牵引成骨技术在严重小颌畸形伴中重度阻塞性睡眠呼吸暂停低通气综合征治疗中的应用

Application of distraction osteogenesis in the treatment of severe mandibular micrognathia with severe obstructive sleep apnea and hypopnea syndrome

目的探讨应用牵引成骨技术治疗严重小颌畸形伴中、重度阻塞性睡眠呼吸暂停低通气综合征（obstructivesleepapneaandhypopneasyndrome，OSAHS）的疗效。方法采用下颌骨牵引成骨技术治疗严重小颌畸形伴中、重度OSAHS患者19例，分别于术前、后行多导睡眠监测仪监测及螺旋CT扫描，评价疗效并比较患者上气道三维结构的改变。结果根据OSAHS疗效判定标准，19例中17例治愈，2例显效；手术后上气道各段的矢状径、矢状面积、横径和横截面积均较术前明显增加，气道容积从治疗前的（15572．03±3370．11）mm^3变为治疗后的（21182．69±4533．15）mm^3，变化主要发生在腭咽及舌咽，喉咽变化不明显。腭咽及舌咽区段气道各项检测指标与术前相比，差异均有统计学意义（P〈0．01或P〈0．05））。结论下颌骨牵引成骨技术可明显扩张上气道腭咽段和舌咽段气道容积，从而有效治疗严重小颌畸形伴中、重度OSAHS。CT作为一种影像学手段，在该研究中有独到和重要的作用。

Objective To investigate the effect of distraction osteogenesis（DO） in the treatment of severe mandibular micrognathia with severe obstructive sleep apnea and hypopnea syndrome （OSAHS）. Methods 19 cases of severe mandibular micrognathia with OSAHS were treated by DO. All the patients received PSG and MSCT examination before and after DO to evaluate the therapeutic effect and changes in the upper airway. Results According to the evaluation standard, 17 cases were cured and 2 cases improved markedly. The saggital distance and area, transverse distance and area of the upper airway increased markedly after DO. The volume of upper airway increased from（ 15 572.03 ±3 370.11 ） mm3to （21 182.69 ±4 533. 15） mm3. The airway change happened mainly in velopharyngeral region and the lingopharyngeal region, but not in the laryngoppharyngeal region. Conclusions DO can treat severe mandibular micognathia patients with OSAHS effectively by enlarging the volume of upper airway, especially in the velopharynx and glossopharyngeum region. The MSCT plays an effective and important role.