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阻塞性睡眠呼吸暂停低通气综合征的正颌外科及牵引成骨治疗
作者姓名:Zhou L  Wang X  Liang C  Yi B  Li ZL
作者单位:1. Department of Stomatology, PUMC Hospital, CAMS and PUMC, Beijing
2. 北京大学口腔医学院,北京,100081
摘    要:目的探讨小下颌畸形伴阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的正颌外科及颌骨牵引成骨手术的适应证及治疗原则.方法回顾性分析17例小下颌畸形伴中至重度OSAHS患者的临床资料,其中4例行正颌外科治疗,5例行颌骨牵引成骨治疗,8例行正颌外科及颌骨牵引成骨联合治疗.结果所有患者的SNB角平均值由术前的64.6°增加至术后的71.9°,平均后气道间隙(PAS)由术前的5.4 mm增加至术后的13.2 mm,平均睡眠呼吸暂停低通气指数(AHI)由术前的58.4下降至术后的7.6,最低血氧饱和度(LSAT)平均值由术前的66%增加至术后的87%,各项指标术前与术后相比差异均具有显著性(P<0.001);平均颏部水平前移(MHA)14.3 mm,与术前及术后的SNB、PAS、AHI和LSAT差值的相关系数分别为0.36、0.62、0.34和-0.14.结论正颌外科及颌骨牵引成骨手术均能有效治疗小下颌畸形伴OSAHS患者,两者适应证略有不同,联合应用疗效更好.

关 键 词:阻塞性睡眠呼吸暂停低通气综合征  小下颌畸形  正颌外科  牵引成骨
文章编号:1000-503X(2005)03-0357-06

Orthognathic surgery and distraction osteogenesis for treatment of obstructive sleep apnea hypopnea syndrome
Zhou L,Wang X,Liang C,Yi B,Li ZL.Orthognathic surgery and distraction osteogenesis for treatment of obstructive sleep apnea hypopnea syndrome[J].Acta Academiae Medicinae Sinicae,2005,27(3):357-362,F003,i004.
Authors:Zhou Lian  Wang Xing  Liang Cheng  Yi Biao  Li Zi-li
Institution:Department of Oral and Maxillofacial Surgery, Peking University School of Stomatology, Beijing 100081, China.
Abstract:OBJECTIVE: To discuss the indication and protocol of surgical therapy when treating mandibular micrognathism accompanying obstructive sleep apnea-hypopnea syndrome (OSAHS) using distraction osteogenesis and orthognathic surgery. METHODS: A total of 17 patients with mandibular micrognathism accompanying moderate to severe OSAHS, aged 11 to 59 years, 15 men and 2 women, were reviewed. Four of them were treated with orthognathic surgery, 5 of them were treated with distraction osteogenesis, and the other 8 patients were treated with an integrated procedure combining distraction osteogenesis with orthognathic surgery. Cephalometric analysis and polysomnography studies were obtained pre- and postoperatively. RESULTS: SNB angle changed from 64.6 degrees to 71.9 degrees, post airway space (PAS) from 5.4mm to 13.2 mm, apnea and hypopnea index (AHI) from 58.4 to 7.6, lowest saturation of oxygen (LSAT) from 66% to 87%. All the differences showed statistical significance (P < 0.001). The average mental horizontal advancement (MHA) was 14.3 mm and its correlation coefficients with deltaSNB, deltaPAS, deltaAHI, and deltaLSAT were 0.36, 0.62, 0.34, and -0.14, respectively. CONCLUSIONS: Both distraction osteogenesis and orthognathic surgery can be effectively used to treat patients with mandibular micrognathism accompanying OSAHS with slightly different indications. A combination of these two operations may be preferred.
Keywords:obstructive sleep apnea-hypopnea-syndrome  micrognathism  orthognathic surgery  distraction osteogenesis
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