阻塞性睡眠呼吸暂停低通气综合征的正颌外科及牵引成骨治疗

Orthognathic Surgery and Distraction Osteogenesis for Treatment of Obstructive Sleep Apnea Hypopnea Syndrome

目的探讨小下颌畸形伴阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的正颌外科及颌骨牵引成骨手术的适应证及治疗原则。方法回顾性分析17例小下颌畸形伴中至重度OSAHS患者的临床资料,其中4例行正颌外科治疗,5例行颌骨牵引成骨治疗,8例行正颌外科及颌骨牵引成骨联合治疗。结果所有患者的SNB角平均值由术前的64.6°增加至术后的71.9°,平均后气道间隙(PAS)由术前的5.4mm增加至术后的13.2mm,平均睡眠呼吸暂停低通气指数(AHI)由术前的58.4下降至术后的7.6,最低血氧饱和度(LSAT)平均值由术前的66%增加至术后的87%,各项指标术前与术后相比差异均具有显著性(P<0.001);平均颏部水平前移(MHA)14.3mm,与术前及术后的SNB、PAS、AHI和LSAT差值的相关系数分别为0.36、0.62、0.34和-0.14。结论正颌外科及颌骨牵引成骨手术均能有效治疗小下颌畸形伴OSAHS患者,两者适应证略有不同,联合应用疗效更好。

Objective To discuss the indication and protocol of surgical therapy when treating man- dibular micrognathism accompanying obstructive sleep apnea-hypopnea syndrome(OSAHS)using distraction osteogenesis and orthognathic surgery. Methods A total of 17 patients with mandibular micrognathism accompanying moderate to severe OSAHS, aged 11 to 59 years, 15 men and 2 women, were reviewed. Four of them were treated with orthognathic surgery, 5 of them were treated with distraction osteogenesis, and the other 8 patients were treated with an integrated procedure combining distraction osteogenesis with orthognathic surgery. Cephalometric analysis and polysomnography studies were obtained pre- and postoperatively. Results SNB angle changed from 64.6° to 71.9°, post airway space(PAS)from 5.4 mm to 13.2 mm, apnea and hypopnea index(AHI)from 58.4 to 7.6, lowest saturation of oxygen(LSAT)from 66% to 87%. All the differences showed statistical significance(P < 0.001). The average mental horizontal advancement(MHA)was 14.3 mm and its correlation coefficients with ΔSNB, ΔPAS, ΔAHI, and ΔLSAT were 0.36, 0.62, 0.34, and -0.14, respectively. Conclusions Both distraction osteogenesis and orthognathic surgery can be effectively used to treat patients with mandibular micrognathism accompanying OSAHS with slightly different indications. A combination of these two operations may be preferred.