口腔矫治器治疗不同垂直骨面型的骨性Ⅱ类错畸形伴阻塞性睡眠呼吸暂停综合征患者上气道形态变化的锥形束CT分析

doi:10.7518/hxkq.2020.04.012

摘要/Abstract

摘要：

目的通过锥形束CT（CBCT）影像比较研究口腔矫治器治疗不同垂直骨面型的骨性Ⅱ类错畸形伴阻塞性睡眠呼吸暂停综合征（OSAS）患者前后上气道三维形态变化。方法采用口腔矫治器对多导睡眠监测仪及白天嗜睡量表诊断为OSAS且为骨性Ⅱ类错畸形的36例患者进行治疗,戴用矫治器治疗4个月后,进行CBCT扫描分析不同垂直骨面型的OSAS患者治疗前后腭咽、舌咽等不同部位上气道形态的三维改变。结果与治疗前相比,在戴用可调式矫治器4个月时,所有患者的腭咽容积测量值均显著增加（P<0.05）;低角和均角患者的舌咽各项测量值均显著提高（P<0.05）,高角患者的舌咽测量值中仅矢状向变化有显著差异,其余测量值变化的差异无统计学意义。结论口腔治疗器治疗下颌后缩的OSAS患者时,能显著改善低角患者和均角患者的上气道形态,但高角患者的上气道形态变化不大。

关键词: 口腔矫治器, 阻塞性睡眠呼吸暂停综合征, 骨性Ⅱ类错畸形, 上呼吸道, 锥形束CT

Abstract:

Objective To analyze the morphological changes in the upper airway of obstructive sleep apnea syndrome (OSAS) patients treated with oral appliance in skeletal class Ⅱ malocclusion with different vertical features by using cone beam CT (CBCT). Methods Thirty-six patients diagnosed with OSAS by polysomnography and daytime sleepiness scale and skeletal class Ⅱ malocclusion were treated with oral appliance for 4 months. The changes based on CBCT in the morphology of glossopharyngeal and palatopharyngeal before and after treatment in OSAS patients with different vertical features were compared. Results After treatment with oral appliance, the glossopharyngeal and palatopharyngeal morphologies of patients with mild OSAS showed significant changes. After treatment with oral appliance, the glossopharyngeal morphology of all patients showed significant changes (P<0.05). The palatopharyngeal morphology of patients in the lower and average groups also exhibited significant changes (P<0.05). Sagittal changes in the glossopharyngeal measurements of high-angle patients demonstrated significant difference, whereas the other measured values showed no significant difference. Conclusion The morphological changes in the upper airway were significant in OSAS patients with lower and average vertical patterns when treated with oral appliance, but the changes in high vertical patterns were not significant.

Key words: oral appliance, obstructive sleep apnea syndrome, skeletal class Ⅱ malocclusion, upper airway, cone beam CT

中图分类号:

R783.9

郭彪, 路荣建. 口腔矫治器治疗不同垂直骨面型的骨性Ⅱ类错畸形伴阻塞性睡眠呼吸暂停综合征患者上气道形态变化的锥形束CT分析[J]. 华西口腔医学杂志, 2020, 38(4): 419-424.

Guo Biao, Lu Rongjian. Morphological change analysis based on cone beam CT of the upper airway for obstructive sleep apnea syndrome patients treated with oral appliance in skeletal class Ⅱ malocclusion with different vertical patterns[J]. West China Journal of Stomatology, 2020, 38(4): 419-424.

