目的 探索一种适用于治疗黄种人群凸面型OSAHS患者的改良双颌前徙手术术式。评估应用改良双颌前徙手术治疗凸面型OSAHS患者的术后效果。初步研究针对于不同患者如何选择各种双颌前徙手术。 方法 应用改良双颌前徙术治疗的OSAHS患者5例，应用传统的双颌前徙术治疗的OSAHS患者2例，应用下颌骨应用牵引成骨+上颌前移术治疗的OSAHS患者1例。通过术前术后睡眠呼吸监测检查、X线头影测量、三维螺旋CT检查、鼻咽纤维镜检查以及主观问询调查，评估应用改良双颌前徙术治疗凸面型OSAHS患者与传统双颌前徙术相比的术后疗效以及优缺点。中国耳鼻喉科OSAHS的诊断标准：正常，AHI小于5次/小时；轻度OSAHS ， AHI在5-20次/小时之间；中度0SAHS， AHI在21-40次/小时之间，；重度OSAHS，AHI大于40次/小时。OSAHS的治愈标准为：AHI<5次/小时，LSAT>85%，且睡眠打鼾、憋气和日间嗜睡症状消失。 结果 所有进行改良双颌前徙手术治疗的5名患者，通过术前术后的PSG检查发现， AHI术前为22.6次/小时到67.3次/小时，平均为43.14±11.23次/小时；术后为1.5次/小时到11.6次/小时，平均为5.36±3.74次/小时，P〈0. 001。术前最低血氧饱和度61%-80%，术后最低血氧饱和度89%-91%。患者术前PAS平均为5.00±2.13㎜，经过改良双颌前徙术术后PAS增加到10.60±2.47㎜。术后3名患者完全治愈。另外2名患者AHI术前分别为67.3次/小时和35.5次/小时，术后分别为11.6次/小时和8.2次/小时；LSAT术前分别为61%和65%，术后分别90%和89%。鼻咽纤维镜检查发现，患者经改良双颌前徙术术后上气道口径得到了明显的增加；患者进行Muller氏运动时，上气道的塌陷也得到了明显的改善，尤其是咽侧壁的塌陷。所有患者主观症状均明显改善，并且所有患者对术后面型的改变十分满意，愿意将此种治疗方法介绍给其他患者。三维CT研究发现术后上气道的横径和前后径在各个层面上都得到了明显的增大，上气道的横截面积在各个层面上也得到了明显的增大。改良双颌前徙手术治疗后咽后壁和咽侧壁的软组织厚度在各个平面上均较术前都有所变薄。 应用传统的双颌前徙手术治疗的2名患者术前AHI分别为77.3次/小时和21.7次/小时，术后分别为3.7次/小时和2.5次/小时；LSAT术前分别为76%和80%，术后分别为90%和95%。术前PAS分别为5.5㎜和7.5㎜，术后分别为11㎜和9. 5㎜。所有患者主观症状均明显改善。所有患者对术后面型的改变十分满意，愿意将此种治疗方法介绍给其他患者。 应用下颌骨牵引成骨+上颌前移术治疗的1名患者术前AHI为92.2次/小时，术后为8.9次/小时；LSAT术前为47%，术后为88%。PAS术前为2㎜，术后12.5㎜。患者术后睡眠打鼾、憋气和日间嗜睡症状消失。该患者对术后面型的改变十分满意，愿意将此种治疗方法介绍给其他患者。 结论 黄种人群0SAHS患者的面型多以凸面型为主。改良的双颌前徙手术十分适用于治疗黄种人群凸面型OSAHS患者。改良的双颁前徙手术与传统的双颌前徙手术的作用机制相同，术后的效果相当。改良双颌前徙手术通过拔除上下颌前磨牙，使上下颌骨整体前移，而前部骨段的位置不变或者不会过度前移，这样既能改善患者的睡眠呼吸情况，同时又不会使患者术后的面型显得更突，不会出现上下颌骨的过度前突。传统的双颌前徙手术主要适用于凹面型和直面型的OSAHS患者。改良的双颌前徙手术主要适用于凸面型和无颌骨畸形的OSAHS患者。下颌骨牵引成骨+上颌前移术主要适用于存在严重颌骨发育不全的患者。

 Objective: A prospective study to evaluate the modified maxillomandibular advancement (MMMA) technique for the treatment of obstructive sleep apnea syndrome (OSAS) in yellow race of convex profile. A primary study to select three kinds of maxillomandibular advancement, including maxillomandibular advancement(MMA),modifiedmaxillomandibular advancement (MMMA), mandibular distraction osteogenesis and manxilla advancement (MDOMA) ,for different kinds of patients. Methods: Five patients underwent MMMA for the treatment of OSAS. Two patients underwent MMA for the treatment. One patient underwent MDOMA for the treatment. All the patients underwent presurgical and postsurgical polysomnography, cephalometric analysis, nasolaryngoscopy, three dimensional helical computed tomography scanning and objective results assessment. Results: The preoperative polysomnography results of the five patients who underwent MMMA were as follows: apnea-hypopnea index, 43.14±11.23; lowest oxygen saturation, 61%--80%; the postoperative polysomnography results were as follows: apnea-hypopnea index, 5.36±3.74; lowest oxygen saturation, 89%--91 %.3 of 5 patients who underwent modified maxillomandibular advancement were cured. The mean preoperative PAS was 5.00±2.13㎜, and the mean postoperative PAS was 10.60±2.47㎜. The preoperative polysomnography results of the two patients who underwent MMA were as follows: apnea-hypopnea index, 77.3 and 21.7; lowest oxygen saturation, 76% and 80%; the postoperative polysomnography results were as follows: apnea-hypopnea index, 3.7 and 2.5; lowest oxygen saturation, 90% and 95%. The preoperative PAS were 5.5㎜ and 7.5㎜, and the postoperative PAS were 11㎜ and 9.5㎜. The preoperative polysomnography results of the two patients who underwent MDOMA were as follows: apnea-hypopnea index, 92.2; lowest oxygen saturation, 47%; the postoperative polysomnography results were as follows: apnea-hypopnea index, 8.9; lowest oxygen saturation, 88%. The preoperative PAS was 2㎜, and the postoperative PAS was 12.5㎜. Conclusions: The preliminary review has demonstrated that the modified MMA technique for the treatment of OSAS is highly effective in the treatment of severe OSAS without the significant facial profile change commonly associated with the traditional MMA technique. With the introduction of this modified MMA technique for the treatment of OSAS, skeletal surgery may be less perceived as an unattractive treatment modality due to the markedly reduced anticipated facial changes after surgery. [Key Words] Modified maxillomandibular advancement, Maxillomandibular advancement,Mandibular distraction osteogenesis and manxilla advancement, Obstructive sleep apnea syndrome.