Cillo Joseph E, Dattilo David J
Associate Professor and Program Director, Division of Oral and Maxillofacial Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA.
Associate Professor and Division Director, Division of Oral and Maxillofacial Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA.
J Oral Maxillofac Surg. 2019 Jun;77(6):1231-1236. doi: 10.1016/j.joms.2019.01.009. Epub 2019 Jan 14.
To evaluate long-term clinically significant cephalometric skeletal stability with maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA).
We performed a retrospective cohort analysis of long-term clinically significant skeletal stability in patients who underwent MMA for OSA. The primary predictor and outcome variables were the occurrence of and time to loss of clinically significant skeletal stability, respectively, at sella-nasion-B point (SNB). The inclusion criteria included severe OSA (apnea-hypopnea index > 30), MMA, diagnostic preoperative and postoperative lateral cephalometric radiographs, and a minimum of 5 years of follow-up. Digitized cephalometric radiographs were analyzed at 3 time points: preoperatively, postoperatively, and at last follow-up. Statistical analyses included Kaplan-Meier time-to-loss of clinical stability analysis, the log-rank test, and the Cox proportional hazards model for hazard ratio determination for the influence of the following independent variables on loss of clinical stability: gender, age at the time of surgery, time to follow-up, and amount of surgical movement. Post hoc stratification for bone grafting was completed. Statistical significance was set at the P < .05 level.
Thirty consecutive patients with an even gender distribution and average follow-up period of 10.7 years were included in this study. Preoperatively, the average age was 43.7 years; apnea-hypopnea index, 59.8; and body mass index, 39.3. Half of the cohort had clinically significant loss of skeletal stability at sella-nasion-A point (SNA), SNB, and A point-nasion-B point (ANB) approximately 13 years after surgery, with no statistically significant difference between SNA, SNB, and ANB curves (χ = 0.12) independent of the independent variables at SNB (χ = 1.9), SNA (χ = 1.3), or ANB (χ = 1.3). The average hazard ratio ranged from 0.89 to 1.02.
Within the limitations of this study, MMA in the treatment of severe OSA is a highly skeletally stable long-term procedure independent of gender, age at the time of surgery, time to follow-up, and amount of surgical movement.
评估用于治疗阻塞性睡眠呼吸暂停（OSA）的上颌下颌前徙术（MMA）的长期临床显著头颅骨骼稳定性。
我们对接受MMA治疗OSA的患者的长期临床显著骨骼稳定性进行了回顾性队列分析。主要预测变量和结果变量分别是蝶鞍-鼻根-B点（SNB）处临床显著骨骼稳定性丧失的发生情况和时间。纳入标准包括重度OSA（呼吸暂停低通气指数>30）、MMA、术前和术后数字化头颅侧位X线片以及至少5年的随访。在3个时间点分析数字化头颅侧位X线片：术前、术后和最后一次随访。统计分析包括Kaplan-Meier临床稳定性丧失时间分析、对数秩检验以及Cox比例风险模型，用于确定以下独立变量对临床稳定性丧失的影响的风险比：性别、手术时年龄、随访时间和手术移动量。完成了骨移植的事后分层。设定统计学显著性水平为P < 0.05。
本研究纳入了30例性别分布均匀且平均随访期为10.7年的患者。术前，平均年龄为43.7岁；呼吸暂停低通气指数为59.8；体重指数为39.3。大约一半的队列在手术后约13年时在蝶鞍-鼻根-A点（SNA）、SNB和A点-鼻根-B点（ANB）处出现了临床显著的骨骼稳定性丧失，SNA、SNB和ANB曲线之间无统计学显著差异（χ = 0.12），与SNB（χ = 1.9）、SNA（χ = 1.3）或ANB（χ = 1.3）处的独立变量无关。平均风险比范围为0.89至1.02。
在本研究的局限性内，MMA治疗重度OSA是一种高度骨骼稳定的长期手术，与性别、手术时年龄、随访时间和手术移动量无关。
