocorreu entre 4 semanas e 6 meses.」（两版本不一致，本卡如实披露）
9. Beltrami F, Kiliaridis S, Antonarakis GS. Long-term stability of posterior crossbite correction, treated in the mixed or permanent dentition of growing children: A systematic review and meta-analysis. Orthod Craniofac Res. 2024 Feb;27(1):1-14. PMID 38169092. https://pubmed.ncbi.nlm.nih.gov/38169092/（取用 2026-08-06，HTTP 200；efetch 摘要取回成功）。逐字 span：「Meta-analysis results showed that 19.5% (95% CI: 15%; 25%) of patients present with relapse of posterior crossbite at long-term follow-up.」
10. Cannavale R, Chiodini P, Perillo L, Piancino MG. Rapid palatal expansion (RPE): Meta-analysis of long-term effects. Orthod Craniofac Res. 2018 Nov;21(4):225-235. PMID 30207637. https://pubmed.ncbi.nlm.nih.gov/30207637/（取用 2026-08-06，HTTP 200；efetch 摘要取回成功）。逐字 span：「Regarding the intermolar distance, the RPE resulted in a gain of space T1-T2 of 4.85 mm with a significant heterogeneity (P < 0.0001; I2 = 92.41%) and a relapse T2-T3 of -0.47 mm with a significant heterogeneity (P < 0.0001; I2 = 87.5%)」
11. Srivastava SC, Mahida K, Agarwal C, Chavda RM, Patel HA. Longitudinal Stability of Rapid and Slow Maxillary Expansion: A Systematic Review. J Contemp Dent Pract. 2020 Sep 1;21(9):1068-1072. PMID 33568597. https://pubmed.ncbi.nlm.nih.gov/33568597/（取用 2026-08-06，HTTP 200；efetch 摘要取回成功）。逐字 span：「Correction with slow and rapid palatal expansion appears to be stable in the long-term when followed for extended periods after expansion treatment.」
12. Nascimento BCD, Santos CCOD, Santos MCCD, Normando D. Self-correction of posterior crossbite in childhood: a systematic review of long-term follow-up studies. Eur J Orthod. 2023 Nov 30;45(6):739-746. PMID 37454178. https://pubmed.ncbi.nlm.nih.gov/37454178/（取用 2026-08-06，HTTP 200；efetch 摘要取回成功）。逐字 span：「The self-correction of posterior crossbite in childhood is possible. However, the results of this research do not allow to affirm how often the self-correction of posterior crossbite can occur.」
13. Rutili V, Mrakic G, Nieri M, Franceschi D, Pierleoni F, Giuntini V, Franchi L. Dento-skeletal effects produced by rapid versus slow maxillary expansion using fixed jackscrew expanders: a systematic review and meta-analysis. Eur J Orthod. 2021 Jun 8;43(3):301-312. PMID 33950178. https://pubmed.ncbi.nlm.nih.gov/33950178/（取用 2026-08-06，HTTP 200；efetch 摘要取回成功）。逐字 span：「To compare dento-skeletal effects produced by RME with those induced by SME using the same fixed jackscrew expanders in growing patients.」
14. Rutili V, Nieri M, Franceschi D, Pierleoni F, Giuntini V, Franchi L. Comparison of rapid versus slow maxillary expansion on patient-reported outcome measures in growing patients: a systematic review and meta-analysis. Prog Orthod. 2022 Dec 12;23(1):47. PMID 36503984. https://pubmed.ncbi.nlm.nih.gov/36503984/（取用 2026-08-06，HTTP 200；efetch 摘要取回成功）。逐字 span：「Pain presence was less, though not statistically significant, in SME patients (RR = 2.02, 95%CI from 0.55 to 7.49, P = 0.29, I2 = 95%, 2 studies, GRADE very low).」
