小颌畸形伴阻塞性睡眠呼吸暂停低通气综合征患者上气道CT测量

CT measurements of upper airway in the patients of obstructive sleep apnea -hypopnea syndrome associated with micrognathism

目的通过小颌畸形伴阻塞性睡眠呼吸暂停低通气综合征(obstructivesleepapneahypopneasyndrome,OSAHS)患者与正常人上气道CT测量结果进行对照,揭示其上气道形态学特点,并进一步改进利用CT进行上气道测量的方法。方法小颌畸形伴OSAHS患者共12例,男10例,女2例,平均年龄28.30岁;对照组为正常志愿者19例,男10例,女9例,平均年龄30.37岁。分别以16排螺旋CT进行头颈部扫描,并在硬腭与杓状软骨上缘之间重建出20层轴位图像,测量上气道矢状径、横径及横截面积;再分别计算腭咽、舌咽及喉咽三个区段上气道矢状径、横径及横截面积的最大值、最小值及平均值。结果研究组与对照组在所有20层图像中测量得到的上气道矢状径均有显著性差异,而横径的差异只在矢状径最小的几层中具有显著性,多数层面(12/20)的横截面积具有显著性差异。两组间在舌咽区段的各项测量值(除横径最大值外)的差异均具有显著性。结论小颌畸形伴OSAHS患者上气道的狭窄主要由矢状径狭窄所致,舌咽区段的狭窄最为明显。

OBJECTIVE The dimensions of upper airway in a group of micrognathic patients associated with obstructive sleep apnea-hypopnea syndrome （OSAHS） were measured using CT to explore the morphologic characteristics and improve the measurement method. METHODS Nineteen normal volunteers （10 males, 9 females）, whose average age was 30.37 years, and 12 micrognathic patients associated with OSAHS （10 males, 2 females） were included in this study. All the objects undertook CT scan in head and neck region with 16 array CT machine, 20 axial images were reconstructed from the palate level to the upper edge of arytenoids, anterior-posterior dimension, transverse dimension,and cross section area（CSA） of the upper airway in each image were measured. The maximum, minimum and mean anterior-posterior dimension, transverse dimension and CSA in velopharyngeal region, glossopharyngeal region and larynpharyngeal region were calculated respectively. RESULTS The differences between OSAHS group and control group were significant on anterior-posterior dimension at all the 20 images, on CSA at 12/20 images, but on transverse dimension only at a few images while anterior-posterior dimensions were quite narrow. All the measurements except the maximum transverse dimension in glossopharyngeal region showed significant differences between two groups. CONCLUSION The majority of the narrow upper airway attributes to the decrease of anterior-posterior dimension in micrognathic patients associated with OSAHS, glossopharyngeal region is the narrowest region in all three regions.