牵引成骨技术对颌骨畸形伴发OSAS未成年患者疗效评价

Evaluation of distraction osteogensis technique to patients in children with maxillary mandible deformities and secondary OSAS

目的:探讨牵引成骨技术治疗颌骨畸形伴发OSAS青少年患者的疗效。方法:采用牵引器治疗颌骨畸形20例,包括颞下颌关节强直,第一、二鳃弓综合症,小下颌畸形和Crouson综合征。1例行上颌骨Le Fort Ⅲ型截骨外置式牵引成骨;19例行下颌骨体部截骨牵引成骨,其中同期行下颌支牵引成骨1例,二期颏成形术4例。牵引幅度5mm～35mm,平均16.79mm。从面容变化、咀嚼功能评价、X线头颅定位侧位片、身高体重、AHI等方面进行疗效评估。结果:20例病例面部外形改善满意、上气道直径和咽腔面积增大,睡眠暂停指数(AI)降级显著,身高体重增加显著;但存在咬合能力降低,部分病例错加重。结论:牵引成骨可以有效改善面形,扩大狭窄的咽腔,改善患者缺氧状况,促进生长发育。

Objective： To investigate therapeutic effect of distraction osteogensis （DO） in children suffering from defonnitas maxillary or mandible deformity and secondum OSAS. Method： A total of 20 children with deformitas maxillaries were performed distraction osteogensis using distractors provided by German company MARTIN and MEDICON, Chinese company SHANXI ZHONGBANG. The diseases included ankylosis of temporo-mandibular joint , first and/or second arch syndrome, micromandibular deformity, Crouson syndrome, Among them, one patient was performed Le Fort Ⅲ osteotomy with external distraction osteogensis;The other 19 patients were performed bilateral distraction osteotomy of the body of mandible, among whom one underwent unilateral distraction osteotomy of the ramus of mandible meanwhile and 4 were performed secondary genioplasty. The amplitudes of traction varied from 5mm to 35mm, averaging 16.79mm. The therapeutic effects were evaluated according to assessment of facial improvement, occlusion ability, lateral cephalometric radiography, height and weight, AHI, etc. Result： All of the 20 patients obtain obtain a markedly improved facial profile, increased diameter of upper airway and in area of cavity of pharynx, significant decrease of AI,significant increase of height and weight; while their ability of occlusion were decreased, some patients showed aggravated malocclusion, some showed complications such as infection and cuffs fistulae. Conclusions： Distraction osteogensis could effectively improve facies, enlarged narrowed cavity of pharynx, relieve hypoxia, and thus promoted growth.