颅外固定牵引矫治重度小下颌畸形伴阻塞性睡眠呼吸暂停低通气综合征六例报告

Treatment of severe micrognathia accompanying obstructive sleep apnea hypopnea syndrome with rigid external distractor

目的探讨使用颅外固定牵引装置矫治儿童患者小下颌畸形伴发阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)。方法 6例均为双侧颞下颌关节强直伴重度小下颌畸形及 OSAHS 患者。男性4例,女性2例,年龄1.5～14岁。全麻下颌下手术入路,下颌骨体部截骨并在远心骨段小型钛板固定,然后安置颅外固定牵引装置并与下颌骨上的钛板连接。同内置式牵引成骨方案。结果 6例手术前后面型、后气道间隙和多道睡眠监测结果均有明显改变,患者术后睡眠及日间状态恢复正常,未发生术后不良反应。4个月后拆除牵引装置及固定钛板,牵引区新骨生长良好。结论治疗重度小下颌畸形伴 OSAHS 时颅外固定牵引装置具有手术简便、成骨质量好、牵引幅度大、牵引方向精确并可调等优点,特别适于下颌骨体积过小、无法安放较长内置式下颌骨牵引器的儿童患者。

Objective To approach the treatment of severe micrognathia accompanying obstructive sleep apnea hypopnea syndrome （OSAHS） with rigid external distractor （RED） in children. Methods Six patients （ 4 males, 2 famales） aged between 1.5 and 14 years, were diagnosed as ankylosis of temporomandibular joint severe micrognathia, and OSAHS. Under the nasal intubation and general aneathesia, the surgical procedures were performed by submandibular approach and osteotomy was done in mandible body. Mini plate was fixed and connected to RED. The distraction procedure was carried out Results Patients＇ profile, posterior airway space, and the results of polysomnography were improved significantly. There were no complications. Four months after removing the RED, the new bone was well formed. Conclusions BED technique has advantages of uncomplicated procedures, high quality of new bone formation, and accurate regulation in the treatment of micrognathia. It is especially suitable for the treatment of children with severe micrognathia whose mandiblar body is too small to insert the internal distractor.