双颌前徙手术治疗黄种人群阻塞性睡眠呼吸暂停低通气综合征的初步研究

Primary study of maxillomandibular advancement surgery for obstructive sleep apnea-hypopnea syndrome

目的初步探讨应用双颌前徙手术治疗黄种人群阻塞性睡眠呼吸暂停低通气综合征患者的术后效果及相关并发症。方法选择北京大学口腔医院正颌外科中心2005年9月到2007年10月诊治的4名阻塞性睡眠呼吸暂停低通气综合征患者,均为男性。所有患者均进行双颌前徙手术治疗。术前和术后3～6个月分别进行多导睡眠图仪检查和拍摄头颅定位侧位片,于术后3～6个月期间进行主观问询。结果术后所有患者的睡眠呼吸暂停低通气指数及睡眠时最低血氧饱和度均得到明显改善,SNA、SNB都有明显增大,术后后气道间隙得到了明显的扩大,舌骨到下颌骨的距离也有所缩短。通过主观调查问卷调查,本研究中所有4名患者术后睡眠打鼾及日间嗜睡症状消失,并且对术后面型的改善比较满意。3名患者术后出现短暂的下唇麻木及颞下颌关节不适,术后短期存在的下唇麻木及颞下颌关节不适的症状基本消失。结论双颌前徙手术是一种治疗黄种人群OSAHS有效的方法。

Objective To assess the outcomes of maxillomandibular advancement （MMA） for the treatment of persistent obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods Four patients with persistent OSAHS were treated by MMA. Polysomnography and cephalometric X-ray were conducted before surgery and 3 to 6 months after surgery. The results of the treatment were subjectively evaluated by questionnaire. Results The apnea hypopnea index （AHI） and SaO2 after operation were greatly improved. The posterior airway space or the distance from mandibular plane to hyoid bone based on the cephalometric analysis increased in all patients. The symptoms of sleep snoring and snooze disappeared. All patients gave a favorable response to their facial esthetic results. Three patients developed temporomandibular joint dysfunction after surgery. Conclusion Maxillomandibular advancement is a highly effective treatment for persistent OSAHS.