阻塞性睡眠呼吸暂停综合征患者不同体位下上气道变化的临床观察

目的:对阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)患者不同体位下上气道的变化做了观察比较,初步探讨了仰卧位时上气道软组织及骨组织位置及结构的变化,为OSAS的诊治提供有关依据.方法:对10例经PSG确诊的OSAS患者分别拍摄常规坐位头影测量侧位片及仰卧位头颅侧位片.测量两种体位下腭后气道前后径、软腭下垂角度、最小矢状咽径、下颌平面角及舌骨至咽后壁水平距离等.结果:两种体位比较,仰卧位时最小矢状咽径、悬雍垂顶点至咽后壁的水平距离及软腭中点至咽后壁的水平距离均小于坐位时;软腭下垂角度及下颌平面角大于坐位时;∠SNB小于坐位时;舌骨无明显前移或后退.结论:OSAS患者仰卧位时腭后气道的前后径及最小矢状咽径更趋狭小,软腭向咽后壁方向移位,下颌骨以颞下颌关节为中心呈向下向后方旋转运动,从而使上气道在腭咽气道、舌咽气道及下咽气道多个水平趋于狭小.OSAS患者多在卧位时发病,在OSAS患者术前评估时,仰卧位X线头颅侧位片可以更客观的反映患者上气道解剖情况,为OSAS患者的治疗提供更为可靠的依据.     

不同体位投照法对上气道影响的对比研究

目的：比较两种投照法上气道空间的改变,为阻塞性睡眠呼吸暂停综合征（OSAS）的治疗提供有关依据。方法：青年男性30人,每人分别拍摄常规头影测量侧位片、仰卧位头颅侧位片,比较二中上气道变化情况。结果：仰卧位时下颌骨、舌骨明显向咽后壁方向移位,最小矢状咽径显减小。结论：仰卧位X线头颅侧位片对于OSAS的诊断、术前评估及 术后疗效判定可提供更为可靠的依据。     

矢状骨面型与上气道形态和舌骨位置关系的研究

目的 研究不同矢状骨面型上气道形态和舌骨位置的差异。方法 对182名恒牙早期青少年按ANB角大小分为I类、Ⅱ类和Ⅲ类三种不同矢状骨面型组，三组的年龄、性别相匹配，垂直骨面型以及腺样体情况三组间分布一致。对上气道矢状径和舌骨位置进行X线头影测量分析，并比较三组间的差异。结果三组间鼻咽段和腭咽段矢状径无显著差异；从悬雍垂尖向下，随ANB角的增大咽腔矢状径有减小趋势，Ⅱ类患者的舌咽矢状径显著小于Ⅲ类。舌骨的垂直向位置三组间无显著差异；水平方向上，Ⅲ类、Ⅰ类、Ⅱ类舌骨位置逐渐后移，Ⅱ类和Ⅰ类比Ⅲ类显著后位。结论 以ANB角为代表与面部矢状发育与上气道鼻咽、腭咽和舌骨垂直向位置无明显关系，而对上气道下段的舌咽和舌骨的矢状位置有显著影响，这可能与不同矢状骨面型下颌大小位置发育差异有关。     

UPPP、颏前徙术及舌骨悬吊术对OSAS患者上气道影响的初步分析

目的:本研究通过不同手术方法对上气道影响的初步定量分析，为阻塞性睡眠呼吸暂停综合征(OSAS)患者选择手术方法及术后疗效评估提供有关依据。方法：对10例经手术治疗的OSAS患者做头影测量分析，比较手术前后上气道结构的变化。结果：悬雍垂腭咽成形术(UPPP)术后腭后气道最小矢径平均增加(2.0±0.58)mm，软腭切除长度与腭后气道最小矢径增加程度无相关性；颏前徙术后舌后气道最小矢径平均增加(4.1±2.2)mm，须点前移与舌后气道最小矢径增加值呈显著正相关；舌骨悬吊术后下咽气道矢径平均增加(2.93±1.2)mm，舌骨前移值与下咽气道矢径增加值呈正相关。结论：UPPP术式对扩大腭后气道矢径有意义；颏前徙术及舌骨悬吊术可以扩大舌后气道及下咽气道。骨组织的前移与咽前壁软组织的前移呈正相关。     

正常人上呼吸道软硬组织的X线片测量分析

本研究通过对40名正常人头颅侧位定位片上呼吸道软硬组织的测量分析,初步建立了男女性別上呼吸道上、中、下咽腔大小,软腭长度、厚度,矢状面积,舌的矢状面积,舌骨相对位置的正常值和变异范围;对性別差异的分析表明:男女间在舌的长度、会厌谷与咽后壁的距离,软腭的厚度,会厌谷的垂直位置,舌骨的水平、垂直位置上均存在着差异。     

