Pierre Robin 序列的手术矫正：下颌骨牵引成骨术与舌唇粘连术。
The surgical correction of Pierre Robin sequence: mandibular distraction osteogenesis versus tongue-lip adhesion.
机构信息
Indianapolis, Ind.; Amman, Jordan; Salt Lake City, Utah; Milwaukee, Wis.; and Hamilton, Ontario, Canada From the Division of Plastic Surgery, Riley Hospital for Children, Indiana University Medical Center; private practice; the Division of Plastic Surgery, McMaster University; and the Department of Plastic Surgery, Medical College of Wisconsin.
出版信息
Plast Reconstr Surg. 2014 Jun;133(6):1433-1439. doi: 10.1097/PRS.0000000000000225.
BACKGROUND
The authors present an outcomes analysis of mandibular distraction osteogenesis versus tongue-lip adhesion in the surgical treatment of Pierre Robin sequence.
METHODS
A retrospective, 15-year, single-surgeon review was undertaken of all nonsyndromic neonates with Pierre Robin sequence treated with mandibular distraction osteogenesis (2004 to 2009; n = 24) or tongue-lip adhesion (1994 to 2004; n = 15). Outcomes included time of extubation, length of intensive care unit stay, incidence of tracheostomy, and surgical complications. Polysomnography data were collected 1 month and 1 year postoperatively. Sleep study data included changes in oxygen saturation and apnea-hypopnea index.
RESULTS
There were no postprocedure tracheostomies in the mandibular distraction osteogenesis group and four tracheostomies in the tongue-lip adhesion group. The preoperative oxygen saturations were significantly lower in the mandibular distraction osteogenesis group compared with tongue-lip adhesion (76.5 percent versus 82 percent; p < 0.05). Preoperative apnea-hypopnea index was significantly higher in the mandibular distraction osteogenesis group compared with the tongue-lip adhesion group (47 versus 37.6; p < 0.05). Despite these preoperative differences, patients undergoing mandibular distraction osteogenesis demonstrated significantly higher oxygen saturation levels at 1 month (98.3 percent versus 87.5 percent; p < 0.05) and 1 year postoperatively (98.5 percent versus 89.2 percent; p < 0.05) and lower apnea-hypopnea index at 1 month (10.9 versus 21.6; p < 0.05) and 1 year postoperatively (2.5 versus 22.1; p < 0.05) compared with tongue-lip adhesion. Surgical complications were comparable between the two groups.
CONCLUSIONS
In nonsyndromic patients with Pierre Robin sequence, mandibular distraction osteogenesis demonstrates superior outcome measures regarding oxygen saturation, apnea-hypopnea index, and incidence of tracheostomy compared with tongue-lip adhesion.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
背景
作者对下颌骨牵引成骨术与舌唇粘连术治疗 Pierre Robin 序列的结果进行了分析。
方法
对 2004 年至 2009 年间采用下颌骨牵引成骨术（n=24）和舌唇粘连术（n=15）治疗非综合征性 Pierre Robin 序列新生儿的单外科医生回顾性研究进行了 15 年的回顾分析。结果包括拔管时间、重症监护病房住院时间、气管切开术发生率和手术并发症。术后 1 个月和 1 年收集多导睡眠图数据。睡眠研究数据包括氧饱和度和呼吸暂停低通气指数的变化。
结果
下颌骨牵引成骨组无术后气管切开术，舌唇粘连组有 4 例气管切开术。下颌骨牵引成骨组的术前氧饱和度明显低于舌唇粘连组（76.5%比 82%；p<0.05）。下颌骨牵引成骨组的术前呼吸暂停低通气指数明显高于舌唇粘连组（47 比 37.6；p<0.05）。尽管存在这些术前差异，但接受下颌骨牵引成骨术的患者在术后 1 个月（98.3%比 87.5%；p<0.05）和 1 年（98.5%比 89.2%；p<0.05）时氧饱和度明显升高，术后 1 个月（10.9 比 21.6；p<0.05）和 1 年（2.5 比 22.1；p<0.05）时呼吸暂停低通气指数明显降低。两组手术并发症相似。
结论
在非综合征性 Pierre Robin 序列患者中，与舌唇粘连术相比，下颌骨牵引成骨术在氧饱和度、呼吸暂停低通气指数和气管切开术发生率方面具有更好的治疗效果。
临床问题/证据水平：治疗，III。
Zotero 插件