摘要
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.
出处
《中国口腔颌面外科杂志》
CAS
2014年第3期247-252,共6页
China Journal of Oral and Maxillofacial Surgery