下颌骨牵引成骨术矫治小颌畸形伴阻塞性睡眠呼吸暂停综合征患者改善呼吸功能的作用

背景严重小下颌畸形伴阻塞性睡眠呼吸暂停综合征(obstructivesleep apnea syndrome,OSAS)常常危及患者生命,并影响患者的呼吸功能.常规手术治疗风险较大,同时不适用于发育中的患者不能获得满意的效果.目的探讨和评价下颌骨牵引成骨技术在治疗小下颌畸形伴OSAS中的应用价值及对呼吸功能的改善作用.设计前后对照研究.单位中国医学科学院中国协和医科大学整形外科医院,澳大利亚墨尔本皇家儿童医院颅面外科.对象2001-10/2004-07在中国医学科学院中国协和医科大学整形外科医院和澳大利亚墨尔本皇家儿童医院颅面外科就治的小下颌畸形伴OSAS患者8例,男5例,女3例,年龄4个月～17岁.方法8例患者均行牵引成骨技术牵引双侧下颌骨治疗,经口内或口外途径共安放16个牵引器,牵引速度1～1.5mm/d,固定4～12周,随访2～18个月.每例患者术前术后均行X射线头影测量或睡眠多导图仪检查.主要观察指标8例患者术后的牵引延长距离、后气道间隙大小、呼吸功能改善情况.结果8例16侧下颌骨牵引成骨,所有病例截骨、牵引过程顺利,牵引区成骨良好.最大牵引延长距离为25mm,最小15 mm,平均19.12 mm.后气道间隙由平均4.5mm增至11mm.1例需要进行继续治疗,7例均恢复正常呼吸,去除鼻咽导气管和气管切开导管.随访2～18个月,效果稳定无复发.结论下颌骨牵引成骨术是治疗OSAS重要的有效治疗手段,能够有效地矫正口咽腔气道狭窄,改善呼吸功能,可在发育中患者及年幼儿童应用.随着应用例数的增多会更详尽阐明其所发挥的作用.

Mandibular distraction osteogenesis for improving respiratory function in patients with micrognathia complicated by obstructive sleep apnea syndrome

BACKGROUND: Obstructive sleep apnea syndrome(OSAS) in patients with serious micrognathia affects the respiratory function and can be life-threatening. Conventional surgical therapies are often highly risky and unsuitable in patients with the craniomaxillofacial skeleton still in development.OBJECTIVE: To assess the value of mandibular distraction osteogenesis in treatment of OSAS in patients with congenital micrognathia and the effect of the surgery on the patients' respiratory functions.DESIGN: A self-controlled study.SETTING: Plastic Surgery Hospital of Peking Union Medical College and Plastic and Maxillofacial Surgery Unit of Royal Children's Hospital of Melbourne, Australia.PARTICIPANTS: Eight consecutive patients with congenital micrognathia who developed OSAS were hospitalized from October 2001 to July 2004 at the Center of Craniomaxillofacial Surgery, Plastic Surgery Hospital of Peking Union Medical College and Plastic and Maxillofacial Surgery Unit of Royal Children's Hospital of Melbourne, Australia. This group included 5 male and 3 female patients aged 4 months to 17 years.METHODS: The 8 patients underwent mandibular distraction osteogenesis,and altogether 16 distractors were placed through extraoral or intraoral incisions for bilateral distraction. The distraction device proceeded at the rate of 1 to 1.5 mm per day and consolidated for 4 to 12 weeks. The follow-up lasted for 2 to 18 months. Each patient was evaluated pre-and postoperatively with cephalometry or polysomnography (PSG).MAIN OUTCOME MEASURES: The distraction distance, posterior airway space, and improvement of the respiratory function of the patients were recorded.RESULTS: Osteotomy and distraction procedures were smooth in all the patients who had good ontogenesis. The average distraction distance was 19.12 mm(ranging from 15 to 25 mm) . The posterior airway space was increased from a mean of 4.5 mm preoperatively to 11 mm after the surgery. Seven patients had normal respiration and sleep after removal of the nasopharyngeal intubation or tracheal decannulation. One patient required a second-stage distraction with a horizontal vector. The therapeutic effect was stable without relapse in the follow-up.CONCLUSION: Mandibular distraction osteogenesis is an important and effective means for treating OSAS. It effectively corrects airway stricture and improve the patients' respiratory function, allowing mandibular development in young patients. When more cases are studied, the role of distraction osteogenesis can be better defined.