颞下颌关节盘前移位患者关节骨形态与矢状向关节盘位置的关系

doi:10.7518/hxkq.2022.04.007

华西口腔医学杂志 ›› 2022, Vol. 40 ›› Issue (4): 414-421.doi: 10.7518/hxkq.2022.04.007

颞下颌关节盘前移位患者关节骨形态与矢状向关节盘位置的关系

鄢梨¹(), 周茂强², 邱嘉旋¹()

^1.南昌大学第一附属医院口腔颌面外科，南昌 330006
^2.杭州优琦口腔门诊，杭州 310016

收稿日期:2022-01-24 修回日期:2022-04-10 出版日期:2022-07-25 发布日期:2022-07-27
通讯作者: 邱嘉旋 E-mail:yanli2020628@163.com;qiujiaxuan@163.com
作者简介:鄢梨，硕士，E-mail：yanli2020628@163.com
基金资助:
国家自然科学基金(81860477);江西省重点研发计划(20212BBG71005)

Association between bone morphology and sagittal disc position in temporomandibular joints of patients with anterior disc displacement

Yan Li¹(), Zhou Maoqiang², Qiu Jiaxuan¹()

^1.Dept. of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
^2.Hangzhou Youqi Dental Clinic, Hangzhou 310016, China

Received:2022-01-24 Revised:2022-04-10 Online:2022-07-25 Published:2022-07-27
Contact: Qiu Jiaxuan E-mail:yanli2020628@163.com;qiujiaxuan@163.com
Supported by:
National Natural Science Foundation of China(81860477);Jiangxi Provincial Key R&D Plan(20212-BBG71005);Correspondence: Qiu Jiaxuan, E-mail: qiujiaxuan@163.com

摘要/Abstract

摘要：

目的　利用磁共振成像（MRI）技术和锥形束CT（CBCT）分析颞下颌关节盘前移位患者矢状向关节盘位置与关节骨形态的关系。方法　对97例患者的178个颞下颌关节（TMJ）进行回顾性分析，根据矢状向MRI上关节盘的位置分成4组，即对照组（关节盘无移位）、轻度组（关节盘轻度前移位）、中度组（关节盘中度前移位）和重度组（关节盘重度前移位）。然后利用Mimics 20软件基于CBCT数据进行TMJ的相关形态学参数测量，包括髁突线性尺寸（宽度、长度和高度）、髁突体积和表面积，关节窝的深度和长度，关节结节倾斜角，关节前、上、后间隙等，并对各组矢状髁突位置进行评估。使用方差分析、非参数检验和卡方检验等比较关节形态及位置参数的组间差异，采用相关性分析探索矢状关节盘位置与关节测量参数之间的相关性。结果　髁突的线性尺寸、关节窝深度、关节倾斜角、关节间隙和矢状髁突位置分布在4组间差异有统计学意义，而关节窝长度在4组间差异没有统计学意义；相关性分析显示：髁突的线性尺寸、髁突的体积及表面积、关节窝的深度、关节结节倾斜角和关节上间隙与关节盘矢状位置之间存在显著负相关，而关节后间隙与矢状关节盘位置之间存在显著正相关。结论　TMJ骨形态与不同矢状关节盘位置之间存在相关性，应警惕临床看到的关节骨形态的退行性改变可能是患者存在关节盘前移位的标志。

关键词: 颞下颌关节, 关节盘前移位, 锥形束CT, 磁共振成像, 矢状向, 形态学测量

Abstract:

Objective To analyze the association between sagittal temporomandibular joint (TMJ) disc position of patients with anterior disc displacement evaluated by magnetic resonance imaging (MRI) and bone morphology of the TMJ evaluated by cone-beam computed tomography (CBCT). Methods One hundred and seventy-eight TMJs of 97 patients were retrospectively analyzed. The TMJ disc position was evaluated using MRI and classified into four types: control group (without disc displacement), slight group (disc slightly anteriorly displaced), moderate group (disc moderately anteriorly displaced), and severe group (disc severely anteriorly displaced). The measurements of TMJ bone morphology among four groups were evaluated by CBCT through Mimics software including condyle linear dimensions (condyle length, width, and height), condylar volume and surface area, and the depth and length of the glenoid fossa, joint anterior space, joint superior space, and joint posterior space. The sagittal plane position of the condyle was also assessed. The differences in all the morphologic measurement parameters among the four groups were detected using the one-way analysis of variance or the Kruskal Wallis test, and Chi-square tests. The correlations between disc sagittal position and all the morphologic measurements were also analyzed. Results There were significant differences in measurements of condyle linear dimensions, condylar volume and surface area, depth of the glenoid fossa, joint spaces, and distribution of the condyle sagittal positions among the four groups. By contrast, there were no statistical differences in terms of the length of the glenoid fossa among the four groups. Correlation analysis revealed that there is a statistically significant negative correlation among condyle linear dimensions, condylar volume and surface area, the depth of the glenoid fossa, joint superior space, and disc position. However, joint posterior space was positively correlated with disc position. Conclusion A statistically significant correlation was determined between TMJ bone morphology and different sagittal disc positions. Degenerative changes in TMJ bone morphology clinically diagnosed should be altered, which can be the patients' marker of anterior disc displacement.