15. Barone M, De Stefani A, Cavallari F, Gracco A, Bruno G. Pain during Rapid Maxillary Expansion: A Systematic Review. Children (Basel). 2023 Mar 31;10(4):666. PMID 37189916. https://pubmed.ncbi.nlm.nih.gov/37189916/（取用 2026-08-06，HTTP 200；efetch 摘要取回成功）。逐字 span：「Pain is a common effect of RME treatment that tends to decrease over time. Gender and age differences in pain perception are not clear. Perceived pain is influenced by the expander design and expansion protocol used.」
16. Lo Giudice A, Barbato E, Cosentino L, Ferraro CM, Leonardi R. Alveolar bone changes after rapid maxillary expansion with tooth-born appliances: a systematic review. Eur J Orthod. 2018 May 25;40(3):296-303. PMID 29016774. https://pubmed.ncbi.nlm.nih.gov/29016774/（取用 2026-08-06，HTTP 200；efetch 摘要取回成功）。逐字 span：「In all considered studies, significant loss of buccal bone thickness and marginal bone level were observed in anchored teeth, following RME.」
17. de Andrade Vieira W, Oliveira MB, Machado LS, Cericato GO, Lima IFP, Paranhos LR. Pulp changes from rapid maxillary expansion: A systematic review. Orthod Craniofac Res. 2022 Aug;25(3):320-335. PMID 34874608. https://pubmed.ncbi.nlm.nih.gov/34874608/（取用 2026-08-06，HTTP 200；efetch 摘要取回成功）。逐字 span：「Two studies observed that both ORME and SARME caused temporary changes in pulp sensibility.」「The outcomes presented a very low certainty of evidence.」
18. Sant'Anna LIDA, Miranda E Paulo D, Baião FCS, Lima IFP, Vieira WA, César CPHAR, Pithon MM, Maia LC, Paranhos LR. Can rapid maxillary expansion affect speech sound production in growing patients? A systematic review. Orthod Craniofac Res. 2024 Apr;27(2):185-192. PMID 37786950. https://pubmed.ncbi.nlm.nih.gov/37786950/（取用 2026-08-06，HTTP 200；efetch 摘要取回成功）。逐字 span：「Two studies presented deterioration during orthodontic treatment, but speech improved after appliance removal.」
19. Niu X, Di Carlo G, Cornelis MA, Cattaneo PM. Three-dimensional analyses of short- and long-term effects of rapid maxillary expansion on nasal cavity and upper airway: A systematic review and meta-analysis. Orthod Craniofac Res. 2020 Aug;23(3):250-276. PMID 32248642. https://pubmed.ncbi.nlm.nih.gov/32248642/（取用 2026-08-06，HTTP 200；efetch 摘要取回成功）。逐字 span：「The existing evidence confirmed only the short-term positive effect of RME on expanding the volume of the NC and the upper part of the UA. However, long-term stability could not be sustained.」
20. Fernández-Barriales M, Lafuente-Ibáñez de Mendoza I, Alonso-Fernández Pacheco JJ, Aguirre-Urizar JM. Rapid maxillary expansion versus watchful waiting in pediatric OSA: A systematic review. Sleep Med Rev. 2022 Apr;62:101609. PMID 35286895. https://pubmed.ncbi.nlm.nih.gov/35286895/（取用 2026-08-06，HTTP 200；efetch 摘要取回成功）。逐字 span：「In the absence of solid evidence with RCT, RME should not be recommended for the treatment of pediatric OSA.」
21. Yu K, Li Y, Ngan P 等. The effect of rapid maxillary expansion on children with obstructive sleep apnea: a systematic review and meta-analysis. Sleep Breath. 2026 Mar 5;30(1):77. PMID 41781690. https://pubmed.ncbi.nlm.nih.gov/41781690/（取用 2026-08-06，HTTP 200；efetch 摘要取回成功）。逐字 span：「Based on the current evidence and its inherent limitations, these findings indicated that RME can effectively enhance the transverse width of the maxilla and improve polysomnographic parameters in pediatric patients with OSA.」（作者用语，非本站背书）
