骨性Ⅱ类伴重度阻塞性睡眠呼吸暂停综合征的综合治疗效果评价

Evaluation of clinical results of skeletal Class Ⅱ malocclusion with severe OSAHS treated by combined modalities

目的:评价手术辅助上颌快速扩弓(SARME)联合下颌骨牵张成骨术(DO)矫治年轻骨性Ⅱ类伴重度阻塞性睡眠呼吸暂停综合征(OSAHS)患者的疗效。方法:4例上颌牙弓狭窄及下颌骨发育不足的骨性Ⅱ类患者(其中男2例,女2例,18～23岁,平均20.3岁),经多导睡眠检测为重度OSAHS。采取SARME联合下颌骨DO术矫治骨性Ⅱ类畸形,术后正畸治疗排齐拥挤牙列及咬合精细调整。分别采用CT、鼻声反射检查及多导睡眠检测,比较治疗前、后(T0、T1)上颌骨宽度、鼻腔体积、鼻阻力以及PSG参数的改变。结果:矫治后患者的上颌骨宽度呈"V"形扩大,鼻腔体积增大,鼻阻力减小。多导睡眠检测结果显示,治疗后睡眠呼吸暂停紊乱指数(AHI)显著减小并恢复正常,患者的OSAHS症状得到显著改善。结论:SARME联合下颌骨DO术对治疗严重骨性Ⅱ类伴OSAHS的年轻患者具有较好疗效。

PURPOSE： To evaluate the combination of surgically assisted rapid maxillary expansion （SARME） and mandibular ramus distraction osteogenesis （DO） for treatment of skeletal Class Ⅱ malocclusion with severe OSAHS. METHODS： Four patients were skeletal Class Ⅱ malocclusion with maxillary transverse deficiency and mandibular hypoplasia , diagnosed as severe OSAHS by polysomnography （PSG）. Combined SARME and mandibular ramus DO were performed. All patients received post-surgical orthodontic treatment for alignment and occlusion adjustment. The changes of maxillary transverse width, nasal volume, nasal resistance and PSG parameters were compared by computer tomography, acoustic rhinometry and PSG before and after treatment （TO, T1）, respectively. RESULTS： All patients had an increase in nasal volume,and decrease in nasal resistance correlated with the V-shaped opening of maxilla. PSG parameters suggested that the severity of OSAHS was significantly improved with apnea and hypopnea index （AHI） decreased to normal. CONCLUSION： Combined SARME and mandibular ramus DO might be an effective treatment for skeletal Class Ⅱ patients with severe OSAHS. Supported by Shanghai University Young Teacher Training Program （shjdy029） and Research Fund of Science and Technology Commission of Shanghai Municipality （11140902001）.