稳定性咬合板治疗伴偏侧咀嚼颞下颌关节骨关节炎患者的临床症状及锥形束CT影像分析

doi:10.7518/hxkq.2026.2025360

华西口腔医学杂志 ›› 2026, Vol. 44 ›› Issue (2): 266-276.doi: 10.7518/hxkq.2026.2025360

• 临床研究 • 上一篇

稳定性咬合板治疗伴偏侧咀嚼颞下颌关节骨关节炎患者的临床症状及锥形束CT影像分析

李晓星¹^,²(), 王家柱², 许来青², 徐鑫宇², 李鸿波², 胡敏², 刘洪臣², 姜华²()

^1.首都医科大学附属北京世纪坛医院口腔科，北京 100038
^2.中国人民解放军总医院第一医学中心口腔科，北京 100853

收稿日期:2025-09-03 出版日期:2026-04-01 发布日期:2026-03-31
通讯作者: 姜华 E-mail:542146668@qq.com;jh1225@163.com
作者简介:李晓星，医师，硕士，E-mail：542146668@qq.com
基金资助:
国家重点研发计划(2023YFC3605604);国家自然科学基金(82370982)

Clinical symptoms and cone beam computed tomography imaging analysis of patients with temporomandibular joint osteoarthritis with chewing side preference before and after treatment of stabilization splint

Li Xiaoxing¹^,²(), Wang Jiazhu², Xu Laiqing², Xu Xinyu², Li Hongbo², Hu Min², Liu Hongchen², Jiang Hua²()

^1.Dept. of Stomatology, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China
^2.Dept. of Stomatology, First Medical Center, Chinese PLA General Hospital, Beijing 100853, China

Received:2025-09-03 Online:2026-04-01 Published:2026-03-31
Contact: Jiang Hua E-mail:542146668@qq.com;jh1225@163.com
Supported by:
National Key Research and Development Plan(2023YFC3605604);National Natural Science Foundation of China(82370982)

摘要/Abstract

摘要：

目的通过分析伴偏侧咀嚼的颞下颌关节骨关节炎（TMJOA）患者经稳定性咬合板（SS）治疗前后颞下颌关节的锥形束CT（CBCT）影像及临床症状，探讨其临床疗效及颞下颌关节CBCT影像学改变的特征。方法回顾性分析2021年6月—2025年1月在解放军总医院第一医学中心口腔科就诊的74例TMJOA患者，年龄为18~40岁。其中无偏侧咀嚼患者31例，平均年龄为（29.81±2.99）岁；伴偏侧咀嚼患者43例，平均年龄为（30.88±5.65）岁。观察2组TMJOA患者初诊和复诊（6个月）时的CBCT影像学特点及临床症状进行分析。应用SPSS 27.0软件分析数据。结果 SS治疗无偏侧咀嚼患者前后对比：疼痛由100%降至3.23%、张口受限由96.77%降至3.23%、关节杂音由80.65%降至38.71%，差异均有统计学意义（P<0.05）；CBCT显示同侧关节后间隙及上间隙均显著增大（P<0.05）；双侧TMJ指标对比差异均无统计学意义（P>0.05）。SS治疗伴偏侧咀嚼患者前后对比：疼痛由100%降至4.65%、张口受限由88.37%降至2.33%、关节杂音由79.07%降至39.53%，差异均有统计学意义（P<0.05）；CBCT显示习惯侧髁突内外径、髁突前后径、关节内间隙、关节后间隙、关节上间隙、关节结节斜度及髁突高度均显著增加（P<0.05）；非习惯侧髁突内外径、髁突前后径、关节内间隙、关节后间隙及关节上间隙均显著增加（P<0.05）；习惯侧关节后间隙、关节内间隙及髁突高度均显著大于非习惯侧（P<0.05）。SS治疗无/伴偏侧咀嚼患者对比：治疗后疼痛、张口受限和关节杂音组间比较，差异均无统计学意义（P>0.05）。结论通过SS治疗无/伴偏侧咀嚼TMJOA患者，均可有效缓解患者的关节疼痛，明显改善开口度，一定程度上减少了关节杂音的比例，具有良好的治疗效果。偏侧咀嚼与TMJOA患者的病情进展密切相关，建议TMJOA患者早期进行SS治疗干预。

关键词: 偏侧咀嚼, 颞下颌关节骨关节炎, 稳定性咬合板, 锥形束CT

Abstract:

Objective This study aimed to explore the clinical efficacy of stabilization splint (SS) and the characteristics of cone beam computed tomography (CBCT) imaging changes by analyzing the CBCT images and clinical symptoms of patients with temporomandibular joint osteoarthritis (TMJOA) complicated with chewing side preference before and after treatment with SS. Me⁃thods　A retrospective analysis was conducted on 74 TMJOA patients (aged 18-40 years) who visited the Department of Stomatology, First Medical Center, Chinese PLA General Hospital from June 2021 to January 2025. Among them, 31 patients had no chewing side preference (mean age: 29.81±2.99 years), and 43 patients had chewing side preference (mean age: 30.88±5.65 years). The CBCT imaging features and clinical symptoms of the two groups at the initial visit and follow-up (6 months later) were observed and analyzed. SPSS 27.0 software was used for data analysis. Results Comparison of patients without chewing side preference before and after SS treatment: the incidence of pain decreased from 100% to 3.23%, limited mouth opening from 96.77% to 3.23%, and joint noise from 80.65% to 38.71%, with statistically significant differences (P<0.05). CBCT showed that the ipsilateral posterior joint space and superior joint space increased significantly (P<0.05), whereas no significant differences were observed in the temporomandibular joint (TMJ) indices between the two sides (P>0.05). Comparison of patients with chewing side preference before and after SS treatment: the incidence of pain decreased from 100% to 4.65%, limited mouth opening from 88.37% to 2.33%, and joint noise from 79.07% to 39.53%, with statistically significant differences (P<0.05). CBCT showed that the medial-lateral diameter of the condyle, anterior-posterior diameter of the condyle, intra-articular space, posterior joint space, superior joint space, slope of the articular eminence, and condylar height on the habitual chewing side increased significantly (P<0.05). Moreover, the medial-lateral diameter of the condyle, anterior-posterior diameter of the condyle, intra-articular space, posterior joint space, and superior joint space on the non-habitual chewing side increased significantly (P<0.05). The posterior joint space, intra-articular space, and condylar height on the habitual chewing side were significantly larger than those on the non-habitual chewing side (P<0.05). Comparison between patients with and without chewing side preference after SS treatment: no significant differences were found in pain, limited mouth opening, and joint noise between the two groups (P>0.05). Conclusion SS is effective in treating patients suffering from TMJOA with or without chewing side preference because it can effectively relieve joint pain, significantly improve mouth opening, and reduce the incidence of joint noise to a certain extent. Chewing side preference is closely related to the progression of TMJOA. Patients with TMJOA are recommended to receive early intervention with SS treatment, which is particularly important for those cases complicated with chewing side preference.

Key words: chewing side preference, temporomandibular joint osteoarthritis, stabilization splint, cone beam computed tomography

中图分类号:

R782.6

李晓星, 王家柱, 许来青, 徐鑫宇, 李鸿波, 胡敏, 刘洪臣, 姜华. 稳定性咬合板治疗伴偏侧咀嚼颞下颌关节骨关节炎患者的临床症状及锥形束CT影像分析[J]. 华西口腔医学杂志, 2026, 44(2): 266-276.

Li Xiaoxing, Wang Jiazhu, Xu Laiqing, Xu Xinyu, Li Hongbo, Hu Min, Liu Hongchen, Jiang Hua. Clinical symptoms and cone beam computed tomography imaging analysis of patients with temporomandibular joint osteoarthritis with chewing side preference before and after treatment of stabilization splint[J]. West China Journal of Stomatology, 2026, 44(2): 266-276.