不同矢状骨面型无鼾症青年上气道形态的锥形束CT分析

目的研究不同矢状骨面型的无鼾症青年错牙合畸形患者上气道形态和舌骨位置的差异。方法在自然头位下,对Ⅰ类、Ⅱ类和Ⅲ类矢状骨面型无鼾症青年错牙合畸形患者各30例进行锥形束CT扫描,借助Dolphin imaging 11.0图像分析软件进行三维重建,并分别测量上气道腭后区、舌后区的矢状径、横径、轴面面积以及上气道容积,最小轴面面积和上气道长度。使用Winceph 7.0软件对侧位片进行头影测量以及舌骨位置的测量,并对测量结果进行统计学分析。结果Ⅰ类、Ⅱ类矢状骨面型组舌后区及腭后区轴面面积均小于Ⅲ类矢状骨面型组。Ⅱ类矢状骨面型组与Ⅲ类矢状骨面型组间的舌后区矢状径,横径,上气道容积,舌骨位置有显著差异性。结论不同矢状骨面型无鼾症青年错牙合畸形患者上气道形态和舌骨位置存在一定的差异,差异有统计学意义。矢状向颌骨关系对上气道形态和舌骨位置有一定影响。     

正颌手术前后舌骨位置和咽下气道变化及相关性研究

目的　通过X线头影测量分析了解颌骨后退与前徙对舌骨位置及咽下气道变化的影响情况,为临床治疗提供参数。方法　下颌前突患者23例与小颌畸形患者9例,分别行双侧矢状劈开后退或前徙下颌,手术前后拍摄X线头颅定位侧位片,进行头影测量,测量项目13项,测量数值配对t检验,并将下颌后退距离与各测量项目变化值作相关分析。结果　各测量项目显著差异的有:(1)下颌前突组,下咽腔矢状面积(PSA),舌骨垂直向变化,舌根后缘至咽后壁距离(TBPW),舌背高点至FH平面距离(DTFH),会厌谷至咽后壁距离(VPW),悬雍垂尖点至后咽壁距离(UPW),下颌颏部水平、垂直向变化(PogPTV,MeFH)。舌骨垂直向变化与下颌颏部垂直向变化显著相关。(2)小颌畸形组,舌骨垂直向变化显著。结论　下颌前突组,(1)舌骨向下移位,舌背上抬,舌根向后移动。(2)咽腔气道空间缩小可表现为永久性,但后气道间隙接近正常人,不会发生通气阻塞,更未出现OSAS。舌骨与下颌前部垂直向变化呈负相关。(3)小颌畸形组,舌骨垂直向显著变化,舌骨因颏舌骨肌牵拉而上移。舌骨水平向无显著移位。除会厌谷前移外,舌体无显著移位,说明颌骨前徙对舌体形态没有大的影响。颌骨前徙对后气道无明显影响。从临床病例来看,小颌畸形愈重,前徙颌骨手术对周围组织结构的影响愈大。     

下颌骨矢状劈开后退术对咽腔间隙及舌骨位置的影响

目的 :CBCT测量分析下颌后退手术治疗下颌前突畸形,对舌骨位置和气道间隙变化的影响。方法 :选取单纯下颌前突畸形患者50例为研究对象,均接受经口内下颌骨升支矢状劈开截骨术,于正颌手术前1周、术后2周、术后6个月拍摄锥形束CT,测量治疗前后咽腔最窄处的矢状径、冠状径、截面积,同时舌骨点的三维位置,分析咽腔间隙大小及及舌骨体位置变化。测量数值配对t检验。结果:所有患者术后咽腔间隙均呈现缩窄趋势。舌骨发生了后下移位,其中术后2周向后、向下平均移动距离分别为2.64、1.56 mm,术后6月向后、向下移位分别为0.97、0.99 mm。术后2周咽腔的矢状径、冠状径及咽腔间隙分别为11.71 mm、3.05 mm、320.67 mm~2,术后6月时分别为14.64 mm、3.23 mm、414.85 mm~2。即随时间推移,舌骨位置及咽腔间隙有恢复正常范围的趋势。结论:双侧下颌骨升支矢状劈开截骨后退术后,舌骨向后下移位,咽腔气道缩小,有可能导致睡眠呼吸暂停综合征的发生,临床需予以重视。     

