Pierre Robin序列征婴儿下颌骨牵引成骨术后声门暴露分级的改变及相关因素分析

Changes of glottic exposure classification and related factors in infants with Pierre Robin sequence after mandibular distraction osteogenesis

目的分析Pierre Robin序列征患儿下颌骨牵引成骨术后声门暴露分级的改变及其相关因素。方法回顾2016-2019年在我院全麻下行下颌骨牵引成骨术的Pierre Robin序列征患儿95例,比较下颌骨牵引成骨术前后Cormack-Lehane分级结果及上气道各CT指标测量值的差异。并应用Spearman相关性分析评价CT测量指标与Cormack-Lehane分级评分的相关性。结果与下颌骨牵引成骨术术前相比,术后患儿Cormack-Lehane评分与声门暴露困难发生率降低(P<0.05),D1、D2、D3、D4、D5、D6、D7、D8、D9、D10、D11长度均增加(P<0.05);角1、角2和角5增大;角3、角4和角6均减小(P<0.05);会厌尖端的气道截面积及腭咽腔容积增加(P<0.05),并与Cormack-Lehane分级呈负相关。结论随着气道截面积及腭咽腔容积增加,Pierre Robin序列征婴儿下颌牵张成骨术后声门暴露分级明显改善。

Objective To analyze the changes of glottic exposure classification and related factors in Pierre Robin sequence pediatric patients after mandibular distraction osteogenesis.Methods Ninety five pediatric patients with Pierre Robin sequence,scheduled for elective mandibular distraction osteogenesis under general anesthesia in our hospital from 2016 to 2019,were enrolled in this study.The results of Cormack Lehane classification and CT parameters of upper airway were compared before and after mandibular distraction osteogenesis.Pearson correlation analysis was used to evaluate the correlation between CT measurement indexes and Cormack Lehane grading score.Results The Cormack Lehane score and the incidence of glottic exposure difficulty were decreased compared with that before mandibular distraction osteogenesis(P<0.05),the length of D1,D2,D3,D4,D5,D6,D7,D8,D9,D10,D11 were increased(P<0.05);angle 1,angle 2 and angle 5 were increased;angle 3,angle 4 and angle 6 were decreased(P<0.05);airway cross-sectional area and palatopharyngeal cavity volume at the tip of epiglottis were increased(P<0.05).It was negatively correlated with Cormack Lehane classification.Conclusion Preoperative maxillofacial and upper airway CT can play an important role in the judgment of laryngoscope exposure classification in PRS patients.With the increase of airway cross-sectional area and velopharyngeal cavity volume,glottic exposure classification of infants with Pierre Robin sequence sign after mandibular distraction osteogenesis was significantly improved.