传统与改良上颌下颌前徙术治疗成人阻塞性睡眠呼吸暂停患者手术效果的比较
Comparison of Surgical Effectiveness Between Conventional and Modified Maxillomandibular Advancement in Adult Patients With Obstructive Sleep Apnea.
文献信息
| PMID | 42802995 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Seung-Hyun Son |
| 作者单位 | Department of Orthodontics, School of Dentistry, Seoul National University. |
| 期刊 | The Journal of craniofacial surgery |
| SCI 分区 | Q3 |
| IF | 1.1 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 本研究旨在比较传统上颌下颌前徙术（cMMA）与改良上颌下颌前徙术（mMMA）在成人阻塞性睡眠呼吸暂停（OSA）患者中的手术效果。
方法： 研究对象为24例接受cMMA（n=11）或mMMA（n=13：拔除上颌和下颌前磨牙，行Le Fort I截骨术并配合分段截骨以向前移动上颌后段，以及行双侧下颌升支矢状劈开截骨术并配合分段截骨以实现下颌整体前徙）的成人OSA患者。对术前（T0）和术后（T1）获得的多导睡眠图（PSG）变量以及头影测量骨骼牙性、软组织、舌骨/舌和上气道（UA）变量进行统计分析。
结果： 在T0时，mMMA组表现出更高的呼吸暂停低通气指数（AHI）和呼吸紊乱指数（RDI）值（均P<0.05）、更靠前的上颌和下颌位置（SNA和SNB；均P<0.05）、更大的切牙唇倾度（U1至SN，P<0.05；IMPA，P<0.01）、更突出的上下唇（上唇至E平面和下唇至E平面，均P<0.05）、更靠前的颏结节（H-RGN，P<0.01）以及更长的舌长度（TGL，P<0.05）。在T1时，两组之间在上颌和下颌位置、切牙倾斜度或唇突出度方面未发现显著差异。此外，PSG参数和UA变量在两组之间也无差异，表明手术结果相当。
结论： 这些发现提示，对于伴有牙槽突和/或唇突出的成人OSA患者，mMMA可能是一种有效的手术选择。
英文摘要
The purpose of this study was to compare the surgical effectiveness of conventional maxillomandibular advancement (cMMA) and modified MMA (mMMA) in adult patients with obstructive sleep apnea (OSA). The subjects were 24 adult OSA patients who underwent either cMMA (n=11) or mMMA (n=13: extraction of maxillary and mandibular premolars, Le Fort I osteotomy with segmental osteotomy for advancement of the posterior maxillary segment, and bilateral sagittal split ramus osteotomy with segmental osteotomy for total advancement of the mandible). Polysomnographic (PSG) variables and cephalometric skeletodental, soft-tissue, hyoid/tongue, and upper-airway (UA) variables obtained before surgery (T0) and after surgery (T1) were statistically analyzed. At T0, the mMMA group exhibited higher apnea-hypopnea index (AHI) and respiratory disturbance index (RDI) values (both P<0.05), a more forward-positioned maxilla and mandible (SNA and SNB; both P<0.05), greater incisor proclination (U1 to SN, P<0.05; IMPA, P<0.01), more protrusive upper and lower lips (upper lip to E-plane and lower lip to E-plane, both P<0.05), a more forward-positioned genial tubercle (H-RGN, P<0.01), and a greater tongue length (TGL, P<0.05). At T1, no significant differences in the position of the maxilla and mandible, incisor inclination, or lip protrusion were found between the 2 groups. In addition, PSG parameters and UA variables did not differ between the 2 groups, indicating comparable surgical outcomes. These findings suggest that mMMA may be an effective surgical option for adult OSA patients with dentoalveolar and/or lip protrusion.