【摘要】 目的 :探讨阻塞性睡眠呼吸暂停综合征 (OSAS)患者下颌从正中颌位至前伸位时 ,上气道形状变化特点及规律。方法 :1 7名成年男性和 2名成年女性OSAS患者取仰卧位 ,螺旋CT分别在正中颌位和下颌前伸位行上气道及周围结构的轴向扫描。测量各扫描层面的上气道矢状径和横径 ,矢状径与横径之比表示上气道形状 ,将正中颌位和前伸位时的测量结果进行统计学检验 ,比较上气道各段形状变化。结果 :下颌前伸 ,舌咽和喉咽的最小矢状径和平均值均增大 ,且上气道横径明显增宽 ,包括除喉咽以外的上气道各层面。此外 ,腭咽在水平面的形状也发生了变化 ,长轴位于横向的椭圆形状有进一步扁平的趋势。结论 :下颌前伸可以影响鼻咽、腭咽、舌咽和喉咽等各段的形态变化 ,这种变化包括矢状和横向及气道几何形状。上气道形态变化不仅是下颌前伸的机械牵拉造成的 ,而且可能还有神经调节及其他尚未知晓的因素的共同作用。这些形态变化构成口腔矫治器治疗OSAS的形态基础更多还原

【Abstract】 Objective: To determine the changes of upper airway morphology induced by mandible position from central relation to advancement position in patients with obstructive sleep apnea syndrome. Methods: Nineteen patients (17 males and 2 females) suffering from obstructive sleep apnea syndrome were confirmed with polysomnography. Occlusal wax record was made with mandible in advancement position. Helical computed tomography was performed on each patient in central relation and mandibular advancement position with wax record in situ respectively. On each slice, anteroposterior and transverse diameters were obtained. Airway shape was expressed as the anteroposterior/transverse (AP/T) diameter ratio. Paired samples t test was employed to compare the measurements. Results: With mandibular advancement, average and minimal diameters of glossopharynx and hypopharynx were increased significantly. Compared with it, the change of transverse diameter was more prominent. All segments of upper airway were increased significantly except hypophaynx laterally. Moreover, the change of velopharynx shape was observed on axial planes. Ellipse with transversal long axis became more compressed. Conclusion: Upper airway morphology of all segments was influenced by mandibular advancement whether in the sagittal or transverse plane of space, or airway shape. Not only anatomic connection but also regulation of the nerve system and other still unknown mechanism make contribution to the changes of upper airway morphology in patients with obstructive sleep apnea syndrome. The changes of upper airway morphology above mentioned constitute the rationale of treatment of obstructive sleep apnea syndrome with oral appliances.更多还原