中面部牵引成骨术治疗骨性气道狭窄  

Experience of midfacial distraction osteogenesis in upper airway stenosis

作　　者：徐海淞[1] 穆雄铮[1] 俞哲元[1] 冯胜之[1] 韩嘉毅[1] 张涤生[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院整复外科,200011

出　　处：《中华外科杂志》2008年第8期577-580,共4页Chinese Journal of Surgery

摘　　要：目的研究中面部Le Fort Ⅲ型截骨牵引成骨术对严重中面部发育不良所致骨性上气道狭窄的治疗效果。方法2000年8月至2007年2月共11例5～16岁严重中面部发育不良伴突眼、反颌及骨性上气道狭窄的患儿接受Le For Ⅲ型颅面部截骨和牵引成骨术治疗。术前术后应用上气道三维CT重建分析体积变化，多导睡眠监测评估气道功能变化，进而评估中面部牵引成骨术对中面部严重发育不良所致骨性上气道狭窄的治疗效果。结果所有患者术后气道梗阻情况均获有效缓解，面部外形明显改善。术后上气道平均体积较术前增加约64.3％，平均增加达（9.13±6．94）ml，术前术后差异有统计学意义（P〈0．05）。多导睡眠监测平均血氧饱和度、最低血氧水平、鼾声指数等多项结果均较术前有明显改善。结论中面部牵引成骨术能有效治疗中面部严重发育不良所致的骨性上气道狭窄。Objective To investigate the therapeutic effects of upper airway stenosis after Le Fort m osteotomy and midfacial distraction osteogenesis （DO）. Methods Eleven cases （age, 5-16 yrs ） with severe midface dysostosis complicated with exophthalmos, anterior crossbite and upper airway stenosis were treated by using Le Fort Ⅲ osteotomy and midfacial DO from August 2000 to February 2007. The 3D reconstruction of the upper-airway from CT data was used to evaluate the upper airway volume before and after the operation. And meanwhile polysomnography was carried out to demonstrate the upper airway functional changes. Results There was a64.3% mean increase [mean, （9. 13 ±6.94） ml, P〈0.05]in upper airway volume in the 11 cases after the operations. It showed that there was significant improvements in the indexs of polysomnography after the operations, such as apnea and hypopnea index, average SaO2, minimum oxygen saturation and snore index. Conclusions The Le Fort m osteotomy and midfacial distraction osteogenesis can efficiently relieve the symptoms of upper-airway stenosis in severe midfacial dysostosis.

关 键 词：颌面畸形 睡眠呼吸暂停 阻塞性 上气道狭窄 中面部牵引成骨 

分 类 号：R686[医药卫生—骨科学]