肌功能训练联合咬合诱导器治疗OSA儿童牙列不齐的临床疗效

辛渊; 陈洁; 孙培音

doi:10.13201/j.issn.2096-7993.2023.08.008

肌功能训练联合咬合诱导器治疗OSA儿童牙列不齐的临床疗效

- 上海交通大学医学院附属上海儿童医学中心耳鼻喉口腔颌面外科(上海，200127)
基金项目:
上海市卫生健康委员会上海市综合医院中西医结合专项(No：ZHYY-ZXYJHZX-202009)

详细信息

通讯作者: 孙培音，E-mail：776526694@qq.com

中图分类号: R766

收稿日期: 2023-05-08

刊出日期: 2023-08-03

The efficacy of muscle function training combined with occlusal inducer in the treatment of malocclusion in children with OSA

- Department of Otorhinolaryngology Oral and Maxillofacial Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China

More Information

Corresponding author: SUN Peiyin, E-mail: 776526694@qq.com

Received Date: 08 May 2023

Publish Date: 03 August 2023

摘要

摘要: 目的探讨肌功能训练联合咬合诱导器在阻塞性睡眠呼吸暂停(obstructive sleep apnea，OSA)儿童术后牙列不齐治疗中的临床效果。方法选取2020年1月—2021年12月就诊于上海交通大学医学院附属上海儿童医学中心耳鼻喉口腔颌面外科OSA术后40例患儿，分为治疗组(20例)和对照组(20例)，治疗组通过肌功能训练联合咬合诱导器，对照组仅行肌功能训练。比较两组头影测量硬组织术前、术后12个月的数值变化及术前、术后6、12个月儿童阻塞性睡眠呼吸暂停18项生活质量调查表(OSA-18)评分。结果 ① 两组患者术后12个月睡眠障碍、身体症状、情绪状况、白天嗜睡和精力状态及对监护人的影响程度均得到明显改善(P＜0.05)，治疗组在睡眠障碍、身体症状、情绪状况、对监护人的影响程度的评分优于对照组(P＜0.05)；②术后12个月头影测量数据显示：治疗组术后12个月的上下齿槽座角(ANB)、覆 (overbite)、上下中切牙角(U1-L1)、覆盖(overjet)，与对照组比较有所减小，差异有统计学意义(P＜0.05)。结论儿童OSA患者术后可通过肌功能训练联合咬合诱导器改善牙列不齐，其效果优于单纯肌功能训练。
- 肌功能训练 /
- 咬合诱导器 /
- 阻塞性睡眠呼吸暂停 /
- 牙列不齐
Abstract: Objective This study aims to investigate the clinical effectiveness of muscle function training combined with occlusal inducers in the treatment for children's malocclusion after obstructive sleep apnea(OSA) surgery.Methods A total of 40 pediatric patients who underwent surgery for OSA at Shanghai Children's Medical Center, affiliated with Shanghai Jiao Tong University School of Medicine, from January 2020 to December 2021 were involved in this study. They were divided into a treatment group(n=20) and a control group(n=20). The treatment group received muscle function training combined with occlusal inducers, while the control group received muscle function training alone. Cephalometric measurements of hard tissues were compared between the two groups before and 12 months after surgery. Additionally, the OSA-18 questionnaire, which includes 18 items to assess the life quality of children with OSA, was filled out before surgery, 6 months after surgery, and 12 months after surgery by these patients.Results ① The scores of sleep disorders, physical symptoms, emotional status, daytime sleepiness and energy status and the degree of influence on guardians in the two groups were significantly improved at 12 months after operation(P < 0.05). The scores of sleep disorders, physical symptoms, emotional status and the degree of influence on guardians in the treatment group were better than those in the control group(P < 0.05). ②Cephalometric data at 12 months after operation showed that the upper and lower alveolar seat angle(ANB), Overbite, upper and lower central incisor angle(U1-L1) and Overjet in the treatment group were lower than those in the control group at 12 months after operation, and the difference was statistically significant(P < 0.05).Conclusion Children with OSA can improve the dentition irregularity by muscle function training combined with occlusal inducer after operation, and the effect is better than that of muscle function training alone.
- muscle function training /
- occlusal inducers /
- obstructive sleep apnea /
- malocclusion

