重度OSAHS上气道骨框架重构-双颌逆时针大幅度前旋治疗

Craniomaxillofacial bone frame reconstruction-bimaxillary substantial advancement and anticlockwise rotation for patients with severe obstructive sleep apnea-hypopnea syndrome

目的:克服东方人微凸面型的限制,尽可能前移上、下颌骨,以达到重度阻塞性睡眠呼吸暂停低通气综合征(obstructivesleepapnea-hypopneasyndrome,OSAHS)手术治疗的良好效果。方法:重度OSAHS患者16例(其中男15例,女1例),平均年龄(36.81±10.41)岁,体重指数(bodymassindex,BMI)为(27.35±3.67)kg/m2,睡眠呼吸暂停低通气指数(apneaandhypopneaindex,AHI)为(61.59±15.78)次/h,LSAT为(72.13±9.63)%。手术前、后对患者进行PSG监测和头影测量分析。采用定量UPPP(QUPPP)-双侧下颌骨矢状劈开(BSSRO)-上颌骨LeFortI型手术次序进行手术。颏前移成形术根据面下1/3的形态决定是否施行,颏前移于手术最后完成。术后定期摄片,进行头影测量分析,复查PSG。随访患者,平均随访(20.88±3.27)个月。采用SAS8.02软件包进行手术前、后资料的配对t检验,评估手术效果。结果:以AHI<20次/h和降低≥50%为评判标准,手术治疗成功率为93.75%。本组患者上颌前移(6.91±1.68)mm,上抬(4.13±0.85)mm;下颌前移(11.03±1.32)mm;施行颏前移术9例,颏前移(9.67±2.00)mm。所有患者OSAHS主观症状均消失或减轻,术前AHI为(61.59±15.78)次/h,术后为(10.04±7.33)次/h(P<0.0001)。术前LSAT为(72.13%±9.63)%,术后LSAT为(87.31±4.30)%(P<0.0001)。术前SNA为(81.32±4.03)°,术后为(87.18±3.70)°(P=0.0002);术前SNB为(72.56±3.99)°,术后为(80.08±3.40)°(P<0.0001);术前MP-H为(26.25±3.49)mm,术后为(21.61±4.04)mm(P=0.0016)。术前PASmin为(5.94±1.02)mm,术后为(9.11±2.17)mm(P<0.0001),患者均无明显语音障碍和吞咽障碍,无明显颌面畸形,咬合关系良好。结论:双颌逆时针前旋术治疗重度OSAHS患者的效果良好、稳定,在相同颌骨水平前移幅度下能更好地减少上颌骨前突程度,避免造成上颌骨前突畸形,同时尽可能绷紧颏部,显著提高了舌骨上肌群的张力,起到舌骨悬吊的良好作用。

PURPOSE： To overcome the oriental face type of micro convex constraints, advancing the maxilla and mandible in order to achieve good surgical effect for patients with severe obstructive sleep apnea-hypopnea syndrome （OSAHS）. METHODS：Sixteen cases with severe OSAHS （15 males and 1 female） were included. The mean age was 36.81±10.41 years, BMI （body mass index, BMI） was （27.35±3.67） kg/m2, AHI was （61.59±15.78）, LSAT was （72.13±9.63）%. Cephalometric analysis and PSG were conducted preoperatively and postoperatively. Q-UPPP and maxillomandibular anticlockwise rotation advancement were performed, in which the maxillae advancing distance was controlled to be 6-8 mm and mandible moved forward beyond 10 mm by BSSRO. Genioplasty was performed based on the need of patients＇ profile. All patients ware followed up for （20.88±3.27） months postoperatively. The data was analyzed with SAS 8.02 software package. RESULTS：According to stanford criteria： AHI〈20 and drop to≥50%, the success rate was 93.75%. The patients’ maxilla moved forward by （6.91±1.68） mm,anteriorly raised by （4.13±0.85） mm; the mandible advanced （11.03±1.32） mm. Nine cases underwent genioplasty and the chin was advanced by （9.67±2.00） mm. All patients feel well and OSAHS symptoms disappeared or remarkably improved. The patients’ AHI was 61.59±15.78 preoperatively, the postoperative AHI was 10.04±7.33 （P〈0.0001）. The LSAT was （72.13±9.63）% preoperatively, the postoperative LSAT was （87.31±4.30）% （P〈0.0001）. The SNA was （81.32±4.03）° preoperatively, the postoperative SNA was （87.18±3.70）°（P=0.0002）;SNB was （72.56±3.99）° preoperatively, and （80.08±3.40）° postoperatively（P〈0.0001）. MP-H was （26.25±3.49） mm preoperatively, and （21.61±4.04） mm postoperatively （P=0.0016）. PASmin was （5.94±1.02） mm preoperatively, and （9.11±2.17） mm postoperatively （P〈0.0001）. There were no dysphagia or VPI, all patients had good occlusion and no visible deformities were noted. CONCLUSIONS：Bimaxillary substantial advancement and anticlockwise rotation is effective and stable for severe OSAHS patients to advance their maxilla and mandible anticlockwise.