牵张成骨术治疗颞下颌关节强直后睡眠呼吸暂停综合征

目的 评估牵张成骨术(DO)治疗颞颌关节强直后睡眠呼吸暂停综合征(OSAS)的效果。方法 对8例患有颞颌关节强直后OSAS的患者采用DO技术进行治疗。手术在全麻下分两期进行。第一期行关节成形、下颌体部截骨,安置牵引器,前徙下颌矫正小颌畸形及OSAS;第二期在拆除第一期牵引器的同时,进行下颌升支后缘L型截骨,安置牵引器,通过牵引延长下颌升支。结果 8例患有颞颌关节强直后OSAS的患者的症状均有不同程度的改善。术后张口度可迭3cm～4cm,小颌畸形得以矫治,AHI指数由术前的20～40降至5以下,最低血氧饱和度由术前的68％提高至术后的96％,OSAS得以治愈。术后半年～两年随访,未见复发。结论 DO技术是治疗颞颌关节强直后OSAS理想方法。

Effects of distraction osteogenesis on obstructive sleep apnea syndrome caused by ankylosis of temporomandibular joint

Objective To evaluate the effects of distraction osteogenesis on obstructive sleep apnea syndrome caused by ankylosis of temporomandibular joint. Methods Eight patients who suffered from obstructive sleep apnea syndrome caused by ankylosis of temporomandibular joint were treated by distraction osteogenesis. The surgery was divided into two stages under general anesthesia. At the first stage,after arthroplasty of temporomandibula joint and osteotomy of mandibular body,the first tractor was put on,then mandible was protruded so as to rectify micrognathism and obstructive sleep apnea syndrome. At the second stage,the first tractor was removed,"L" type osteotomy was carried on at rear line of ramus. Then the second tractor was put on, and pseudoarthrosis was formed through traction. Results The symtom of all the eight patients were improved at different levels. The gape can reach to 3- 4 centimeter, and micrognathism was rectified. AHI index reduced from 20- 40 before surgery to 5 or less after surgery, while the minimum oxygen degree of saturation in blood raised from 68% to 96%. Thus the obstructive sleep apnea syndrome was cured. There was no recurence in half to two years after surgery. Conclusion Distraction osteogenesis is an ideal means to treat obstructive sleep apnea syndrome caused by ankylosis of temporomandibular joint.