8～12岁无鼾儿童上气道发育的X线头影测量研究

Cephalometric study of upper airway development in non-snoring children of 8-12 years old

目的本研究对处于生长发育高峰期的无鼾少年儿童进行观察测量，旨在探讨年龄、颅颌面结构及周围软组织发育对上气道的影响。方法本研究样本为混合纵向资料。包括73组志愿者资料（男36例，女37例），按年龄分为五组：8岁组、9岁组、10岁组、11岁组及12岁组。志愿者均进行整夜多导睡眠监测以排除睡眠障碍儿童，并进行头颅侧位片拍摄及测量，结果进行方差分析。结果上气道鼻咽部PNS-R（P=0．003）、UPW（P=0．001）均在8～11岁随年龄增长而增长，而在11～12岁出现下降趋势；腺样体在8～9岁间出现明显减小趋势，而在10岁后表现出增大趋势；腭咽部SPP-SPPW（P=0．01）在8～9岁间出现明显增长；UMPW及舌咽部PAS随年龄无显著性变化；SPT（P=0．05）、TGL（P=0．oo）、TGH（P=O.00）及CoMe（P=0．oo）均在10岁后表现为明显增长；v_LPw、H—CVP（P=0．00）在10岁后显著性增长。在颌骨垂直方向上N-ANS、N-Me、Co-Go随年龄增长而出现显著增大（P=0.00）。结论上气道鼻咽部生长主要受腺样体影响；舌体及软腭的生长可能会限制腭咽及舌咽部气道的生长；舌骨随年龄变化相对于脊椎向前移动可能是喉咽部气道增长的主要原因之一。

Objective The aim of the present study was to describe the effects of age, dentofacial development and its surrounding tissue on the upper airway in a sample of non-snoring children at their peak growth. Methods Mixed longitudinal data was used in this study. The sample included 73 subjects （36 males, 37 females）. Sleep disorders were excluded by polysomnographic （PSG）monitoring during their nocturnal sleep. All children were divided into 5 groups by age.. 8-, 9-, 10- 11- and 12- years. The cephalograms were performed on all subjects. Cephalometric measurements of craniofacial pattern and upper airway morphology were compared among the five groups by ANOVA. Results In the nasopharynx level, PNS-R（P=0. 003）, UPW（P=0. 001） increased with age from 8 to 11 years old and started to decrease by age of 11. The adenoid pad shrank between 8 and 9 year of age, and then enlarged after 10. SPP-SPPW of velopharynx （P=0.01） significantly increase between 8-9 years old, while UMPW and glossopharynx remained unchanged. SPT （P=O. 05）, TGL （P=0. 00）, TGH （P= 0. 00） and GoMe （P= 0. 00） all increased significantly after 10 years old. V-LPW and H-CVP （P=0. 00） also increase after 10. Vertically, N-ANS, N-Me Co-Go all increase with age （P=0. 00）. Conclusions The development of upper airway was mainly affected by adenoids. Tongue and soft palate might restrict the development of velopharynx and glossopharynx airway. The hyoid forward movement relative to spinal vertebrae might be the main reason of airway increase of laryngopharynx.