下颌支矢状骨劈开术后退下颌治疗骨性Ⅲ类错𬌗畸形对上气道和睡眠呼吸通气功能的影响

doi:10.13591/j.cnki.kqyx.2025.02.008

摘要/Abstract

摘要：

目的分析下颌支矢状骨劈开术(SSRO)后退下颌治疗骨性Ⅲ类错𬌗畸形对患者上气道间隙和睡眠呼吸通气功能的影响。方法选取18例接受双侧下颌支矢状骨劈开术治疗骨性Ⅲ类错𬌗畸形的患者。于正颌手术前3 d及术后6个月拍摄锥形束CT,利用Mimics软件重建颅颌面气道的三维模型。测量手术前后气道矢状径、冠状径、截面积,以及气道各部分体积变化。利用多导睡眠监测系统分别进行单次多导睡眠监测(polysomnography,PSG),记录监测数据。采用SPSS 25.0软件包对以上数据进行统计学分析。结果术后软腭下缘所在平面矢状径(SP-AP)、截面积(SP-CSA)减小(P<0.05);会厌谷所在平面矢状径(EP-AP)显著减小(P<0.01)、截面积(EP-CSA)减小(P<0.05);术后口咽区气道体积、气道总体积显著减小(P<0.01),会厌区气道体积减小(P<0.05)。术后多导睡眠监测AHI、睡眠效率、平均血氧饱和度、最低血氧饱和度与术前比较未见统计学差异。结论接受下颌支矢状骨劈开术后退下颌治疗骨性Ⅲ类错𬌗畸形的患者术后气道软腭下缘所在平面、会厌谷所在平面矢状径、截面积均减小。口咽区气道体积、会厌区气道体积、气道总体积均显著减小。而术后睡眠呼吸通气功能无变化。

关键词: 下颌支矢状骨劈开术, 骨性Ⅲ类错𬌗畸形, CBCT, 气道体积, 多导睡眠监测, 睡眠通气功能

Abstract:

Objective To examine the effects of SSRO (sagittal split ramus osteotomy) for Class Ⅲ malocclusion treatment on pharyngeal airway space (PAS) and respiratory function during sleep. Methods The subjects were 18 patients in whom mandibular prognathism was corrected by sagittal split ramus osteotomy. Morphological changes were studied using cone beam computed tomography at 3 days before surgery and 6 months after surgery. 3D models of the craniofacial and pharyngeal airway morphology were reconstructed with a 3D image analysis system (Mimics Innovation Suite). The anteroposterior dimension, lateral width, cross-sectional area of each subject’s pharyngeal airway were measured before and after surgery. The three airway volumes and total PAS volume were measured before and after surgery. Single polysomnography (PSG) monitoring was performed using the polysomnography system 3 days before and 6 months after orthognathic surgery, respectively, and the monitoring data were recorded. Statistical analysis of the data was performed using SPSS 25.0 software package. Results SP-AP and SP-CSA decreased after operation (P<0.05). EP-AP was significantly decreased (P<0.01)and EP-CSA decreased (P<0.05). The oropharynx volume and total PAS volume were significantly decreased, and the epiglottic volume decreased (P<0.05). There were no significant changes in respiratory function during sleep. Conclusion SP-AP, SP-CSA, EP-AP, EP-CSA, the oropharynx volume, the epiglottic volume and total PAS volume were decreased significantly after surgery. There were no significant changes in respiratory function during sleep.

Key words: sagittal split ramus osteotomy, Class Ⅲ malocclusion, CBCT, pharyngeal airway volume, polysomnography, respiratory function during sleep

中图分类号:

R783.5

马惠, 王雯, 仇岩, 华泽权. 下颌支矢状骨劈开术后退下颌治疗骨性Ⅲ类错𬌗畸形对上气道和睡眠呼吸通气功能的影响[J]. 口腔医学, 2025, 45(2): 123-128.

MA Hui, WANG Wen, QIU Yan, HUA Zequan. The effect of SSRO of Class Ⅲ malocclusion on the pharyngeal airway and respiratory function during sleep[J]. Stomatology, 2025, 45(2): 123-128.

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测量项目	T0	T1	P
PNS-AP/mm	21.53±3.89	21.54±3.88	0.946
PNS-W/mm	29.09±2.18	28.90±2.24	0.120
PNS-CSA/mm²	478.00±104.76	476.58±106.92	0.862
SP-AP/mm	13.54±1.40	12.76±1.31	0.024^*
SP-W/mm	28.24±4.86	28.17±4.92	0.073
SP-CSA/mm²	389.56±109.48	335.91±97.81	0.015^*
EP-AP/mm	16.25±2.11	14.80±1.97	0.006^*
EP-W/mm	35.93±4.10	35.30±4.43	0.239
EP-CSA/mm²	346.90±69.88	318.14±52.60	0.028^*
V_鼻咽区/mm³	9 401.33±723.62	9 274.55±1 104.25	0.640
V_口咽区/mm³	11 548.30±5 901.21	9 518.67±4 853.60	0.003^**
V_会厌区/mm³	21 251.58±8 898.72	20 911.26±8 607.68	0.024^*
V_总/mm³	42 232.52±10 315.39	39 996.62±9 155.68	0.005^**

测量项目	T0	T1	P
AHI	0.52±0.72	0.48±0.61	0.691
睡眠效率	89.38±8.99	89.52±8.18	0.631
平均血氧饱和度	97.80±1.00	97.67±0.81	0.439
最低血氧饱和度	94.75±1.87	94.65±1.81	0.417