颌骨畸形伴阻塞性睡眠呼吸暂停低通气综合征的牵引成骨治疗

Treatment of distraction osteogenesis in the patients of obstructive sleep apnea-hypopnea syndrome with micrognathia

目的 探讨牵引成骨技术在颌骨畸形继发阻塞性睡眠呼吸暂停低通气综合征(obstructivesleepapnea hypopneasyndrome,OSAHS)治疗中应用的效果。方法 收集自 1 997年 1 0月～2 0 0 2年 9月共 46例颌骨畸形伴OSAHS少年儿童 ,患者睡眠呼吸障碍经夜间多导睡眠监测证实。年龄从 4～ 1 8岁 ,平均年龄 1 1 4岁 ,其中颞下颌关节强直伴小下颌畸形 32例 ;小下颌畸形患者 9例 ;第一、二鳃弓综合征 2例 ;Crouzon综合征 3例。患者术前常规拍照、摄头颅定位侧位片 ,全景片。每位患者根据畸形情况 ,采取单侧或双侧牵引成骨治疗 ,根据侧位片预测 ,一般牵引到略微反覆盖为准。牵引幅度为 5～ 35mm ,平均牵引幅度 1 8 34mm。比较患者术前后颅颌面形态、呼吸道测量分析、多导睡眠监测结果评价治疗效果。结果 患者术后颌骨畸形明显改善 ,头影测量分析提示上呼吸道狭窄得以显著缓解 ,最小后气道径 ( x±s)由 (5 48± 2 76)mm增加到 (9 97± 2 0 5)mm ,睡眠呼吸暂停低通气指数 (apnea hypopneaindex,AHI, x±s)从术前 (66 31± 1 7 1 5)次 /s降低到 (3 1 6± 1 70 )次 /s,以上结果统计分析表明差异具有非常显著性 (P <0 0 0 1 )。

Objective To apply the treatment of distraction osteogenesis(DO) to obstructive sleep apnea hypopnea syndrome(OSAHS) patients with croniomaxillofacial deformities Methods All 46 OSAHS patients with micrognathia are had polysomnography(PSG) study and cephalometric analysis Their age from 4 to 18 years old, the mean age is 11 4 The number of temporal mandibular joint (TMJ) ankylosis with micrognathia, micrognathia, 1st & 2nd bronchial arch syndrome and crouzon syndrome patients were 32, 9,2 and 3 respectively All were treated with DO Maxilla or mandible was advanced from 5 to 35 micrometers; the mean advanced distance is 18 34 mm They were all revaluated by PSG and cephalometric analysis postoperatively Results All patients have good respond to the treatment They have a better appearance and the narrow upper airway was enlarged remarkably, their AHI drop from 66 31±14 74 pre operately to 3 16±1 70 pro operately, and minimal posterior airway space(PAS) from (5 48±2 76)mm to (9 97±2 05)mm There is remarkable difference ( P <0 001) Conclusion DO is a good method for the patients of OSAHS with micrognathia