图/表 4

图 1

表 1

表 2

表 3

参考文献 18

[1]	高雪梅, 赵颖, 曾祥龙, 等. 北京地区鼾症和睡眠呼吸暂停综合征的流行病学研究[J]. 口腔正畸学, 1997,4(4):162-165.
	Gao XM, Zhao Y, Zeng XL , et al. The epidemiological survey of snoring and sleep apnea syndrome in Beijing[J]. Chin J Orthod, 1997,4(4):162-165.
[2]	Li M, Li XY, Lu Y. Obstructive sleep apnea syndrome and metabolic diseases[J]. Endocrinology, 2018,159(7):2670-2675. doi: 10.1210/en.2018-00248 URL pmid: 29788220
[3]	Li L, Liu H, Cheng HJ, et al. CBCT evaluation of the upper airway morphological changes in growing patients of class Ⅱ division 1 malocclusion with mandibular retrusion using twin block appliance: a comparative research[J]. PLoS One, 2014,9(4):e94378. URL pmid: 24705466
[4]	伍军, 徐宝华. 安氏Ⅱ类Ⅰ分类错的分型及其高低面角的颅面特征[J]. 口腔医学纵横, 1999,15(3):151-153.
	Wu J, Xu BH . The subtypes of Angle class Ⅱ division Ⅰ malocclusion and the maxillofical morphologic features of high and low mandibular angle[J]. J Compr Stomatol, 1999,15(3):151-153.
[5]	何权瀛, 王莞尔. 阻塞性睡眠呼吸暂停低通气综合征诊治指南(基层版)[J]. 中国呼吸与危重监护杂志, 2015,14(4):398-405.
	He QY, Wang WE . The guidelines for the diagnosis and treatment of obstructive sleep apnea hypopnea syndrome (basic version)[J]. Chin J Respir Crit Care Med, 2015,14(4):398-405.
[6]	傅民魁. 口腔正畸专科教程[M]. 北京: 人民卫生出版社, 2007: 92.
	Fu MK. Textbook of orthodontics[M]. Beijing: People’s Medical Publishing House, 2007: 92.
[7]	高雪梅, 曾祥龙, 傅民魁, 等. 口腔矫治器治疗OSAS的下颌定位[J]. 口腔正畸学, 2000,7(1):20-22.
	Gao XM, Zeng XL, Fu MK , et al. Mandible relocating in dental appliance treatment of obstructive sleep apnea syndrome[J]. Chin J Orthod, 2000,7(1):20-22.
[8]	O’Connor C, Thornley K, Hanly P. Gender differences in the polysomnographic features of obstructive sleep apnea[J]. Am J Respir Crit Care Med, 2000,161(5):1465-1472. doi: 10.1164/ajrccm.161.5.9904121 URL pmid: 10806140
[9]	陈科名, 杨崇实, 邓锋. 不同矢状骨面型错畸形患者气道大小形态的CBCT研究[J]. 口腔医学研究, 2012,28(1):54-57.
	Chen KM, Yang CS, Deng F . Airway morphology and volume in malocclusion patients with different sagittal facial types[J]. J Oral Sci Res, 2012,28(1):54-57.
[10]	Liu Y, Lowe AA, Zeng X, et al. Cephalometric comparisons between Chinese and Caucasian patients with obstructive sleep apnea[J]. Am J Orthod Dentofacial Orthop, 2000,117(4):479-485.
[11]	杜林娜, 郭泾. 双侧拉杆式口腔矫治器治疗阻塞型睡眠呼吸暂停综合征前后舌骨位置变化及相关因素分析[J]. 华西口腔医学杂志, 2013,31(1):34-37.
	Du LN, Guo J . Position change of hyoid bone induced by oral appliance of double-pull rods in patients with obstructive sleep apnea and hypopnea syndrome and analysis of relevant factors[J]. West China J Stomatol, 2013,31(1):34-37.
[12]	廉晨晨. 成人骨性Ⅱ类不同垂直骨面型气道容积与舌骨位置的CBCT分析[D]. 大连: 大连医科大学, 2017.
	Lian CC . The analysis based on CBCT for airway volume and hyoid bone abnormal changes related with diverse class Ⅱ skeletal vertical facial type[D]. Dalian: Dalian Medical University, 2017.
[13]	Cossellu G, Biagi R, Sarcina M, et al. Three-dimensional evaluation of upper airway in patients with obstructive sleep apnea syndrome during oral appliance therapy[J]. J Craniofac Surg, 2015,26(3):745-748. URL pmid: 25974784
[14]	曾祥龙, 唐志慧. 矢状骨面型与上气道形态和舌骨位置关系的研究[J]. 现代口腔医学杂志, 2004,18(3):231-234.
	Zeng XL, Tang ZH . A study of relationship between upper airway form and hyoid position and sagittal facial type[J]. J Modern Stomatol, 2004,18(3):231-234.
[15]	王越. Twin-Block和Activator矫治器对青春期骨性Ⅱ类上气道结构变化的研究[D]. 乌鲁木齐: 新疆医科大学, 2019.
	Wang Y . The study of twin-block and activator appliances on the structural change of class Ⅱ upper airway in adolescence[D]. Urumqi: Xinjiang Medical University, 2019.
[16]	涂景秋, 樊佳倩, 雷勇华. 不同垂直骨面型个别正常下颌骨形态及牙列特征研究[J]. 华西口腔医学杂志, 2017,35(4):403-407.
	Tu JQ, Fan JQ, Lei YH . Characteristics of mandible and mandibular dentition in patients with near-normal occlusion and different vertical facial skeletal types[J]. West China J Stomatol, 2017,35(4):403-407.
[17]	Wang S, Ye L, Li M, et al. Effects of growth hormone and functional appliance on mandibular growth in an adolescent rat model[J]. Angle Orthod, 2018,88(5):624-631. URL pmid: 29708397
[18]	Saglam-Aydinatay B, Taner T. Oral appliance therapy in obstructive sleep apnea: long-term adherence and patients experiences[J]. Med Oral Patol Oral Cir Bucal, 2018,23(1):e72-e77. doi: 10.4317/medoral.22158 URL pmid: 29274155

