改良Twin-block功能矫治器治疗儿童阻塞性睡眠呼吸暂停低通气综合征临床研究

目的探讨改良Twin-block功能矫治器（Twin—block functional appliance，TBA）治疗儿童阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome，OSAHS）患者的临床疗效。方法改良TBA治疗25例伴有下颁骨发育不足的儿童OSAHS患者，对比分析患儿治疗前后多导睡眠监测结果及颅颌面部的硬软组织变化，并通过锥形束CT三维重建分析上气道的改变。结果改良TBA治疗后，患者SNB角、Z角及软组织面角增加，ANB角及H角减小（P〈0．05）；患者口咽气道总体积、气道最小截面积、最小截面矢状径、最小截面横径及最小截面矢状径／横径均较治疗前增加（P〈0．05）；患者睡眠监测结果显示治疗后血氧饱和度增加（t=-16．055，P〈0．05），睡眠呼吸暂停低通气指数降低（t=20．358，P〈0．01）。结论改良TBA不仅有利于患者后期错猞畸形的矫治，还从病因上对儿童OSAHS进行早期阻断性治疗，达到双重治疗的效果。

Clinical evaluation of the modified Twin-block functional appliance in the treatment of obstructive sleep apnea hypopnea syndrome in children patients

Objective To evaluate the effect of modified Twin-block functional appliance（ TBA ） in the treatment of children with obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods Twenty-five cases of OSAHS children associated with mandibular deficiency treated with modified TBA, polysomnography, hard and soft tissues analysis, CBCT analysis of the upper airway were used before and after treatment. Results After treatment, the patient＇ s SNB angle, Z angle and soft tissue surface angle increased, ANB angle and H angle decreased（ P 〈 0.05） ; the oropharyngeal airway total volume, the minimum sectional area of the airway, the minimum cross section sagittal diameter, the minimum cross section diameter and the minimum cross section sagittal diameter/width increased （ P 〈 0.05 ） ; sleep monitoring results showed that the AHI decreased, while the SaO2 increased （P 〈 0.05）. Conclusion The modified TBA treatment is not only beneficial to the treatment of the late malocclusion, but also to the early orthodontic treatment based on the etiology of children OSAHS.