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指标	右侧				左侧
指标	初诊	复诊	t值	P值	初诊	复诊	t值	P值
髁突内外径/mm	17.64±3.01	18.84±3.08	-1.463	0.154	18.39±1.87	18.09±2.04	0.761	0.453
髁突前后径/mm	8.13±1.96	8.37±2.42	-0.414	0.682	8.15±2.60	7.89±1.27	0.498	0.622
半径值/mm	54.56±8.35	54.33±5.37	0.121	0.905	53.98±8.33	54.19±3.20	-0.131	0.897
髁突水平角/°	29.49±14.63	28.52±11.84	0.295	0.770	29.71±14.66	25.83±9.34	1.384	0.176
关节内间隙/mm	2.68±1.26	2.78±1.18	-0.347	0.731	3.17±1.54	2.75±0.93	1.354	0.186
关节外间隙/mm	3.92±2.10	3.25±1.24	1.473	0.151	3.55±2.10	3.14±1.02	0.952	0.349
髁突垂直角/°	18.33±9.10	19.59±9.09	-0.490	0.628	18.41±9.11	19.66±9.26	-0.476	0.637
髁突受力角/°	49.26±14.51	53.43±12.49	-1.450	0.157	52.11±14.43	56.3±7.01	-1.431	0.163
关节窝宽度/mm	22.85±4.91	23.07±4.38	-0.178	0.860	23.09±2.78	23.16±2.58	-0.105	0.917
关节窝深度/mm	9.12±3.18	7.63±3.10	1.847	0.075	8.15±3.09	8.38±3.19	-0.286	0.777
关节结节斜度/°	54.95±13.94	55.33±15.08	-0.104	0.918	54.96±13.97	51.29±15.06	1.028	0.312
关节前间隙/mm	3.32±1.24	2.86±1.43	1.233	0.227	3.32±0.92	3.26±0.83	0.278	0.783
关节上间隙/mm	3.34±0.75	5.15±1.64	-5.515	0.000**	4.01±2.09	5.06±1.65	-2.584	0.015*
关节后间隙/mm	2.29±1.44	3.36±2.03	-2.361	0.025*	2.42±1.47	3.33±1.62	-2.176	0.038*
髁突高度/mm	17.86±4.28	18.17±4.10	-1.003	0.324	16.8±4.70	16.8±4.70	-1.000	0.325

指标		初诊			复诊
指标		均值	t值	P值	均值	t值	P值
髁突内外径/mm	左侧	18.39±1.87	1.175	0.245	18.09±2.04	-1.121	0.267
	右侧	17.64±3.01			18.84±3.08
髁突前后径/mm	左侧	8.15±2.60	0.031	0.975	7.89±1.27	-0.983	0.329
	右侧	8.13±1.96			8.37±2.42
半径值/mm	左侧	53.98±8.33	-0.272	0.787	54.19±3.20	-0.123	0.903
	右侧	54.56±8.35			54.33±5.37
髁突水平角/°	左侧	29.71±14.66	0.060	0.953	25.83±9.34	-0.992	0.325
	右侧	29.49±14.63			28.52±11.84
关节内间隙/mm	左侧	3.17±1.54	1.378	0.173	2.75±0.93	-0.105	0.917
	右侧	2.68±1.26			2.78±1.18
关节外间隙/mm	左侧	3.55±2.10	-0.686	0.496	3.14±1.02	-0.369	0.714
	右侧	3.92±2.10			3.25±1.24
髁突垂直角/°	左侧	18.41±9.11	0.037	0.970	19.66±9.26	0.028	0.977
	右侧	18.33±9.10			19.59±9.09
髁突受力角/°	左侧	52.11±14.43	0.775	0.441	56.3±7.01	1.115	0.269
	右侧	49.26±14.51			53.43±12.49
关节窝宽度/mm	左侧	23.09±2.78	0.243	0.809	23.16±2.58	0.101	0.919
	右侧	22.85±4.91			23.07±4.38
关节窝深度/mm	左侧	8.15±3.09	-1.227	0.225	8.38±3.19	0.932	0.355
	右侧	9.12±3.18			7.63±3.10
关节结节斜度/°	左侧	54.96±13.97	0.003	0.998	51.29±15.06	-1.053	0.297
	右侧	54.95±13.94			55.33±15.08
关节前间隙/mm	左侧	3.32±0.92	0.027	0.979	3.26±0.83	1.360	0.179
	右侧	3.32±1.24			2.86±1.43
关节上间隙/mm	左侧	4.01±2.09	1.690	0.096	5.06±1.65	-0.204	0.839
	右侧	3.34±0.75			5.15±1.64
关节后间隙/mm	左侧	2.42±1.47	0.351	0.727	3.33±1.62	-0.064	0.949
	右侧	2.29±1.44		0.727	3.36±2.03
髁突高度/mm	左侧	17.05±4.56	-0.982	0.330	17.05±4.56	-0.983	0.329
	右侧	18.13±4.06			18.13±4.07