济南地区儿童上气道及舌骨位置正常参考值的研究

目的建立济南市11～13岁儿童上气道大小及舌骨位置的正常参考值范围。方法选择无阻塞性睡眠呼吸暂停综合征临床症状的儿童208名,男性71名,女性137名,年龄11～13岁,拍摄X线数字头颅侧位片,测量其骨面型、上气道形态及舌骨位置,使用SPSS 13.0软件对测量值进行统计学分析,建立上气道及舌骨正常参考值范围。结果恒牙列初期儿童上气道大小和舌骨位置存在性别差异,女性上气道SPP-SPPW平面的矢状径比男性大（P〈0.05）;女性软腭中后气道间隙较男性大;男性比女性的舌骨位置低且靠前。结论建立了济南市恒牙初期儿童上气道及舌骨位置的正常参考值范围。     

恒牙早期青少年上气道宽度及舌骨位置的X线头影测量研究

目的：研究恒牙早期青少年不同矢状骨面型上气道宽度及舌骨位置,从而探讨阻塞性睡眠呼吸暂停综合症发病与矢状骨面型的关系。方法：对110名青少年分成3组,分别为Ⅰ、Ⅱ、Ⅲ类骨面型,无鼾症,无腺样体,扁桃体肥大等咽部疾患,进行X线头影测量分析,研究不同矢状骨面型的气道宽度,舌骨位置。结果：通过ANB角进行分组,得出3种矢状骨面型青少年的气道宽度值,舌骨位置值和变异范围,并比较3组间的差异。结论：3组矢状骨面型间腭咽宽度无显著性差异,但舌咽宽度Ⅱ、Ⅰ、Ⅲ类有渐增大趋势,并且Ⅱ类与Ⅲ类比较舌咽宽度有显著性差异,舌骨垂直向位置无明显关系,而矢状位置有显著差异。     

Changes in posterior airway space and hyoid bone position after surgical mandibular advancement

Objective: To evaluate cephalometric changes in posterior airway space (PAS) and in hyoid bone distance to mandibular plane (MP) 1–3 years after bilateral sagittal split osteotomy (BSSO).

Material and methods: The sample consisted of 36 females and 16 males who underwent mandibular advancement by BSSO. To observe sagittal changes in PAS and in hyoid bone distance to MP both pre- and postoperative cephalograms were analyzed using WinCeph^® 8.0 software. For the statistical analyses paired T-test and multivariate logistic regression models were used.

Results: By the surgical-orthognathic treatment the sagittal dimension of PAS showed variable changes but it mainly diminished when the mandibular advancement exceeded 6?mm. In most cases the hyoid bone moved superiorly by BSSO. Logistic regression models showed that males, patients with narrow PAS at the baseline, and those with counterclockwise rotation of the mandible by the treatment gained more increase in PAS. However, an increase in sagittal PAS dimension tended to relapse over time. Concerning the movement of the hyoid it was found that the more PAS increased the less hyoid moved superiorly. In males the change in hyoid position was more obvious than in females.

Conclusion: Males, patients with narrow PAS at the baseline, and those whose mandible moved in the counterclockwise direction with moderate advancement gained more retrolingual airway patency by BSSO.     

不同体位下无鼾者与OSAHS患者的头影测量比较

目的:借助X线头影测量分析,探讨3种不同体位下,无鼾者和阻塞性睡眠呼吸暂停低通气综合征(Obstructivesleepapneahypopneasyndrome,OSAHS)患者的颅面结构及气道周围软硬组织的关系。方法:10例无鼾者和10例OSAHS患者在3种不同体位下,分别拍摄常规坐位头影测量侧位片及仰卧位、放松位头颅侧位片,并进行头颅测量分析。结果:同一体位下,与无鼾者相比,OSAHS患者的ANB角、软腭厚度及舌骨前上点至下颌平面垂直距离增加,口咽距(U-Pu)减小;仰卧位和放松位时,无鼾者的SNB角、MP-SN角均比坐位时减小,SPT增加;H-C3距、PAS距减小;OSAHS患者H-C3距比坐位时也减小。结论:3种不同体位下,无鼾者与OSAHS患者在颅面结构及气道周围软硬组织结构关系方面的差异具有显著性。     

Relations between mandible-only advancement surgery,the extent of the posterior airway space,and the position of the hyoid bone in Class II patients: a three-dimensional analysis

The objective of the present study was to evaluate the relation between mandibular advancement, the three-dimensional extent of the posterior airway space (PAS), and the position of the hyoid bone, using cone-beam computed tomography (CT). Twenty-eight Class II patients (21 women (mean (SD) age 29 (9) years) and seven men (mean (SD) age 23 (6) years)), who had had mandibular-only advancement surgery (Obwegeser-Dal Pont) were included in the study. In each case, cone-beam CT scans were taken one week before and six months after operation, and a retrospective analysis made of the alterations of several airway variables (volume, mean cross-sectional area, and diameter) and the three-dimensional extent of mandibular and hyoid movement, by using IPlan® cranial software. A linear regression was also done to correlate mandibular advancement, the movement of the hyoid bone, and airway variables. There were significant postoperative increases in all volumetric PAS variables, and in most diametric and spherical variables (p < 0.05). There was also a significant linear relation between forward displacement of the mandible and the movement of the hyoid bone (p < 0.05). These results show that mandible-only advancement surgery causes an increase in most dimensions of the PAS. This intervention can be assumed to reduce airway resistance and therefore might be a suitable treatment option for patients with obstructive sleep apnoea syndrome.     

