牵张成骨术与双颌前徙术治疗阻塞性睡眠呼吸暂停低通气综合征的临床回顾性对照研究  

A retrospective controlled study on the treatment effect of distraction osteogenesis and maxillomandibular advancement for severe obstructive sleep apnea hypopnea syndrome patients

作　　者：张于凡 张哲儒 谭志军 于擘[1] 戴太强[1] 刘富伟 孔亮[3] 田磊[1] 蔡卜磊[1] Zhang Yufan;Zhang Zheru;Tan Zhjun;Yu Bo;Dai Taiqiang;Liu Fuwei;Kong Liang;Tian Lei;Cai Bole(Department of Maxillofacial Trauma and Orthognathic Surgery,School of Stomatology,The Fourth Military Medical University&State Key Laboratory of Military Stomatology&National Clinical Research Center for Oral Diseases&Shaanxi Clinical Research Center for Oral Diseases,Xi′an 710032,China;Zhijun Tan Department of Health Statistics,Military Preventive Medical College,Forth Military Medical University,Xi′an 710032,China;Department of Craniofacial Plastic and Aesthetic Surgery,School of Stomatology,Forth Military Medical University&State Key Laboratory of Military Stomatology&National Clinical Research Center for Oral Diseases&Shaanxi Clinical Research Center for Oral Diseases,Xi′an 710032,China)

机构地区：[1]第四军医大学口腔医学院颅颌面创伤正颌外科,军事口腔医学国家重点实验室口腔疾病国家临床医学研究中心,陕西省口腔疾病临床医学研究中心,西安710032 [2]第四军医大学军事预防医学系卫生统计学教研室,西安710032 [3]第四军医大学口腔医学院颅颌面整形与美容外科,军事口腔医学国家重点实验室口腔疾病国家临床医学研究中心,陕西省口腔疾病临床医学研究中心,西安710032

出　　处：《中华口腔医学杂志》2022年第9期907-913,共7页Chinese Journal of Stomatology

摘　　要：目的比较牵张成骨术(distraction osteogenesis,DO)和双颌前徙术(maxillomandibular advancement,MMA)治疗重度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者的疗效,为不同程度OSAHS患者的治疗方式选择提供参考。方法收集2017年6月至2019年6月于第四军医大学口腔医学院颅颌面创伤正颌外科接受DO和MMA治疗的37例OSAHS患者资料,分析37例患者术前术后的头颅侧位片X线头影测量数值、多导睡眠测量指标和睡眠质量评估指数。经过倾向评分匹配后比较两种治疗方法对患者面型的改变以及对睡眠呼吸指标的改善。结果MMA组中仅呼吸暂停低通气指数(apnea hypopnea index,AHI)与手术成功率和(或)治愈率相关,随着患者AHI值的增高,MMA对OSAHS患者的治疗效果逐步下降,统计计算出预测MMA手术成功和失败的AHI截点数值为78.2 n/h。匹配DO组与MMA组OSAHS患者后,MMA组均为重度OSAHS患者,对比头颅侧位X线片显示,DO组患者的下颌前移量[(24.00±4.39)mm]显著大于MMA组[(11.20±1.37)mm](t=-6.11,P<0.001);多导睡眠监测显示,DO组对OSAHS患者最长呼吸暂停时间和最长低通气时间的改善量均显著大于MMA组(t=4.39,P=0.003;t=5.49,P=0.004);治疗后DO组的匹兹堡睡眠质量指数评分[(4.20±0.83)分]显著低于MMA组[(8.80±2.39)分](t=4.07,P=0.001);治疗后DO组的Epworth嗜睡量表评分[(3.40±1.52)分]显著低于MMA组[(9.40±2.88)分](t=4.12,P=0.002)。结论在重度OSAHS患者的治疗中,DO对重度OSAHS患者的客观指标和主观指标的改善均有更好的效果。Objective To compare the treatment effect of distraction osteogenesis(DO)and maxillomandibular advancement(MMA)for severe obstructive sleep apnea hypopnea syndrome(OSAHS)patients and to guide clinical decisions about treatment of OSAHS.Methods Thirty-seven OSAHS patients which accepted maxillomandibular advancement(MMA)or distraction osteogenesis(DO)in Stomatological Hospital of the Department of Maxillofacial Trauma and Orthognathic Surgery,School of Stomatology,The Forth Military Medical University from June 2017 to June 2019 were collected.Their preoperative and postoperative data of cephalometry,polysomnography(PSG),Pittsburgh sleep quality index(PSQI)and Epworth sleepiness scale(ESS)scores were collected and analyzed.With propensity score matching method,the treatment effect of MMA and DO was analyzed and compared.Results According to the statistics of MMA group,only AHI was correlated with operative successful rate and cure rate.With the increase of AHI,the treatment effect of MMA on OSAHS patients gradually decreased.The cut-off point of AHI as a predictor of MMA treatment failure was 78.2 n/h.All the matched cases were severe OSAHS patients.Statistical analysis showed that the mandibular elongation of DO patients[(24.00±4.39)mm]was significantly more than that of MMA group[(11.20±1.37)mm](t=-6.11,P<0.001),the improvement of PSG index[including lowest oxygen saturation(LSpO2),longest apnea(LA)and longest hypopnea(LH)]in DO group[LSpO2=(93.40±1.82)%;LA=(18.28±8.32)s;LH=(61.84±32.94)s]was significantly higher than that in the MMA group[LSpO2=(86.00±4.06)%,LA=(64.08±21.78)s,LH=(172.40±30.70)s](t=-3.72,P=0.005;t=4.39,P=0.003;t=5.49,P=0.004).The PSQI and the ESS scores of DO group(PSQI=4.20±0.83;ESS=3.40±1.52)were also significantly better than that of MMA group(PSQI=8.80±2.39,ESS=9.40±2.88)(t=4.07,P=0.001;t=4.12,P=0.002).Conclusions For severe OSAHS patients,the objective and subjective indicators of DO treatment group showed a better therapeutic effect than that of MMA.

关 键 词：睡眠呼吸暂停 阻塞性 正颌外科学 牵张成骨术 双颌前徙术 

分 类 号：R766[医药卫生—耳鼻咽喉科]