颞下颌关节强直患者在关节松解术前采用牵引成骨术治疗阻塞性睡眠呼吸暂停。
Distraction osteogenesis for management of obstructive sleep apnoea in temporomandibular joint ankylosis patients before the release of joint.
作者信息
Yadav Rahul, Bhutia Ongkila, Shukla Garima, Roychoudhury Ajoy
机构信息
Department of Oral & Maxillofacial Surgery (Head: Dr. Ajoy Roychoudhury), All India Institute of Medical Sciences, New Delhi 110029, India.
Department of Oral & Maxillofacial Surgery (Head: Dr. Ajoy Roychoudhury), All India Institute of Medical Sciences, New Delhi 110029, India.
出版信息
J Craniomaxillofac Surg. 2014 Jul;42(5):588-94. doi: 10.1016/j.jcms.2013.07.031. Epub 2013 Aug 22.
AIM
To evaluate the effects of distraction osteogenesis in management of obstructive sleep apnoea patients secondary to temporomandibular joints ankylosis.
METHODS
Fifteen patients were included in study. Preoperatively the patients were worked up for polysomnography and CT scans. Only those patients with Apnoea-hypopnoea index >15 events/h denoting moderate to severe obstructive sleep apnoea were included in the study. Distraction osteogenesis was followed with 5 days latency period in adult patients and 0 days for children. Rate of distraction was 1 mm/day for adults and 2 mm/day for children till the mandibular incisors were in reverse overjet. After 3 months post distraction assessment was done using polysomnography and CT scan. TMJ ankylosis was released by doing gap arthroplasty after distraction osteogenesis.
RESULTS
Post distraction improvement was seen in clinical features of OSA like daytime sleepiness and snoring. Epworth sleepiness scale improved from a mean of 10.25 to 2.25. Polysomnographic analysis also showed improvement in all cases with apnoea-hypopnoea index from 57.03 to 6.67 per hour. Lowest oxygen saturation improved from 64.47% to 81.20% and average minimum oxygen saturation improved from 92.17% to 98.19%. Body mass index improved from a mean of 18.26 to 21.39 kg/m2.
CONCLUSION
Distraction osteogenesis is a stable and beneficial treatment option for temporomandibular joint ankylosis patients with obstructive sleep apnoea.
目的
评估牵张成骨术在治疗颞下颌关节强直继发阻塞性睡眠呼吸暂停患者中的效果。
方法
本研究纳入15例患者。术前对患者进行多导睡眠图检查和CT扫描。仅将呼吸暂停低通气指数>15次/小时（表明中度至重度阻塞性睡眠呼吸暂停）的患者纳入研究。成年患者牵张成骨术后延迟5天开始牵张，儿童患者术后0天开始牵张。成年人牵张速率为每天1毫米，儿童为每天2毫米，直至下颌切牙出现反覆盖。牵张后3个月，使用多导睡眠图和CT扫描进行评估。牵张成骨术后通过间隙关节成形术松解颞下颌关节强直。
结果
牵张后，阻塞性睡眠呼吸暂停的临床特征如白天嗜睡和打鼾有所改善。爱泼华嗜睡量表评分从平均10.25提高到2.25。多导睡眠图分析也显示所有病例的呼吸暂停低通气指数从每小时57.03次改善到6.67次。最低血氧饱和度从64.47%提高到81.20%，平均最低血氧饱和度从92.17%提高到98.19%。体重指数从平均18.26 kg/m²提高到21.39 kg/m²。
结论
牵张成骨术对于患有阻塞性睡眠呼吸暂停的颞下颌关节强直患者是一种稳定且有益的治疗选择。
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