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图 1 术前面相照

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图 2 术后12个月面相照

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图 3 前后口内照

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图 4 X线侧位片

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图 5 全景牙片

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图 6 生物力学仿真图

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表 1 肌功能训练内容

练习内容	方法	时间/次数	具体内容
唇肌训练	包唇训练	2 min/组，5组/d	上、下唇红完全包裹在一起，持续10 s/次
舌肌训练	N点训练	5 min/组，3组/d	上切牙后5 mm，舌尖顶在切牙乳突(N点)，保证唇肌无运动，每次保持10 s
吞咽训练	喝水训练	50口/组，2组/d	喝一口水，吞咽时舌尖放置切牙乳突的位置，每次持续10 s，连续50口
咬肌训练	咬肌练习	10 min/组，2组/d	双手触之下颌角，咬紧后牙，可触摸凸出的咬肌，每次持续10 s

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表 2 两组OSA患儿手术前后OSA-18问卷调查分析 X±S

分组	总分			睡眠障碍
分组	术前	术后6个月	术后12个月	术前	术后6个月	术后12个月
治疗组	76.47±7.81	41.82±6.84	33.47±3.61	17.59±2.45	7.88±1.36	5.47±1.23
对照组	76.12±7.87	45.24±6.51	40.88±5.87	18.35±2.52	10.94±2.63	6.71±2.20
P	0.445	0.057	＜0.01	0.170	＜0.01	＜0.05

分组	身体症状			情绪状况
分组	术前	术后6个月	术后12个月	术前	术后6个月	术后12个月
治疗组	20.29±2.97	9.29±1.21	5.35±1.05	14.88±2.47	8.76±1.82	5.71±1.49
对照组	20.12±3.08	11.18±1.97	8.06±1.81	15.06±2.72	9.94±1.02	7.06±1.19
P	0.43	＜0.01	＜0.01	0.417	＜0.01	＜0.01

分组	白天嗜睡和精力状态			对监护人的影响
分组	术前	术后6个月	术后12个月	术前	术后6个月	术后12个月
治疗组	10.35±2.37	6.59±2.12	5.71±1.49	18.00±2.37	10.12±2.59	8.41±1.69
对照组	10.53±2.18	6.19±2.12	6.24±2.16	17.94±2.33	10.35±2.47	9.53±2.09
P	0.402	0.276	0.187	0.468	0.387	＜0.05

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表 3 术前、术后12个月头影测量硬组织变化 X±S

组别	例数	SNA/°		SNB/°
组别	例数	治疗前	治疗后	治疗前	治疗后
治疗组	20	79.85±2.37	81.80±0.67	73.46±2.12	74.95±1.33
对照组	20	80.52±4.51	81.17±3.52	73.88±3.65	74.14±3.02
P		0.280	0.218	0.326	0.140

组别	例数	ANB/°		MP-FH/°
组别	例数	治疗前	治疗后	治疗前	治疗后
治疗组	20	7.26±1.35	5.40±0.40	28.38±9.74	29.05±4.38
对照组	20	7.41±1.60	7.45±3.53	27.98±5.14	28.31±5.11
P		0.367	＜0.01	0.436	0.313

组别	例数	覆/mm		L1-MP/°
组别	例数	治疗前	治疗后	治疗前	治疗后
治疗组	20	3.59±2.31	0.65±2.31	89.28±8.76	92.36±7.62
对照组	20	3.46±1.54	2.73±1.56	91.13±8.61	91.23±5.35
P		0.418	＜0.01	0.252	0.296

组别	例数	U1-L1/°		覆盖/mm
组别	例数	治疗前	治疗后	治疗前	治疗后
治疗组	20	137.12±13.06	116.52±23.75	6.12±0.90	3.34±0.59
对照组	20	139.65±9.85	137.15±10.10	5.80±1.34	5.43±1.49
P		0.247	＜0.01	0.190	＜0.01

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