重度OSAHS上气道骨框架重构-双颌逆时针大幅度前旋治疗  

Craniomaxillofacial bone frame reconstruction-bimaxillary substantial advancement and anticlockwise rotation for patients with severe obstructive sleep apnea-hypopnea syndrome

作　　者：卢晓峰[1] 王猛[1] 于雯雯[1] 陆立彦[1] 据梧桐 何建德[1] 孙红霞[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院·口腔医学院口腔颅颌面科,上海市口腔医学重点实验室,上海200011

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

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 goo

关 键 词：重度阻塞性睡眠呼吸暂停低通气综合征 双颌逆时针大幅度前旋术 定量腭垂软腭切除腭咽成形术 

分 类 号：R766[医药卫生—耳鼻咽喉科]