Key words: temporomandibular joint, anterior disc displacement, cone beam CT, magnetic resonance ima-ging, sagittal position, morphologic measurement

中图分类号:

R 782.6

鄢梨, 周茂强, 邱嘉旋. 颞下颌关节盘前移位患者关节骨形态与矢状向关节盘位置的关系[J]. 华西口腔医学杂志, 2022, 40(4): 414-421.

Yan Li, Zhou Maoqiang, Qiu Jiaxuan. Association between bone morphology and sagittal disc position in temporomandibular joints of patients with anterior disc displacement[J]. West China Journal of Stomatology, 2022, 40(4): 414-421.

图/表 6

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表 1

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表 4

参考文献 26

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测量参数	对照组	轻度组	中度组	重度组	P值
髁突
宽度/mm	19.69±2.09^a	19.07±1.57^a	18.78±2.11^a	17.32±2.46^b	0.000 1²
长度/mm	8.18±1.20^a	7.95±1.42??	7.16±1.40??	6.73±1.41?	<0.000 1¹
高度/mm	19.30±3.12^a	18.10±2.75^a	17.74±2.56^a	14.86±3.38^b	<0.000 1¹
体积/mm³	2 033±442.1^a	1 832±455.4^a	1 709±422.4^a	1 216±477.9^b	<0.000 1²
表面积/mm²	1 019.0±160.1^a	941.1±158.7^a	917.8±144.4^a	735.2±184.4^b	<0.000 1²
关节窝
深度/mm	6.33±1.16^a	6.31±1.14^a	6.50±1.03^a	5.40±1.57^b	0.000 3¹
长度/mm	18.19±1.77	17.68±2.22	17.26±1.29	18.03±2.02	0.142 1¹
深/长比	0.35±0.06??	0.36±0.06?	0.38±0.05?	0.30±0.09?	<0.000 1²
关节结节倾斜角/?	29.70±4.60??	32.02±6.50^a	32.49±5.33^a	26.33±8.70^b	<0.000 1¹
关节间隙
前/mm	2.33±0.62?	2.67±0.80??	2.89±0.90?	2.54±0.86??	0.021 0²
上/mm	3.57±0.68^a	3.52±0.87^a	3.52±0.86^ab	3.07±1.05^b	0.009 0²
后/mm	2.06±0.53^ab	1.84±0.51^a	2.01±0.60^ab	2.24±0.67^b	0.005 7²
（后-前）/（后+前）/%	-5.97±16.82?	-17.52±16.69?	16.95±20.22?	-5.46±19.22?	0.000 6¹
矢状髁突位置/例（%）					0.044 4³
前	8（15.38）	1（2.00）	3（9.68）	8（17.78）
后	21（40.39）	31（62.00）	20（64.51）	18（40.00）
中	23（44.23）	18（36.00）	8（35.81）	19（42.22）

测量参数		关节盘矢状位置
测量参数		r	P值
髁突	宽度	-0.406 6	<0.000 1
	长度	-0.358 4	<0.000 1
	高度	-0.481 2	<0.000 1
	体积	-0.562 8	<0.000 1
	表面积	-0.541 8	<0.000 1
关节窝	深度	-0.325 2	<0.000 1
关节窝	长度	0.030 7	0.685 6
关节结节	倾斜角	-0.318 1	<0.000 1
关节间隙	前	0.029 8	0.695 6
	上	-0.244 7	0.001 1
	后	0.187 8	0.012 8

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颞下颌关节盘前移位患者关节骨形态与矢状向关节盘位置的关系

Association between bone morphology and sagittal disc position in temporomandibular joints of patients with anterior disc displacement

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测量参数		定义
髁突关节窝	宽度	轴面上测量的最大内外径
	长度	轴面上经过最大内外径中点的垂直线上髁突的最前点与最后点的距离
	体积	利用Mimics软件在轴向上以髁突顶点和下颌切迹最底点所在轴面为上下界，分割建立髁突模型，自动测量体积
	表面积	利用Mimics软件在轴向上以髁突顶点和下颌切迹最底点所在轴面为上下界，分割建立髁突模型，自动测量表面积
	高度	正中矢状面上髁突最顶点到经过下颌切迹最底点所在轴面的最短距离
	长度	正中矢状面上关节结节最低点到关节窝后部最低点的距离
	深度	正中矢状面上关节窝最高点至关节窝宽度线的垂直距离
关节结节	倾斜角	正中矢状面上经过关节窝最高点和关节结节最低点的直线与关节窝长度所在直线所形成的夹角
关节间隙	前	画过关节窝最高点，与髁突前缘相切的线，过切点的垂线上切点到对应关节窝的距离
	上	上关节间隙是从关节窝最上点到髁头最顶点的距离
	后	画过关节窝最高点，与髁突后缘相切的线，过切点的垂线上切点到对应关节窝的距离
髁突位置	前	根据公式：（后间隙-前间隙）/（后间隙+前间隙），若比值R>12%，则为髁突前位
	后	根据公式：（后间隙-前间隙）/（后间隙+前间隙），若比值R<-12%，则为髁突后位
	中	根据公式：（后间隙-前间隙）/（后间隙+前间隙），若比值R介于-12%~12%之间，为髁突中间位