双颌前移术治疗阻塞性睡眠呼吸暂停低通气综合征

Maxillomandibular advancement for obstructive sleep apnea/hypopnea syndrome

目的探讨双颌前移术（maxillomandibular advancement，MMA）在阻塞性睡眠呼吸暂停低通气综合征（OSAHS）治疗中的应用。方法10例前颅底平面一下齿槽座点角（mandibular protrusion angle，SNB）〈75°，后气道间隙（posterior airway space，PAS）〈11mm的下颌骨发育不良，手术愿望强烈的OSAHS患者行双颌前移术，6例患者同期或分期行悬雍垂腭咽成形术，6例患者术后随访6个月以上。数据采用中位数（范围）表示。结果术中出血约250～600ml，术中和术后无严重并发症。术后患者对面形改变均满意。6例患者术后6个月复查多道睡眠监测（PSG），按2009年OSAHS指南，呼吸暂停低通气指数（AHI）〈20次／h和降低≥50％的显效5例，AHI降低≥50％有效患者1例。术后鼾声响度及Epworth嗜睡评分分别由术前的8分（6～10分）和15分（11～24分）下降至2分（0—4分）和5分（1～8分）。AHI由术前52．2次／h（23．7～83．8次／h）下降至12．6次／h（7．6～31．8次／h），最低血氧饱和度（LSaO2）及血氧饱和度小于0．90的时间占总睡眠时间百分比分别由术前0．64（0．57—0．83）和21．0％（12．0％～37．2％）改善至0．82（0．78—0．93）和2．0％（0％-8．0％）。结论对于伴有颌骨发育不良的OSAHS患者，双颌前移术不失为最佳选择。

Objective To explore effectiveness of maxillomandibular advancement （MMA） in the treatment of obstructive sleep apnea/hypopnea syndrome （OSAHS）. Methods MMA was performed in 10 OSAHS patients with mandibular dysplasia diagnosed by mandibular protrusion angle （SNB） 〈 75° and a posterior airway space （PAS） 〈 11 mm. Six patients had uvulopalatopharyngoplasty （UPPP） also. Six patients had over 6 months postoperative follow up. Resnlts The blood loss was about 250 -600 ml in the operation, and the serious complications didn＇t happen. The patients were satisfied with the postoperative facial change. Based on success criteria of 2009, of 5 patoents showed highly responsive result and 1 patient was responsive （valid）. rate was 83% and the responsive rate 100%o. The snoring loudness score and Epworth sleepy score were reduced from preoperative 8（6 - 10） and 15（ 11 -24） to postoperative 2（0 -4） and 5 （1 -8 ）. AHI was reduced from preoperative 52. 2 （23.7 -83.8 ） to postoperative 12. 6 （7.6 -31.8 ）, lowest mean oxygen saturation increased from 0.64 （0. 57 - 0.83 ） to 0.82 （0.78 - 0.93 ）. Percentage of time with oxyhemoglobin saturation below 0. 90 （CT90） reduced from 21.0% （12. 0% -37.2% ） to 2. 0% （0% -8.0% ）. Conclusions MMA is effective for the OSAHS patients with mandibular dysplasia.