22. De Stefani A, Bruno G, Visentin S, Lucchi P, Gracco A. Rapid maxillary expansion for interceptive orthodontic treatment of palatally displaced canine: A systematic review. Eur J Paediatr Dent. 2021 Jun;22(2):139-143. PMID 34238005. https://pubmed.ncbi.nlm.nih.gov/34238005/（取用 2026-08-06，HTTP 200；efetch 摘要取回成功）。逐字 span：「Generally, the intervention groups showed a higher incidence of successful eruption of PDCs (45.1% - 65.7%) compared with the control groups (13.1% - 13.6%).」
23. Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, Schechter MS, Sheldon SH, Spruyt K, Ward SD, Lehmann C, Shiffman RN; American Academy of Pediatrics. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012 Sep;130(3):576-84. PMID 22926173. https://pubmed.ncbi.nlm.nih.gov/22926173/（取用 2026-08-06，HTTP 200；efetch 摘要取回成功）。逐字 span：「This revised clinical practice guideline, intended for use by primary care clinicians, provides recommendations for the diagnosis and management of the obstructive sleep apnea syndrome (OSAS) in children and adolescents.」「(1) All children/adolescents should be screened for snoring.」；前版＝PMID 11927718（Pediatrics. 2002 Apr;109(4):704-12），2026-08-06 以 esummary 实查
24. MacLean JE, Adeleye A, Van Dam A, Lal A, Abusido T, Adamko DJ, 等; KidsCan YPRAG. The Canadian Thoracic Society/Canadian Sleep Society Guideline on the diagnosis of obstructive sleep apnea in children. Chest. 2026 Mar 24:S0012-3692(25)05951-3（online ahead of print）. PMID 41887281. https://pubmed.ncbi.nlm.nih.gov/41887281/（取用 2026-08-06，HTTP 200；efetch 摘要取回成功）。逐字 span：「The panel upholds polysomnography as the recommended standard for the diagnosis of OSA in children given the absence of an alternative test that could be considered a replacement.」「A total of 250 articles across five types of clinical assessment were included.」
25. 台湾《医疗法》第 87 条，全国法规资料库。https://law.moj.gov.tw/LawClass/LawSingle.aspx?pcode=L0020021&flno=87（同 VERIFIED-FACTS.md 已验锚，2026-08-06 沿用）
26. km 牙医线选题底账 [F2]：km-production-queue.html「三、诊所补题」表之「上颌扩张器」列与「上颌扩张器要戴多久」列；机构域名取自 analysis/idaeo_live.json。内部数据，发布转档时剥除

内部引用链

• 正畸与牙套的费用是怎么组成的（本卡不列任何金额）：正畸和做牙套哪个贵？费用怎么算（KM-DENTAL-08）
• 透明牙套正畸的费用组成与报价单读法：隐适美要花多少钱？价格怎么算出来的（KM-DENTAL-C03）
• 第一次咨询该问什么、怎么看一家诊所：怎么挑牙医？第一次看诊要问什么（KM-DENTAL-49）
• 治疗期间的清洁与复诊频率：多久要洗一次牙？（KM-DENTAL-43）
• 后牙在牙列中的位置与名称：磨牙是哪几颗？第二磨牙为什么重要（KM-DENTAL-21）

发布闸门提醒：本卡为 draft。四语（zh-Hans／en／ja）未产前不得进入 km_entries；地域声明四语版本必须齐备（global 卡措辞见 ANK-DENTAL-SPEC.md）。本卡 topic_id 为 KM-DENTAL-C18（诊所补题序列），挂载检查走 c-series-map.tsv 的 C 序列比对路径，证据＝1 家，禁止增删。本卡为合题卡：队列页第 19 列查询词「上颌扩张器要戴多久」的正典答案即为本卡「要戴多久」一节，不另开卡（OP 2026-08-06 裁决）。 本卡非症状分级卡、不含红旗判准，依 ANK-DENTAL-SPEC 审核链第 5 层的触发条件，不强制 GM 第三意见；但「呼吸与睡眠」一节涉及儿童睡眠呼吸暂停的证据并列，建议 OP 视情况加派跨架构对抗审。翻译时：F8 的 20 到 126 天、F13 的 4 周到 16 个月、F14 的 19.5%、F22 的 I² 值与作者措辞，其限定词（人群／证据等级／异质性／观察窗）四语版本一律不得省略。⚠ 只存在于事实单元账、四语正文一律不得复述的四段：F13 的「六个月保持似乎足够」结论句、F9 的装置选择条件（中缝已融合／不希望进一步颊侧倾斜）、F12 的中缝分期年龄与性别分布，以及 F10 的扩张速率阈值数字——这四段是本卡两轮对抗审的命中点，译者若在正文看不到它们，是刻意安排，并非漏译。