中国实用口腔科杂志

中国实用口腔科杂志

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基于锥形束CT分析骨性Ⅲ类高角伴下颌偏斜患者髁突形态和位置的研究

周林曦1，张幸竹2，房兵1，张桂荣2   

  1. 1. 上海交通大学医学院附属第九人民医院·口腔医学院口腔正畸科，国家口腔疾病临床医学研究中心，上海市口腔医学重点实验室，上海市口腔医学研究所，上海 200011；2. 沈阳市口腔医院，辽宁 沈阳 110002
  • 出版日期:2021-01-30 发布日期:2021-02-08
  • 基金资助:
    国家自然科学基金面上项目（81870790）；上海市科委生物医药项目（18441903600）；辽宁省“兴辽英才”计划项目（XLYC1902073）

  • Online:2021-01-30 Published:2021-02-08

摘要： 目的 应用锥形束CT（CBCT）对比分析骨性Ⅲ类高角伴下颌偏斜患者与个别正常牙合患者髁突的形态和位置。方法 选取2017年9月至2019年9月于上海交通大学医学院附属第九人民医院口腔正畸科就诊的患者40例，其中骨性Ⅲ类高角伴下颌偏斜患者20例（偏斜组），个别正常牙合患者20例（对照组）。所有患者于治疗前拍摄CBCT，使用Invivo 5.0软件对CBCT影像进行三维重建及测量，并比较两组患者两侧髁突形态和位置的差异。结果 （1）偏斜组患者两侧髁突形态和位置指标测量值比较发现，在髁突形态方面，偏斜侧髁突最大轴面面积、髁突高度、髁顶高度均比非偏斜侧小，差异均有统计学意义（均P < 0.05）。在髁突位置方面，偏斜侧髁突外间隙、上间隙和后间隙比非偏斜侧小；偏斜侧髁突前间隙、内间隙及髁突外突距比非偏斜侧大，差异均有统计学意义（均P < 0.05）。（2）对照组两侧髁突形态和位置指标测量值比较，差异均无统计学意义（均P > 0.05）。（3）偏斜组两侧髁突形态和位置指标测量值分别与对照组比较发现，在髁突形态方面，偏斜组偏斜侧髁突高度比对照组大，最大轴面面积比对照组小；非偏斜侧髁突高度大于对照组，差异均有统计学意义（均P < 0.05）。在髁突位置方面，偏斜组偏斜侧髁突上间隙小于对照组，髁突内间隙、前间隙、髁突外突距及髁突与正中矢状面距大于对照组，差异均有统计学意义（均P < 0.05）。结论 骨性Ⅲ类高角伴下颌偏斜患者双侧髁突的形态和位置具有明显的不对称性，偏斜侧髁突形态较对侧小，并向后上外方向移位。骨性Ⅲ类高角伴下颌偏斜患者的髁突高度比个别正常牙合患者大。

关键词: 下颌偏斜, 骨性Ⅲ类高角, 髁突, 锥形束CT

Abstract: Objective Compare and analyze the morphology and position of the condyle in skeletal class Ⅲ high-angle patients with mandibular deviation and normal patients by using cone-beam CT（CBCT）. Methods A total of 40 patients were selected，who took CBCT imaging before treatment in Orthodontics Department of Shanghai Ninth People′s Hospital between September 2017 and September 2019. Among them，there were 20 patients with skeletal class Ⅲhigh-angle with mandibular deviation（deviated group），and 20 patients with normal occlusion（control group）. Invivo 5.0 software was used to measure the CBCT and to reconstruct the TMJ in all patients. The difference in the position and morphology of bilateral condyle between the two groups was compared. Results （1）Comparison between two sides of the deviated group：in morphology，the condylar maximum area，condylar apex height and condylar perpendicular height on the deviated side were all smaller than those of the non-deviated side （P < 0.05）. Comparison of the two sides in position showed that the outer joint space，superior joint space and posterior joint space of the deviated side were smaller than those of the other side， while the anterior joint space，inner joint space and length of outermost point of the deviated side were bigger （P < 0.05）.（2）There were no significant differences between the two sides of condylar in control group.（3）The two sides of the deviated group were compared with those of the control group：in morphology，the condylar perpendicular height on the deviated side of deviated group was bigger than that of control group， while the condylar maximum area was smaller than the contorl group. The condylar perpendicular height on the non-deviated side in deviated group was also bigger than that of the control group （P < 0.05）. Comparing the position，the superior joint space of deviated side in deviated group was smaller than that of control group，while the inner joint space，anterior joint space，length of outermost point and radius of the deviated group was bigger than those of control group（P < 0.05）. Conclusion　The condyles of skeletal class Ⅲ high-angle patients with mandibular deviation are obviously asymmetric in morphology and position. The condyle in deviated side is smaller，shifting backward，upward and outward. Condylar perpendicular height in the deviated group is bigger in skeletal class Ⅲ high-angle patients with mandibular deviation than in those with normal mandible.

Key words: mandibular deviation；skeletal class Ⅲ high angle；condyle；cone-beam CT, CBCT