监测指标	分组	治疗前	治疗后	Р值
AHI/（次·h^-1）	高角组	30.56±0.68	19.77±1.12	>0.05
	均角组	29.35±1.31	7.54±0.25	<0.05
	低角组	28.15±0.48	6.36±0.54	<0.05
LSaO₂/%	高角组	75.47±0.76	83.54±1.12	>0.05
	均角组	73.85±0.31	85.93±0.55	<0.05
	低角组	72.24±0.69	86.14±0.81	<0.05

测量项目	分组	治疗前	治疗后	Р值
最小矢状径/mm	高角组	12.24±1.25	14.68±1.31	<0.05
	均角组	14.43±2.14	17.75±1.78	<0.05
	低角组	16.69±1.89	19.54±2.52	<0.05
最小横径/mm	高角组	23.12±1.37	24.63±1.93	<0.05
	均角组	24.85±2.35	26.97±2.45	<0.05
	低角组	25.77±2.66	27.83±1.82	<0.05
最小横截面积/mm²	高角组	208.33±39.26	267.67±43.53	<0.05
	均角组	230.15±42.39	314.49±41.98	<0.05
	低角组	251.23±36.42	330.75±45.71	<0.05
最小体积/mm³	高角组	6 130.67±1 108.54	6 647.23±1 315.36	<0.05
	均角组	7 344.51±1 237.30	8 093.14±1 309.71	<0.05
	低角组	7 689.38±1 208.47	8 109.81±1 401.65	<0.05

测量项目	分组	治疗前	治疗后	Р值
最小矢状径/mm	高角组	8.72±1.27	10.33±1.45	<0.05
	均角组	10.14±1.31	12.45±2.08	<0.05
	低角组	12.46±2.16	15.18±2.35	<0.05
最小横径/mm	高角组	21.27±2.63	21.97±2.49	>0.05
	均角组	22.36±3.14	23.74±2.31	<0.05
	低角组	23.12±2.56	24.48±3.24	<0.05
最小横截面积/mm²	高角组	247.49±40.28	279.38±48.02	>0.05
	均角组	286.85±46.13	337.92±39.50	<0.05
	低角组	279.43±43.51	310.49±52.22	<0.05
最小体积/mm³	高角组	5 958.32±1 027.54	6 210.54±1 152.62	>0.05
	均角组	6 587.24±1 316.37	7 139.41±1 272.83	<0.05
	低角组	6 704.74±1 027.54	7 366.19±1 443.29	<0.05