指标	习惯侧				非习惯侧
指标	初诊	复诊	t值	P值	初诊	复诊	t值	P值
髁突内外径/mm	18.41±2.38	19.29±2.39	-2.311	0.026*	18.53±2.43	19.12±2.35	-2.357	0.023*
髁突前后径/mm	7.94±1.47	8.32±1.38	-2.057	0.046*	7.69±1.48	7.94±1.09	-2.092	0.043*
半径值/mm	52.34±4.47	53.05±3.09	-0.938	0.353	52.89±3.86	53.11±4.18	-0.303	0.763
髁突水平角/°	25.59±8.14	23.13±1.55	1.983	0.054	25.09±8.04	23.23±5.79	1.435	0.159
关节内间隙/mm	2.82±0.47	3.16±0.85	-2.300	0.026*	2.53±0.95	2.79±1.03	-2.032	0.049*
关节外间隙/mm	2.79±0.49	2.71±0.84	0.590	0.558	2.98±1.00	2.63±1.06	1.679	0.101
髁突垂直角/°	10.37±3.41	11.66±4.98	-1.509	0.139	11.63±2.97	11.19±3.16	0.706	0.484
髁突受力角/°	54.09±7.74	53.34±7.17	0.445	0.659	56.64±11.81	55.42±6.02	0.577	0.567
关节窝宽度/mm	22.76±2.89	23.09±3.73	-0.451	0.654	22.41±2.66	21.97±2.15	0.932	0.357
关节窝深度/mm	10.56±2.82	10.38±1.31	0.423	0.675	10.49±1.24	10.31±1.13	0.723	0.473
关节结节斜度/°	45.52±6.92	46.03±6.69	-2.567	0.014*	44.86±5.69	44.87±6.53	-0.010	0.992
关节前间隙/mm	2.33±0.59	2.52±0.94	-1.060	0.295	2.46±1.25	2.42±0.81	0.174	0.863
关节上间隙/mm	3.60±0.67	4.14±1.45	-2.289	0.027*	3.15±1.47	3.83±1.12	-2.226	0.031*
关节后间隙/mm	2.95±1.15	3.83±1.78	-2.480	0.017*	2.83±0.92	3.06±0.83	-2.126	0.039*
髁突高度/mm	18.56±4.92	18.58±4.91	-2.223	0.032*	18.46±2.45	18.56±2.46	0.510	0.613

指标	位置	均值	t值	P值
髁突内外径/mm	非习惯侧	19.64±2.29	0.008	0.994
	习惯侧	19.63±2.08	0.008	0.994
髁突前后径/mm	非习惯侧	8.13±1.34	-1.565	0.121
	习惯侧	8.6±1.44	-1.565	0.121
半径值/mm	非习惯侧	53.11±4.18	0.076	0.939
	习惯侧	53.05±3.09	0.076	0.939
髁突水平角/°	非习惯侧	23.23±5.79	0.107	0.915
	习惯侧	23.13±1.55	0.107	0.915
关节内间隙/mm	非习惯侧	2.79±1.03	-2.195	0.031*
	习惯侧	3.23±0.81	-2.195	0.031*
关节外间隙/mm	非习惯侧	2.63±1.06	-0.391	0.697
	习惯侧	2.71±0.84	-0.391	0.697
髁突垂直角/°	非习惯侧	11.19±3.16	-0.521	0.603
	习惯侧	11.66±4.98	-0.521	0.603
髁突受力角/°	非习惯侧	55.42±6.02	1.453	0.150
	习惯侧	53.34±7.17	1.453	0.150
关节窝宽度/mm	非习惯侧	21.97±2.15	-1.713	0.090
	习惯侧	23.09±3.73	-1.713	0.090
关节窝深度/mm	非习惯侧	10.31±1.13	-0.247	0.805
	习惯侧	10.38±1.31	-0.247	0.805
关节结节斜度/°	非习惯侧	44.87±6.53	-0.948	0.346
	习惯侧	46.24±6.86	-0.948	0.346
关节前间隙/mm	非习惯侧	2.42±0.81	-0.514	0.609
	习惯侧	2.52±0.94	-0.514	0.609
关节上间隙/mm	非习惯侧	4.37±1.17	0.632	0.529
	习惯侧	4.19±1.47	0.632	0.529
关节后间隙/mm	非习惯侧	3.06±0.83	-2.596	0.011*
	习惯侧	3.83±1.78	-2.596	0.011*
髁突高度/mm	非习惯侧	16.88±2.45	-2.029	0.047*
	习惯侧	18.58±4.91	-2.029	0.047*

稳定性咬合板治疗伴偏侧咀嚼颞下颌关节骨关节炎患者的临床症状及锥形束CT影像分析

Clinical symptoms and cone beam computed tomography imaging analysis of patients with temporomandibular joint osteoarthritis with chewing side preference before and after treatment of stabilization splint

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