无鼾者不同体位下戴下颌前伸矫治器前后的头影测量分析

目的：研究无鼾者在三种不同体位下戴下颌前伸矫治器前后，对气道周围软硬组织结构关系的影响在头影测量片上的表现。方法：10名无鼾者在坐位、仰卧位及放松位状态下，戴下颌前伸矫治器前后分别拍摄头颅定位侧位片并进行多导睡眠仪监测。结果：经多导睡眠仪监测，10名志愿者均无明显异常；同一体位下戴入矫治器后，下颌平面角、舌骨水平距离及口咽距离增加，软腭厚度减小；同坐位相比，在仰卧位和放松位时，SNB角增加，舌骨垂直距离与水平距离减少；U—PU距离增加，变化显著者在放松位。结论：下颌前伸矫治器在不同体位下，均可改变口咽通气道。     

颌骨后退术后舌骨位置和后气道间隙变化的相关性研究

目的　通过X线头影测量分析下颌后退手术对舌骨位置和后气道间隙 (PAS)变化的影响 ,为临床治疗提供依据。方法　下颌前突畸形患者 18例 ,均接受经口内下颌骨升支垂直截骨术 ,术前和术后 1个月拍摄标准颅颌侧位片进行头影测量 ,测量项目 6项 ,测量数值配对t检验 ,并将下颌骨后退距离与各测量项目变化作相关分析。结果　术后下颌骨后退的平均值是 (10 .2 0± 1.31)mm。各测量项目显著差异的有 :舌骨垂直方向变化 ,舌根后缘至咽后壁的距离 ,后气道间隙面积。下颌骨后退距离与PAS面积的减小值和舌骨垂直方向变化密切相关 ,与PAS宽度减小值和舌骨水平方向变化没有密切相关。结论　双侧下颌升支垂直截骨后退术后近期 ,舌骨向下移位 ,舌根后移 ,咽腔气道缩小 ,如果患者同时具有超重、短颈、舌体大等其他危险因素 ,下颌骨后退手术可能导致睡眠呼吸暂停综合征的发生。下颌骨后退距离与后气道间隙面积的减小值和舌骨垂直方向变化呈正相关。     

Long-term changes of hyoid bone and pharyngeal airway size following advancement of the mandible

OBJECTIVE: To determine long-term changes in hyoid bone position and pharyngeal airway size after mandibular advancement, including evaluation of the relationship between length of suprahyoidal musculature and skeletal relapse. STUDY DESIGN: A cephalometric follow-up study (12 years) of 15 patients who underwent mandibular advancement surgery. RESULTS: The final position of the hyoid bone was more posterior than it had been preoperatively. Suprahyoidal musculature continuously lengthened from preoperatively to 12 years postoperatively. Total skeletal relapse at B-point and pogonion correlated significantly with postoperative stretch of suprahyoidal musculature. The upper and middle pharyngeal airways were narrower than their preoperative values. CONCLUSIONS: Mandibular changes influence hyoid bone position during the entire postoperative period, whereas stretching of suprahyoidal musculature seems to contribute to skeletal relapse. Mandibular advancement surgery alone possibly does not achieve a stable increase of pharyngeal airway size over a long-term period of 12 years.     

Relationship of the hyoid bone and posterior surface of the tongue in prognathism and micrognathia

In order to study relationship of the hyoid bone and posterior surface of the tongue in prognathism and micrognathia, we focused on the effect of the tongue on the upper airway lumen in 16 patients with Angle's Class II and 51 patients with Angle's Class III, and assessed the position of the hyoid, the depth from the posterior surface of the tongue, from the bottom of the vallecula and from hyoid bone to the posterior pharyngeal wall using lateral cephalograms. We were able to assess significant correlations between the posterior surface of the tongue and hyoid position in Angle's Class III. However, we found no association between them in Angle's Class II. This could be an adaptive feature of the genioglossus in response to hyoid localization to serve a compensatory role to prevent respiratory impairment in micrognathia at risk of apnoea.