中华口腔医学杂志
中華口腔醫學雜誌
중화구강의학잡지
Chinese Journal of Stomatology
2015年
4期
202-205
,共4页
于擘%丁明超%石晋%Ujjwal Koirala%王维戚%马秦
于擘%丁明超%石晉%Ujjwal Koirala%王維慼%馬秦
우벽%정명초%석진%Ujjwal Koirala%왕유척%마진
正颌外科手术%睡眠呼吸暂停,阻塞性%阻塞性睡眠呼吸暂停低通气综合征
正頜外科手術%睡眠呼吸暫停,阻塞性%阻塞性睡眠呼吸暫停低通氣綜閤徵
정합외과수술%수면호흡잠정,조새성%조새성수면호흡잠정저통기종합정
Orthognathic surgical procedures%Sleep apnea,obstructive%Obstructive sleep apneahypopnea syndrome
目的 分析正颌手术不同术式治疗重度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apneahypopnea syndrome,OSAHS)的疗效.方法 对2011年1月至2014年1月就诊于第四军医大学口腔医学院口腔颌面外科重度OSAHS患者24例,采用3种手术术式:①双颌水平前徙术+颏成形术(5例);②双颌逆时针前旋转+颏成形术(13例);③双颌水平前徙术+根尖下截骨后退术(6例).手术前、后对患者进行多导睡眠监测(polysomnography,PSG)和头影测量分析,比较术前、术后患者的呼吸紊乱指数(apnea and hypopea index,AHI)、体质量指数(body mass index,BMI)、平均血氧饱和度(average blood oxyen saturation,AOS)、后气道间隙(posterior airway space,PAS)、反映上颌突度的SNA角及反映下颌突度的SNB角等参数指标,采用SAS 8.02软件进行术前、术后配对t检验,评估手术效果.结果 依据斯坦福标准,手术治疗成功率达100％.双颌水平前徙术+颏成形术术前、术后AHI、SNA、SNB、SNPg(反映颏突度)、PAS比较,差异均有统计学意义(P＜0.000 1);双颌逆时针前旋转+颏成形术术前、术后患者AHI、SNB、SNPg、PAS比较,差异均有统计学意义(P＜0.01),SNA术前(82.25±2.71)°、术后(86.54±3.65)°(P=0.000 2),SNB术前(73.65±3.80)°,术后(81.37±2.96)°(P＜0.000 1);双颌水平前徙术+根尖截骨后退术术前、术后患者AHI、SNPg、PAS比较,差异均有统计学意义(P＜0.0001),SNA术前(82.18±4.27)°、术后(84.19±2.70)°(P=0.201 5),SNB术前(73.28±3.04)°、术后(75.35±2.56)°(P=0.2640),SNPg术前(75.91±4.06)°、术后(85.42±3.05)°(P＜0.000 1).术后患者平均正畸时间8.3个月.结论 ①双颌前徙术是治疗重度OSAHS的有效术式,术前需行头影测量、计算机辅助设计,选择个性化手术术式;②双颌水平前徙术+颏前徙术术后面型前突畸形明显;③逆时针旋转双颌前徙术+颏前徙术达到治疗目的同时尽量减小对面型的影响;④双颌水平前徙术+根尖下截骨后退术对面型影响小,但手术时间长、创伤大,术后需较长时间正畸治疗.
目的 分析正頜手術不同術式治療重度阻塞性睡眠呼吸暫停低通氣綜閤徵(obstructive sleep apneahypopnea syndrome,OSAHS)的療效.方法 對2011年1月至2014年1月就診于第四軍醫大學口腔醫學院口腔頜麵外科重度OSAHS患者24例,採用3種手術術式:①雙頜水平前徙術+頦成形術(5例);②雙頜逆時針前鏇轉+頦成形術(13例);③雙頜水平前徙術+根尖下截骨後退術(6例).手術前、後對患者進行多導睡眠鑑測(polysomnography,PSG)和頭影測量分析,比較術前、術後患者的呼吸紊亂指數(apnea and hypopea index,AHI)、體質量指數(body mass index,BMI)、平均血氧飽和度(average blood oxyen saturation,AOS)、後氣道間隙(posterior airway space,PAS)、反映上頜突度的SNA角及反映下頜突度的SNB角等參數指標,採用SAS 8.02軟件進行術前、術後配對t檢驗,評估手術效果.結果 依據斯坦福標準,手術治療成功率達100％.雙頜水平前徙術+頦成形術術前、術後AHI、SNA、SNB、SNPg(反映頦突度)、PAS比較,差異均有統計學意義(P＜0.000 1);雙頜逆時針前鏇轉+頦成形術術前、術後患者AHI、SNB、SNPg、PAS比較,差異均有統計學意義(P＜0.01),SNA術前(82.25±2.71)°、術後(86.54±3.65)°(P=0.000 2),SNB術前(73.65±3.80)°,術後(81.37±2.96)°(P＜0.000 1);雙頜水平前徙術+根尖截骨後退術術前、術後患者AHI、SNPg、PAS比較,差異均有統計學意義(P＜0.0001),SNA術前(82.18±4.27)°、術後(84.19±2.70)°(P=0.201 5),SNB術前(73.28±3.04)°、術後(75.35±2.56)°(P=0.2640),SNPg術前(75.91±4.06)°、術後(85.42±3.05)°(P＜0.000 1).術後患者平均正畸時間8.3箇月.結論 ①雙頜前徙術是治療重度OSAHS的有效術式,術前需行頭影測量、計算機輔助設計,選擇箇性化手術術式;②雙頜水平前徙術+頦前徙術術後麵型前突畸形明顯;③逆時針鏇轉雙頜前徙術+頦前徙術達到治療目的同時儘量減小對麵型的影響;④雙頜水平前徙術+根尖下截骨後退術對麵型影響小,但手術時間長、創傷大,術後需較長時間正畸治療.
