中国实用口腔科杂志

中国实用口腔科杂志

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不同矢状骨面型患者颞下颌关节形态特征锥形束CT研究

崔    燕，唐天琪，刘    琳   

  1. 大连医科大学附属大连市口腔医院，辽宁  大连 116021
  • 出版日期:2016-06-15 发布日期:2016-07-13

  • Online:2016-06-15 Published:2016-07-13

摘要：

目的    通过锥形束CT（cone beam computed tomography，CBCT）探讨不同矢状骨面型患者颞下颌关节形态特征的差异。方法    选择2013年1月至2014年12月在大连医科大学附属大连市口腔医院正畸科就诊、临床资料完整、CBCT影像资料采集方法一致的60例高角患者［SN-MP角（下颌平面与前颅底平面之交角）＞38°］为研究对象，年龄 17～21岁，男女比例1∶1。根据中国人正常牙合Steiner分析法的测量均值，以ANB角（上齿槽座点-鼻根点-下齿槽座点角）均值加减1倍标准差为界限分为骨性Ⅰ、Ⅱ、Ⅲ类（每组均为男10例，女10例）。采用美国KaVo公司的KaVo3DeXam计算机锥形束体层摄影系统，在相同条件下对所有研究对象的CBCT影像进行扫描，通过三维分析软件InvivoDental5.1对获得的头颅三维影像进行颞下颌关节的分析。将所得数据输入SPSS19.0软件，建立数据库并进行统计学分析。结果    骨性Ⅱ类患者左侧关节前间隙小于右侧关节前间隙、左侧关节结节后斜面角度和关节窝深度均大于右侧，差异有统计学意义（P＜0.05）；骨性Ⅲ类患者左侧关节窝深度均大于右侧，差异有统计学意义（P＜0.05）。骨性Ⅰ类和Ⅲ类患者关节前间隙均小于骨性Ⅱ类患者，差异有统计学意义（P＜0.05）；骨性Ⅰ类和Ⅱ类患者关节后间隙均小于骨性Ⅲ类患者、关节窝宽度和关节窝深度均小于骨性Ⅲ类患者、关节结节后斜面角度均大于骨性Ⅲ类患者，差异有统计学意义（P＜0.05）。本研究中骨性Ⅰ类患者80.0％髁突在关节窝的位置居中，骨性Ⅱ类患者77.5％髁突发生后移，骨性Ⅲ类患者75.0％髁突发生前移。结论    （1）各类错牙合间左右关节位置基本对称；（2）骨性Ⅰ类患者髁突位置居中、骨性Ⅱ类患者髁突位置后移、骨性Ⅲ类患者髁突位置前移的比例较大；（3）骨性Ⅲ类患者的关节窝比骨性Ⅰ类、Ⅱ类患者更宽、更浅；（4）关节窝的形态与关节结节后斜面斜度和关节窝高度相关。

关键词: 颞下颌关节, 锥形束CT, 错牙合畸形, 不同矢状骨面型, 高角

Abstract:

Objective    To investigate the difference in the features of temporomandibular joint morphology of patients with different sagittal skeletal patterns by CBCT. Methods    Totally 60 cases（age：17 to 21 years old， male 30， female 30）were chosen as the research objects in the Dalian Stomatology Hospital from 2013 January to 2014 December.Their clinical data was complete and CBCT image data was acquired in the same way.According to the measuring means of Chinese normal occlusion by Steiner analysis method，patients were divided into three groups：classⅠ，class Ⅱand class Ⅲ （each group included 10 male cases， 10 female cases）.Patients were scaned by KaVo3DeXam cone beam tomography system of American KaVo Company in the same condition，the 3-D images obtained. TMJ analysis of the InvivoDental5.1 was used to analyze the condylar position and glenoid fossa morphology in three dimensions. All of the data was analyzed by SPSS19.0 software. Results    The left joint′s anterior space of class Ⅱpatients was smaller than the right；left articular tubercle posterior slope angle and the glenoid fossa depth were bigger than the right side，the difference being statistically significant （P < 0.05）. The left articular fossa depth of classⅢpatients were bigger than the right side，the difference being statistically significant（P < 0.05）. ClassⅠpatients′ and class Ⅲ patients′ anterior space was smaller than that of class Ⅱ patients′， the difference being statistically significant（P < 0.05）．Class Ⅰ patients′and class Ⅱ patients′ posterior space was smaller than ClassⅢpatients′. The width and depth of the glenoid fossa were smaller than Class Ⅲ patients′ and the posterior slope angles of the articular eminence were greater than the class Ⅲ patients′. The difference was statistically significant（P < 0.05）．In this experiment，80.0％of class Ⅰ patients′ condyles were concentric in the glenoid fossa. About 77.5％ class Ⅱ patients′ condyles showed posterior position，and 75.0％class Ⅲ patients′ condyles showed anterior position．Conclusion    （1） The joints′position of different malocclusions is basically symmetrical. （2）Most class Ⅰ patients′condyles are concentric in the fossa， most class Ⅱ patients′ show posterior position and most class Ⅲ patients′ show anterior position. （3） Class Ⅲ patients′ articular fossa is much wider and more shallow than the classⅠand class Ⅱ patients′. （4） Morphology of articular fossa is highly relevant to the depth of articular fossa and the inclination of the glenoid fossa.

Key words: temporomandibular joint, CBCT, malocclusion, different sagittal skeletal pattern, high angle