摘要
目的 观察锁结式口腔矫治器、架定位式口腔矫治器治疗轻、中度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)主、客观疗效及其对颞下颌关节(temporomandibular joint,TMJ)形态的影响.方法 本研究为病例对照研究,选取30例成年OSAHS患者,随机分为A、B两组.A组15例患者戴用锁结式口腔矫治器,男性9例,女性6例;B组15例患者戴用架定位式口腔矫治器,男性10例,女性5例.在治疗前和治疗6个月时,进行睡眠呼吸监测仪监测,拍摄TMJ锥形束CT进行测量分析,填写Epworth嗜睡评分量表(epworth sleepiness scale,ESS).结果 A组治疗前呼吸暂停低通气指数(apnea hypopnea index,AHI)为(18.10±5.73)次/时,治疗后为(4.47±1.33)次/时(P＜0.001);B组治疗前 AHI 为(18.33±6.02)次/时,治疗后为(4.77±1.18)次/时(P＜0.001);A组治疗前ESS为(10.67±2.64)分,治疗后为(4.73±2.34)分(P＜0.001);B组治疗前 ESS 为(10.93±2.71)分,治疗后为(4.87±2.30)分(P＜0.001);A组治疗前关节前间隙为(2.55±0.17)mm,治疗后为(2.42±0.18)mm(P=0.041);B组治疗前关节前间隙(2.57±0.14)mm,治疗后为(2.39±0.15)mm(P=0.006);A组治疗前关节后间隙为(2.42±0.11)mm,治疗后为(2.56±0.22)mm(P=0.044);B组治疗前关节后间隙为(2.43±0.11)mm,治疗后为(2.61±0.19)mm(P=0.006);A组治疗前关节上间隙为(2.94±0.17)mm,治疗后为(3.07±0.18)mm(P=0.012);B组治疗前关节上间隙为(2.93±0.14)mm,治疗后为(3.06±0.19)mm(P=0.017).两组间比较结果显示睡眠监测值、TMJ形态指标、ESS分值差异无统计学意义.结论 两种口腔矫治器对OSAHS患者均有较好的主、客观疗效;戴入两种口腔矫治器后髁突发生前下移位,但未发现髁突及关节窝形态发生明显变化.
Abstract
Objective Observation of the subjective and objective efficacy of the locking knot oral appliance and articulator positioning oral appliance in the treatment of mild and moderate Obstructive Sleep Apnea Hypopnea Syndrome(OSAHS)and its effect on the morphology of the temporomandibular joint(TMJ).Methods The present study was a case-control study,and 30 study subjects were selected and randomly divided into two groups,A and B.Fifteen patients in group A wore locking knot oral appliance,9 males and 6 females,and 15 patients in group B wore articulator positioning oral appliance,10 males and 5 females.Before treatment and at 6 months of treatment,a sleep apnea monitor was performed,a cone beam CT of the TMJ was taken for measurement and analysis,and the Epworth Sleepiness Scale(ESS)was filled out.Results Apnea Hypopnea Index(AHD was(18.10±5.73)before treatment and(4.47±1.33)after treatment in group A(P＜0.001).AHI in group B was(18.33±6.02)before treatment and(4.77±1.18)after treatment(P＜0.001).ESS of group A was(10.67±2.64)points before treatment and(4.73±2.34)points after treatment(P=0.00).ESS of group B was(10.93±2.71)points before treatment and(4.87±2.30)points after treatment(P＜0.001).Group A's pre-treatment anterior joint space was(2.55±0.17)mm and after treatment it was(2.42±0.18)mm(P=0.041).Group B's pre-treatment anterior joint space was(2.57±0.14)mm and after treatment it was(2.39±0.15)mm(P=0.006).Group A's pre-treatment posterior joint space was(2.42±0.11)mm and after treatment it was(2.56±0.22)mm(P=0.044).Group B's post joint gap was(2.43±0.11)mm before treatment and(2.61±0.19)mm after treatment(p=0.006).Group A's supra-articular gap was(2.94±0.17)mm before treatment and(3.07±0.18)mm after treatment(P=0.012).Group A's supra-articular gap was(2.93±0.14)mm before treatment and(3.06±0.19)mm after treatment(P=0.017).Comparison of the results between the two groups showed that the p-values of sleep monitoring values,TMJ morphology indexes,and ESS scores were not statistically significant.Conclusions Both kinds of oral appliance have good subjective and objective curative effect on OSAHS patients.After the two kinds of orthodontic devices were used,the condyle was shifted anterior-downward,but neither condyle nor joint fossa morphology changed significantly.
维普
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