重度OSAHS上气道骨框架重构-双颌逆时针大幅度前旋治疗

中国口腔颌面外科杂志 ›› 2014, Vol. 12 ›› Issue (3): 247-252.

重度OSAHS上气道骨框架重构-双颌逆时针大幅度前旋治疗

卢晓峰,王猛,于雯雯,陆立彦,据梧桐,何建德,孙红霞

上海交通大学医学院附属第九人民医院·口腔医学院口腔颅颌面科,上海市口腔医学重点实验室,上海 200011

收稿日期:2013-07-12 出版日期:2014-05-10 发布日期:2014-07-15
通讯作者: 卢晓峰,E-mail:lukeluxf@yahoo.com
作者简介:卢晓峰(1962-),男,博士,主任医师,博士研究生导师

Craniomaxillofacial bone frame reconstruction-bimaxillary substantial advancement and anticlockwise rotation for patients with severe obstructive sleep apnea-hypopnea syndrome

LU Xiao-feng, WANG Meng, YU Wen-wen, LU Li-yang, JU Wu-tong, HE Jian-de, SUN Hong-xia

Department of Oral and Craniomaxillofacial Science, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology. Shanghai 200011, China

Received:2013-07-12 Online:2014-05-10 Published:2014-07-15

摘要/Abstract

摘要： 目的:克服东方人微凸面型的限制,尽可能前移上、下颌骨,以达到重度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome, OSAHS)手术治疗的良好效果。方法:重度OSAHS患者16例(其中男15例,女1例),平均年龄(36.81±10.41)岁,体重指数(body mass index,BMI)为(27.35±3.67)kg/m2,睡眠呼吸暂停低通气指数(apnea and hypopnea index,AHI)为(61.59±15.78)次/h ,LSAT为(72.13±9.63)%。手术前、后对患者进行PSG监测和头影测量分析。采用定量UPPP(QUPPP)-双侧下颌骨矢状劈开(BSSRO)-上颌骨Le Fort I型手术次序进行手术。颏前移成形术根据面下1/3的形态决定是否施行,颏前移于手术最后完成。术后定期摄片,进行头影测量分析,复查PSG。随访患者,平均随访(20.88±3.27)个月。采用SAS 8.02软件包进行手术前、后资料的配对t检验,评估手术效果。结果:以AHI<20次/h和降低≥50%为评判标准,手术治疗成功率为93.75%。本组患者上颌前移(6.91±1.68) mm,上抬(4.13±0.85) mm;下颌前移(11.03±1.32) mm;施行颏前移术9例,颏前移(9.67±2.00) mm。所有患者OSAHS主观症状均消失或减轻,术前AHI为(61.59±15.78)次/h,术后为(10.04±7.33)次/h(P<0.0001)。术前LSAT为(72.13%±9.63)%,术后LSAT为(87.31±4.30)%(P<0.0001)。术前SNA为(81.32±4.03)°,术后为(87.18±3.70)°(P=0.0002);术前SNB为(72.56±3.99)°,术后为(80.08±3.40)°(P<0.0001);术前MP-H为(26.25±3.49) mm,术后为(21.61±4.04) mm(P=0.0016)。术前PASmin为(5.94±1.02) mm,术后为(9.11±2.17) mm(P<0.0001),患者均无明显语音障碍和吞咽障碍,无明显颌面畸形,咬合关系良好。结论:双颌逆时针前旋术治疗重度OSAHS患者的效果良好、稳定,在相同颌骨水平前移幅度下能更好地减少上颌骨前突程度,避免造成上颌骨前突畸形,同时尽可能绷紧颏部,显著提高了舌骨上肌群的张力,起到舌骨悬吊的良好作用。

