摘要目的:探索头帽－肌激动器，腺扁切除术以及二者联合应用对伴有呼吸异常的生长发育期Ⅱ类高角患者气道形态和通气功能的影响。方法:本研究为回顾性非随机对照实验，收集生长发育高峰期Ⅱ类高角患者33例，根据治疗项目不同，分为3组。矫形组15例[男女比例1∶2，年龄(8.8±1.1)岁]仅接受头帽－肌激动器治疗，手术组9例[男女比例2∶1，年龄(8.6±1.6)岁]仅接受腺扁切除术治疗，联合组9例[男女比例2∶7，年龄(8.2±1.0)岁]先行腺扁切除术，再行头帽－肌激动器治疗。采用头影测量分析和图片处理软件对侧位片进行测量，采用鼻通气检测观察通气功能变化。结果:三个组腭舌咽段交界处[矫形组治疗前(7.4±2.8) mm，治疗后(8.5±3.2) mm， P＝0.080；手术组治疗前(2.0±0.4) mm，治疗后(8.9±0.5) mm， P<0.001；联合组治疗前(4.1±0.6) mm，治疗后(9.5±0.7) mm， P<0.001]和舌咽段[矫形组治疗前(6.1±2.5) mm，治疗后(8.0±2.6) mm， P＝0.002，手术组治疗前(4.2±0.6) mm，治疗后(7.9±0.5) mm， P＝0.001，联合组治疗前(3.5±0.6) mm，治疗后(9.5±0.7) mm， P<0.001]矢状径均增大。手术组气道鼻咽段、鼻咽段下界矢状径增大[分别为治疗前11.2(1.6) mm，治疗后(20.4±0.9) mm， P<0.001；治疗前(18.8±1.4) mm，治疗后(23.2±0.9) mm， P＝0.002]。联合组气道鼻咽段矢状径增大[治疗前(13.6±0.8) mm，治疗后(19.1±1.0) mm， P<0.001]。矫形组[治疗前(802.8±396.3) ml/s，治疗后(1694.7±381.2) ml/s， P<0.001]和联合组[治疗前614.0(887.5) ml/s，治疗后1946.0(581.0) ml/s， P＝0.010]喷药后通气量增大。 结论:头帽－肌激动器能使咽部气道各段矢状径增大，通气功能明显好转。联合治疗能避免扁桃体切除术导致的喉咽段咽腔塌陷。

abstractsObjective:To explore the effects of and interactions between headgear-activator and adenotonsillectomy on pharyngeal airway morphology and ventilatory function in high angle Class Ⅱ children with abnormal breath and at growth spurt.Methods:The study was a retrospective non-randomized controlled trial. Thirty-three patients at the growth spurt were collected and divided into three groups according to treatment. Fifteen patients [the ratio of male to female was 1∶2, the average age was (8.8±1.1) year] in orthopedic group were treated by headgear-activator only. Nine patients [the ratio of male to female was 2∶1, the average age was (8.6±1.6) year] in operation group received adenotonsillectomy only. Nine patients [the ratio of male to female was 2∶7, the average age was (8.2±1.0) year] in combined group received adenotonsillectomy followed by headgear-activator. Cephalometric analysis and graphic software were used to measure lateral cephalograms. Nasal ventilatory function was used to observe the changes of ventilatory function.Results:Sagittal diameter of the junction between the palatopharynx and glossopharynx [orthopedic group from (7.4±2.8) mm to (8.5±3.2) mm, P=0.080; operation group from (2.0±0.4) mm to (8.9±0.5) mm, combined group from (4.1±0.6) mm to (9.5±0.7) mm, P<0.001] and the glossopharynx [orthopedic group from (6.1±2.5) mm to (8.0±2.6) mm, P=0.002; operation group from (4.2±0.6) mm to (7.9±0.5) mm, P=0.001; combined group from (3.5±0.6) mm to (9.5±0.7) mm, P<0.001] enhanced in all groups. In operation group, sagittal diameter of the nasopharynx [from 11.2(1.6) mm to (20.4±0.9) mm, P<0.001] and inferior border of nasopharynx [from (18.8±1.4) mm to (23.2±0.9) mm, P=0.002] enhanced. In combined group, sagittal diameter of the nasopharynx [from (13.6±0.8) mm to (19.1±1.0) mm, P<0.001] enhanced. The nasal ventilatory function enhanced in orthopedic group [from (802.8±396.3) ml/s to (1694.7±381.2) ml/s, P<0.001] and combined group [from 614.0(887.5) ml/s to 1946.0(581.0) ml/s, P=0.001]. Conclusions:Headgear-activator can increase the sagittal diameter throughout the whole pharyngeal airway and improve the nasal ventilatory function significantly. The combined treatment can avoid the collapse of the pharyngeal cavity of the laryngopharynx caused by tonsillectomy.