个性化的口腔矫治器治疗OSAHS机制的研究

Obstructive sleep apnea and hypopnea syndrome (OSAHS) is one of the most complicated and potentially fatal disease, which can seriously endanger people's health. Oral appliance (OA) is one of methods to cure OSAHS. The effective has been proved. The lower jaw needs to be moved forward when OA is applied. The adjusted position of the lower jaw was decided by dentist's experience, which will affect treatment effect if the position is improper. We have done many studies and found that it is better that letting patient adjusts the lower jaw position by themselves under dentist's direction. It can reach the personalized treatment effect. Base on above studies, we have developed a new OA named self-adjusted OA and used in the clinical, and got very good effect. However, the mechanisms of self-adjusted OA treatment is unclear. In this project, we will study the self-adjusted OA treatment mechanism. On OSAHS patients using CT, MRI image to obtain the individual upper airway and interrelated structure and analyze the three different position initial treatment position, the experience position and self-adjusted position. A biomechanics' simulation model is constructed, and used to do the biomechanied mechanism studies. This study will provide a theoretical guidance for individualized OA treatment of OSAHS and make the self-adjusted OA be popularization in the clinical field.

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是一种复杂的、具有潜在致死性的疾病，严重危害人们的健康。口腔矫治器作为治疗OSAHS的主要方法之一，其临床疗效已被证实。患者戴用矫治器时下颌需向前移位，目前下颌定位主要依靠临床医师的经验，若定位不当则影响其疗效。申请者在医师经验位的基础上，由医师指导，患者根据自身情况参与确定下颌位置即患者调节位，研发个性化的口腔矫治器，达到个性化治疗OSAHS的目的，初步取得了良好的临床疗效，但其形态学和生物力学机制尚不完全清楚。本项目在上述工作基础上，利用OSAHS患者上气道及相关结构（UAVS）的初始位、医师经验位、患者调节位的头颅侧位定位片进行X线头影测量，探讨其形态学机制；利用CT、MRI数据建立UAVS生物力学仿真系统模型，进行生物力学机制研究。为个性化的口腔矫治器治疗OSAHS提供理论依据，以提高和普及口腔矫治器治疗OSAHS的临床疗效及应用。

本项目利用OSAHS患者上气道及相关结构（UAVS）的初始位、医师经验位、患者调节位的头颅侧位定位片进行X线头影测量，医师经验位和患者调节位与治疗前比较均有差异，两者比较S-Ar-Go P值为0.095,H-MP P值为0.84，均大于0.05，其他测量项目均有显著差异（P<0.05）。探讨其形态学机制得出自行调节式口腔矫治器的医师经验位和患者调节位的下颌位置存在差异，该差异可以为下颌前伸类口腔矫治器个性化治疗的下颌前伸定位研究提供参考【1】。利用CT、MRI数据获得OSAHS从颞颌关节及上气道DICOM格式的图像信息，采用Mimics三维建模软件、 Imageware 逆向工程学软件、Ansys有限元分析软件建立的三维有限元模型。建立了OSAHS患者下颌骨和颞下颌关节（并包含上气道及周围结构）的三维有限元模型，共得到了949850个单元，932932个节点，既能精确显示其三维空间结构和形态，又可以模拟下颌前移式口腔矫治器治疗OSAHS【2】，能模拟治疗睡眠呼吸暂停低通气综合征评价疗效的UAVS生物力学仿真系统模型，进行了髁状突三维方向位置变化、颞下颌关节盘、舌咽部、舌骨、软腭末端截面三维有限元生物力学机制研究，得出上气道舌咽部会厌尖横截面横径增加，而上气道舌咽会厌尖横截面矢状径减小；S1主应力主要分布于上气道前壁区肌肉牵拉处，应力位置未发生明显改变，舌咽部主应力值随下颌距离增加而不断增加【3】。为个性化的口腔矫治器治疗OSAHS提供了理论依据，口腔矫治器可有效减轻OSAHS患者的白天嗜睡、打鼾等主观症状，改善患者睡眠过程中的呼吸情况，使OSAHS患者的睡眠呼吸状况趋向于健康正常人。有效的改善了OSAHS患者的生活质量及心理状况。