关键词: 重度阻塞性睡眠呼吸暂停低通气综合征, 双颌逆时针大幅度前旋术, 定量腭垂软腭切除腭咽成形术

Abstract: PURPOSE: To overcome the oriental face type of micro convex constraints, advancing the maxilla and mandible in order to achieve good surgical effect for patients with severe obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS:Sixteen cases with severe OSAHS (15 males and 1 female) were included. The mean age was 36.81±10.41 years, BMI (body mass index, BMI) was (27.35±3.67) kg/m2, AHI was (61.59±15.78), LSAT was (72.13±9.63)%. Cephalometric analysis and PSG were conducted preoperatively and postoperatively. Q-UPPP and maxillomandibular anticlockwise rotation advancement were performed, in which the maxillae advancing distance was controlled to be 6-8 mm and mandible moved forward beyond 10 mm by BSSRO. Genioplasty was performed based on the need of patients' profile. All patients ware followed up for (20.88±3.27) months postoperatively. The data was analyzed with SAS 8.02 software package. RESULTS:According to stanford criteria: AHI<20 and drop to≥50%, the success rate was 93.75%. The patients’ maxilla moved forward by (6.91±1.68) mm,anteriorly raised by (4.13±0.85) mm; the mandible advanced (11.03±1.32) mm. Nine cases underwent genioplasty and the chin was advanced by (9.67±2.00) mm. All patients feel well and OSAHS symptoms disappeared or remarkably improved. The patients’ AHI was 61.59±15.78 preoperatively, the postoperative AHI was 10.04±7.33 (P<0.0001). The LSAT was (72.13±9.63)% preoperatively, the postoperative LSAT was (87.31±4.30)% (P<0.0001). The SNA was (81.32±4.03)° preoperatively, the postoperative SNA was (87.18±3.70)°(P=0.0002);SNB was (72.56±3.99)° preoperatively, and (80.08±3.40)° postoperatively(P<0.0001). MP-H was (26.25±3.49) mm preoperatively, and (21.61±4.04) mm postoperatively (P=0.0016). PASmin was (5.94±1.02) mm preoperatively, and (9.11±2.17) mm postoperatively (P<0.0001). There were no dysphagia or VPI, all patients had good occlusion and no visible deformities were noted. CONCLUSIONS:Bimaxillary substantial advancement and anticlockwise rotation is effective and stable for severe OSAHS patients to advance their maxilla and mandible anticlockwise.

Key words: Severe OSAHS, Bimaxillary anticlockwise rotation and substantial advancement, Q-UPPP

中图分类号:

R783.5

卢晓峰,王猛,于雯雯,陆立彦,据梧桐,何建德,孙红霞. 重度OSAHS上气道骨框架重构-双颌逆时针大幅度前旋治疗[J]. 中国口腔颌面外科杂志, 2014, 12(3): 247-252.

LU Xiao-feng, WANG Meng, YU Wen-wen, LU Li-yang, JU Wu-tong, HE Jian-de, SUN Hong-xia. Craniomaxillofacial bone frame reconstruction-bimaxillary substantial advancement and anticlockwise rotation for patients with severe obstructive sleep apnea-hypopnea syndrome[J]. China J Oral Maxillofac Surg, 2014, 12(3): 247-252.

参考文献

【1】Riley RW, Powell N, Guilleminault C. Current surgical concepts for treating obstructive sleep apnea syndrome . J Oral Maxillofac Surg, 1987, 45(2): 149-157.
【2】Fairbanks DNF. Snoring and obstructive sleep apnea . 2nd ed. New York: Raven Press, 1987:101-128.
【3】张震康, 张熙恩, 傅民魁. 正颌外科学 . 北京: 人民卫生出版社, 1994: 60-68.
【4】卢晓峰, 唐友盛, 李青云, 等. 计算机辅助设计的定量UPPP手术及其评价 . 中国口腔颌面外科杂志, 2003, 1(3): 138-142.
【5】卢晓峰,唐友盛,沈国芳,等. 悬雍垂腭咽成形术与双颌前徙术联合治疗阻塞性睡眠呼吸暂停低通气综合征的初步报告 . 中华口腔医学杂志, 2007, 42(4): 199-202.
【6】Caples SM, Rowley JA, Prinsell JR, et al. Surgical modifications of the upper airway for obstructive sleep apnea in adults a systematic review and meta-analysis . Sleep, 2010, 33(10): 1396-1407.
【7】Aurora RN, Casey KR, Kristo D, et al. Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults . Sleep, 2010, 33(10): 1408-1413.
【8】Akahoshi T, White DP, Edwards JK, et al. Phasic mechanoreceptor stimuli can induce phasic activation of upper airway muscles in humans. J Physiol,2001,531(Pt 3):677-691.
【9】Younes M. Contributions of upper airway mechanics and control mechanisms to severity of obstructive apnea . Am J Respir Crit Care Med, 2003, 168(6): 645-658.
【10】Patil SP, Schneider H, Marx JJ, et al. Neuromechanical control of upper airway patency during sleep. J Appl Physiol,2007,102(2): 547-556.
【11】Kinoff RJ. Upperairway myopathy is important in the pathophysiology of obstructive sleep apnea . J Clin Sleep Med, 2007, 3(6): 567-569.
【12】Loewen AH, Ostrowski M, Laprairie J, et al. Response of genioglossus muscle to increasing chemical drive in sleeping obstructive apnea patients . Sleep, 2011, 34(8): 1061-1073.

