两种治疗OSAHS矫治器疗效及其对颞下颌关节形态影响的观察  

Observation of the efficacy of two appliances for the treatment of OSAHS and their effects on the morphology of the temporomandibular joint

作　　者：杨乐 周玮 张佐[3] 高莹卉 刘霖[5] 路健 马婷 王少 Yang Le;Zhou Wei;Zhang Zuo;Gao Yinghui;Liu Lin;Lu Jian;Ma Ting;Wang Shao(School of Stomatology,Ningria Medical University,Yinchuan 750003,China;Department of Respiratory Medicine,People's Hospital of Ningria Hui Autonomous Region,Yinchuan 750002,China;Department of Stomatology,People's Hospital of Ningria Hui Autonomous Region,Yinchuan 750002,China;Peking University International Hospital Sleep Center,Beijing 102206,China;Department of Respiratory and Critical Care Medicine,Second Medical Center,General Hospital of the People's Liberation Army,Beijing 100853,China;Nanliangtaitizi Health Hospital,Yinchuan City,Helan County,Yinchuan 750200,Chin)

机构地区：[1]宁夏医科大学口腔医学院,银川750003 [2]宁夏回族自治区人民医院呼吸科,银川750002 [3]宁夏回族自治区人民医院口腔科,银川750002 [4]北京大学国际医院睡眠中心,北京102206 [5]解放军总医院第二医学中心呼吸与危重症医学科,北京100853 [6]宁夏银川市贺兰县南梁台子卫生院,银川750200

出　　处：《中华口腔正畸学杂志》2024年第3期121-125,共5页Chinese Journal of Orthodontics

基　　金：宁夏重点研发基金项目(2022BEG02031)。

摘　　要：目的观察锁结式口腔矫治器、[牙合]架定位式口腔矫治器治疗轻、中度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)主、客观疗效及其对颞下颌关节(temporomandibular joint,TMJ)形态的影响。方法本研究为病例对照研究,选取30例成年OSAHS患者,随机分为A.B两组。A组15例患者戴用锁结式口腔矫治器,男性9例,女性6例;B组15例患者戴用[牙合]架定位式口腔矫治器,男性10例,女性5例。在治疗前和治疗6个月时,进行睡眠呼吸监测仪监测,拍摄TMJ锥形束CT进行测量分析,填写Epworth嗜睡评分量表(epworth sleepiness scale,ESS)。结果A组治疗前呼吸暂停低通气指数(apnea hypopnea index,AHI)为(18.10±5.73)次/时,治疗后为(4.47±1.33)次/时(P<0.001);B组治疗前AHI为(18.33±6.02)次/时,治疗后为(4.77±1.18)次/时(P<0.001);A组治疗前ESS为(10.67±2.64)分,治疗后为(4.73±2.34)分(P<0.001);B组治疗前ESS为(10.93±2.71)分,治疗后为(4.87±2.30)分(P<0.001);A组治疗前关节前间隙为(2.55±0.17)mm,治疗后为(2.42±0.18)mm(P=0.041);B组治疗前关节前间隙(2.57±0.14)mm,治疗后为(2.39±0.15)mm(P=0.006);A组治疗前关节后间隙为(2.42±0.11)mm,治疗后为(2.56±0.22)mm(P=0.044);B组治疗前关节后间隙为(2.43±0.11)mm,治疗后为(2.61±0.19)mm(P=0.006);A组治疗前关节上间隙为(2.94±0.17)mm,治疗后为(3.07±0.18)mm(P=0.012);B组治疗前关节上间隙为(2.93±0.14)mm,治疗后为(3.06±0.19)mm(P=0.017)。两组间比较结果显示睡眠监测值、TMJ形态指标、ESS分值差异无统计学意义。结论两种口腔矫治器对OSAHS患者均有较好的主、客观疗效;戴入两种口腔矫治器后髁突发生前下移位,但未发现髁突及关节窝形态发生明显变化。Objective Observation of the subjective and objective efficacy of the locking knot oral appliance and articulator positioning oral appliance in the treatment of mild and moderate Obstructive Sleep Apnea Hypopnea Syndrome(OSAHS)and its effect on the morphology of the temporomandibular joint(TMJ).Methods The present study was a case-control study,and 30 study subjects were selected and randomly divided into two groups,A and B.Fifteen patients in group A wore locking knot oral appliance,9 males and 6 females,and 15 patients in group B wore articulator positioning oral appliance,10 males and 5 females.Before treatment and at 6 months of treatment,a sleep apnea monitor was performed,a cone beam CT of the TMJ was taken for measurement and analysis,and the Epworth Sleepiness Scale(ESS)was filled out.Results Apnea Hypopnea Index(AHI)was(18.10±5.73)before treatment and(4.47±1.33)after treatment in group A(P<0.001).AHI in group B was(18.33±6.02)before treatment and(4.77±1.18)after treatment(P<0.001).ESS of group A was(10.67±2.64)points before treatment and(4.73±2.34)points after treatment(P=0.00).ESS of group B was(10.93±2.71)points before treatment and(4.87±2.30)points after treatment(P<0.001).Group A's pre-treatment anterior joint space was(2.55±0.17)mm and after treatment it was(2.42±0.18)mm(P=0.041).Group B's pre-treatment anterior joint space was(2.57±0.14)mm and after treatment it was(2.39±0.15)mm(P=0.006).Group A's pre-treatment posterior joint space was(2.42±0.11)mm and after treatment it was(2.56±0.22)mm(P=0.044).Group B's post joint gap was(2.43±0.11)mm before treatment and(2.61±0.19)mm after treatment(P=0.006).Group A's supra-articular gap was(2.94±0.17)mm before treatment and(3.07±0.18)mm after treatment(P=0.012).Group A's supra-articular gap was(2.93±0.14)mm before treatment and(3.06±0.19)mm after treatment(P=0.017).Comparison of the results between the two groups showed that the p-values of sleep monitoring values,TMJ morphology indexes,and ESS scores were not statistically significant.Con

关 键 词：口腔矫治器 阻塞性睡眠呼吸暂停低通气综合征 临床疗效 颞下颌关节形态 

分 类 号：R783.5[医药卫生—口腔医学]