3D打印个体化颏舌肌前移术治疗小下颌阻塞性睡眠呼吸暂停的初步疗效  

Preliminary efficacy of individualized genioglossus advancement with 3D printing in the treatment of obstructive sleep apnea with micrognathia

作　　者：陈仁辉[1] 梁发雅[1] 韩萍[1] 林沛亮 林惜君 王静怡[1] 陈伟琪 黄晓明[1] Chen Renhui;Liang Faya;Han Ping;Lin Peiliang;Lin Xijun;Wang Jingyi;Chen Weiqi;Huang Xiaoming(Department of Otolaryngology,Head and Neck Surgery,Sun Yat-sen Memorial Hospital,Sun Yat-sen Univeristy,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation,Guangzhou510280,China)

机构地区：[1]中山大学孙逸仙纪念医院耳鼻咽喉头颈外科,广东省恶性肿瘤表观遗传与基因调控重点实验室,广州510280

出　　处：《中华耳鼻咽喉头颈外科杂志》2024年第11期1193-1198,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨3D打印个体化颏舌肌前移术(genioglossus advancement, GA)治疗合并小下颌的成人阻塞性呼吸暂停(obstructive sleep apnea, OSA)的初步疗效。方法该研究为前瞻性队列研究, 收集2021年8月至2024年7月在中山大学孙逸仙纪念医院耳鼻咽喉头颈外科行3D打印个体化GA的小下颌成人OSA患者病例资料。比较手术前后多导睡眠监测和头影测量颏前移指标的改变, 并记录患者主观症状和外观评价, 以及手术并发症。手术前后数据的比较采用配对设计t检验。结果共19例合并下颌后缩的成人OSA患者顺利完成悬雍垂腭咽成形术(uvulopalatopharyngoplasty, UPPP)联合GA手术, 男16例, 女3例, 年龄(35.9±6.7)岁, 体质量指数(23.8±3.1)kg/m2。19例患者实际颏前移距离(9.0±1.4)mm与术前计划(9.4±1.0)mm一致(t=0.81, P=0.427);其中14例患者术后6个月呼吸暂停低通气指数(apnea hypopnea index, AHI)平均下降60.4%, 治愈5例(5/14), 显效5例(5/14), 手术应答率10/14。所有患者均满意术后面容改变, 13例患者认为更有吸引力;术后暂时性颏麻木2例, 下颌咬合无力1例。结论 3D打印个体化GA联合UPPP可有效降低合并小下颌的成人OSA患者AHI, 手术并发症少, 患者术后面容满意度高。Objective To investigate the preliminary efficacy of 3D printed individualized genioglossus advancement(GA)for the treatment of obstructive sleep apnea(OSA)in adults with micrognathia.Methods The OSA patients with retropalatal and retroglossal collapses due to micrognathia underwent 3D printed individualized GA combined with Uvulopalatopharyngoplasty(UPPP)in Department of Otolaryngology,Head and Neck Surgery,Sun Yat-sen Memorial Hospital,Sun Yat-sen University.Clinical data including pre-and post-operative polysomnography(PSG),cephalometric measurements of genioglossus advancement,patient-reported symptom and surgical complications were collected.A comparison of pre-and post-operative data was conducted using paired t-tests.Results Nineteen OSA patients with micrognathia successfully underwent 3D printed individualized GA combined with UPPP,and achieved an actual mean genioglossus advancement distance of(9.0±1.4)mm compared to the planned distance of(9.4±1.0)mm preoperatively(t=0.81,P=0.427).Among the 14 patients followed up for more than 6 months,the mean AHI reduced by 60.4%at 6 months postoperatively,with 5 cases(5/14)cured and 5 cases(5/14)showing significant improvement,resulting in an overall surgical response rate of 10/14.All patients expressed satisfaction with their postoperative facial appearance,with 13 cases perceiving an improvement in attractiveness.Two patients reported temporary genial numbness,and one patient experienced temporary mandibular occlusal asthenia.ConclusionThe 3D printed individualized GA combined with UPPP effectively reduces AHI in adult OSA patients with micrognathia,accompanied by a low incidence of surgical complications and high patient satisfaction regarding postoperative facial appearance.

关 键 词：阻塞性睡眠呼吸暂停 手术治疗 颏舌肌前移术 下颌后缩 虚拟手术计划 3D打印 疗效 

分 类 号：R766.9[医药卫生—耳鼻咽喉科]