小下颌畸形伴阻塞性睡眠呼吸暂停综合征的牵引成骨矫治

Distraction osteogenesis in correction of mandibular micrognathia accompanying obstructive sleep apnea syndrome

目的 探讨颌骨牵引成骨技术在矫治小下颌畸形伴阻塞性睡眠呼吸暂停综合征(OSAS)中的应用价值。方法 15例患者其中 7例系双侧颞下颌关节 (TMJ)强直致重度小下颌畸形伴重度OSAS ,3例系单侧TMJ强直伴OSAS ,5例为先天发育性或外伤导致的小下颌畸形伴OSAS。双侧牵引 12例 ,单侧牵引 3例。每例患者术前术后均行X线头影测量及睡眠多导图仪检查。结果 15例2 7侧下颌骨最小牵引距离 9mm ,最大 30mm ,平均 2 0 .4mm ,所有病例牵引过程顺利 ,牵引区成骨良好 ,无感染及其他并发症发生。其中术前重度 5例 ,中度 2例 ,轻度 4例均治愈。 4例术前重度术后变为轻度。后气道间隙由治疗前的平均 4.5mm ,增加到 12 .4mm。SNB角 (蝶鞍点与鼻根点、下颌槽座点三角之间形成的角 )由术前平均 6 6度增加到术后的 75度。患者在牵引过程中自觉症状逐渐减轻或消失。平均随访 12个月 ,效果稳定 ,未见复发。结论 颌骨牵引成骨技术不仅可有效矫治小下颌畸形而且可治疗其伴发的OSAS ,且方法简单 ,风险小 ,治愈率高 ,复发率低 ,效果稳定 。

Objective To evaluate the effect of distraction osteogenesis in correction of mandibular micrognathia accompanying obstructive sleep apnea syndrome (OSAS). Methods A total of 15 patients, aged 9 to 43 years, 11 males and 4 females, were treated. 7 patients suffered from bilateral ankylosis of temporo manclibular joint inducing severe mandibular micrognathia and accompanying severe OSAS. 3 cases suffered from unilateral TMJ ankylosis with OSAS. 3 patients suffered from congenital developmental micrognathia with OSAS. 2 cases were caused by trauma. Among the 15 patients, 12 were treated by synchronous bilateral mandibular distraction, 3 patients were distracted unilaterally. Every patient had been evaluated pre and postoperatively with cephalometry and polysomnography. Results The minimum distance of distraction was 9 mm, the maximum was 30 mm, with a mean of 20.4 mm, in mandible of 15 patients with 27 sides. The distraction process was smooth in all the cases. The osteogenesis was good, without infection and other complications. Complete curative effect was achieved in 4 severe, 3 moderate, and 4 mild cases. The posterior airway space was increased from averaged 4.5 mm preoperatively to 12.4 mm. The increase of SNB angle was from preoperative 66° to 75° on average postoperatively. The vast majority of the patients had their subjective symptoms alleviated gradually or disappeared completely. The results were stable without relapse during a follow up period of 12 months. Conclusion The distraction osteogenesis can not only be used to effectively correct severe mandibular micrognathia deformity, but also can cure its accompanying OSAS. The procedure is simple, with low risk, high curative rate, low relapse rate, and stable result. Up to now, it is the most effective method in the treatment of this difficult and complicated kind of disorder.