[1]	吕政展, 朱柏恺, 郑美里, 刘旌毅, 汪席均, 洪越扬, 江凌勇. 55例特发性髁突吸收患者临床特点与颅颌面结构特征分析[J]. 中国口腔颌面外科杂志, 2022, 20(6): 541-547.
[2]	迟浩姝, 詹宗历, 赵志扬, 蔡鸣. 改良鬼冢法治疗单侧唇裂术后短期唇峰高度的对称性分析[J]. 中国口腔颌面外科杂志, 2022, 20(6): 560-564.
[3]	朱柏恺, 刘旌毅, 吕政展, 郑美里, 汪席均, 河奈玲, 江凌勇. 关节功能板联合正颌-正畸治疗对特发性髁突吸收患者上气道结构变化的影响[J]. 中国口腔颌面外科杂志, 2022, 20(4): 354-359.
[4]	王博, 于洪波, 夏韫晖, 房兵, 郭秋曼. 牙槽骨再生正畸技术治疗成人错畸形伴原发性牙槽骨缺损的远期疗效评价[J]. 中国口腔颌面外科杂志, 2022, 20(3): 225-229.
[5]	盖云, 蒋芝月, 刘曙, 郑之峻. 青春期错畸形患者髁突位置与性别、颅面骨骼形态的相关性分析[J]. 中国口腔颌面外科杂志, 2022, 20(1): 42-47.
[6]	李若梅, 翁梦佳, 孙一丹, 陈振琦. Fgf9在小鼠下颌骨发育软骨成骨及膜内成骨过程中的作用探讨[J]. 中国口腔颌面外科杂志, 2021, 19(4): 309-314.
[7]	买买提·吐地, 哈尼克孜·莫明, 麦合布拜木·吐儿逊. 下颌颊棚区微螺钉解剖学植入区域位点锥形束CT测量分析[J]. 中国口腔颌面外科杂志, 2020, 18(1): 38-41.
[8]	翁梦佳, 章筱悦, 陈振琦. 条件性敲除软骨组织中FGF9基因小鼠模型的建立[J]. 中国口腔颌面外科杂志, 2019, 17(5): 412-417.
[9]	阿力木江·苏甫尔, 比力克孜·玉素甫, 热娜古孜·阿不都米吉提. 新疆喀什地区非综合征型唇腭裂发病危险因素的病例对照研究[J]. 中国口腔颌面外科杂志, 2019, 17(5): 436-439.
[10]	师佳君, 陈振琦. 唇腭裂患者牙龄与骨龄关系研究进展[J]. 中国口腔颌面外科杂志, 2018, 16(5): 469-474.
[11]	杨双羽，钱玉芬. 深覆分类与治疗方法进展[J]. 中国口腔颌面外科杂志, 2018, 16(3): 284-288.
[12]	史春玲, 李铎, 刘奕. 东北地区274例腭裂患者临床特征与ABO血型分析[J]. 中国口腔颌面外科杂志, 2018, 16(2): 149-152.
[13]	姚侃, 王猛, 于雯雯, 胥雷, 魏思龙, 孙红霞, 卢晓峰. UPPP术后短期上气道重塑现象的初步探讨[J]. 中国口腔颌面外科杂志, 2017, 15(1): 63-68.
[14]	彭莉, 牛振民, 黄薇, 陈振琦. 染色体10q25位点多态性与中国非综合征性唇腭裂的关联研究[J]. 中国口腔颌面外科杂志, 2016, 14(4): 324-327.
[15]	王博, 于洪波, 孙良龑, 沈国芳, 王旭东, 房兵, 郭秋曼. 槽骨再生正畸治疗成人中重度牙周炎错畸形远期疗效评价[J]. 中国口腔颌面外科杂志, 2016, 14(3): 234-238.