목적 분석정합수술불동술식치료중도조새성수면호흡잠정저통기종합정(obstructive sleep apneahypopnea syndrome,OSAHS)적료효.방법 대2011년1월지2014년1월취진우제사군의대학구강의학원구강합면외과중도OSAHS환자24례,채용3충수술술식:①쌍합수평전사술+해성형술(5례);②쌍합역시침전선전+해성형술(13례);③쌍합수평전사술+근첨하절골후퇴술(6례).수술전、후대환자진행다도수면감측(polysomnography,PSG)화두영측량분석,비교술전、술후환자적호흡문란지수(apnea and hypopea index,AHI)、체질량지수(body mass index,BMI)、평균혈양포화도(average blood oxyen saturation,AOS)、후기도간극(posterior airway space,PAS)、반영상합돌도적SNA각급반영하합돌도적SNB각등삼수지표,채용SAS 8.02연건진행술전、술후배대t검험,평고수술효과.결과 의거사탄복표준,수술치료성공솔체100％.쌍합수평전사술+해성형술술전、술후AHI、SNA、SNB、SNPg(반영해돌도)、PAS비교,차이균유통계학의의(P＜0.000 1);쌍합역시침전선전+해성형술술전、술후환자AHI、SNB、SNPg、PAS비교,차이균유통계학의의(P＜0.01),SNA술전(82.25±2.71)°、술후(86.54±3.65)°(P=0.000 2),SNB술전(73.65±3.80)°,술후(81.37±2.96)°(P＜0.000 1);쌍합수평전사술+근첨절골후퇴술술전、술후환자AHI、SNPg、PAS비교,차이균유통계학의의(P＜0.0001),SNA술전(82.18±4.27)°、술후(84.19±2.70)°(P=0.201 5),SNB술전(73.28±3.04)°、술후(75.35±2.56)°(P=0.2640),SNPg술전(75.91±4.06)°、술후(85.42±3.05)°(P＜0.000 1).술후환자평균정기시간8.3개월.결론 ①쌍합전사술시치료중도OSAHS적유효술식,술전수행두영측량、계산궤보조설계,선택개성화수술술식;②쌍합수평전사술+해전사술술후면형전돌기형명현;③역시침선전쌍합전사술+해전사술체도치료목적동시진량감소대면형적영향;④쌍합수평전사술+근첨하절골후퇴술대면형영향소,단수술시간장、창상대,술후수교장시간정기치료.
Objective To review the outcomes of three different methods of maxillomandibular advancement for the treatment of severe obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods Twenty-four patients with severe OSAHS from January 2011 to January 2014 treated by three different methods of maxillomandibular advancement(MMA) and genioplasty,maxillomandibular advancement without rotation plus genioplasty,maxillomandibular advancement with counterclockwise rotation plus advancement genioplasty,maxillomandibular advancement with first premolars extraction and subapical osteotomy setback under general anesthesia were included in the study.Comparison of per-operative and post-operative cephalometric analysis,polysomnography(PSG),apnea and hypopea index(AHI),body mass index(BMI),average blood oxygen saturation(AOS),lowest oxygen saturation(LSaO2) and posterior airway space(PAS) data were performed.The operative time and post-surgical orthodontic treatment data were collected and analyzed.Results According to Stanford criteria,the success rate of 100％ was achieved with all the three methods.The difference between per-operative and post-operative AHI,AOS,SNPg and PAS were statistically significant(P＜0.000 1) for all the three methods.Significant difference was found between per-operative and post-operative SNA(81.51 °±3.36° vs 88.17°±4.51 °,P＜0.000 1),(82.25°±2.71 ° vs 86.54°±3.65°,P=0.000 2) and SNB(72.37°±3.99° vs 80.59°±3.40°,P＜0.000 1),(73.65°±3.80° vs 81.37°±2.96°,P＜0.000 1) among MMA without rotation plus genioplasty and MMA with counterclockwise rotation and advancement genioplasty respectively.However,no significant difference was found between the pre-operative and post-operative SNA(82.18°±4.27° vs 84.19°±2.70°,P=0.201 5) and SNB(73.28°±3.04° vs 75.35°±2.56°,P=0.264 0) among MMA with first premolars extraction and subapical osteotomy setback.The average duration of postoperative orthodontics treatment was 8.3 months.Conclusions MMA and advancement genioplasty is an effective surgical management for severe OSAHS.Cephalometric analysis and computer aided design are needed for personalized surgical methods.MMA without rotation and advancement genioplasty method leads to the protrusive skeletal deformity.MMA with counterclockwise rotation and advancement genioplasty method is effective in curing severe OSAHS with little effect on facial profile.MMA with first premolars extraction and subapical osteotomy requires longer operative time and longer postoperative orthodontic treatment.
