双侧下颌骨升支矢状劈开截骨后退术对骨性Ⅲ类错牙合患者颞下颌关节症状及髁突位置影响的锥形束CT研究

doi:10.7518/hxkq.2020.05.008

华西口腔医学杂志 ›› 2020, Vol. 38 ›› Issue (5): 519-524.doi: 10.7518/hxkq.2020.05.008

双侧下颌骨升支矢状劈开截骨后退术对骨性Ⅲ类错牙合患者颞下颌关节症状及髁突位置影响的锥形束CT研究

郭美玲¹(), 黄臻², 王宠³, 王予江⁴()

^1. 南昌大学附属口腔医院综合科江西省口腔生物医学重点实验室,南昌 330006
^2. 南昌大学附属口腔医院正畸科江西省口腔生物医学重点实验室,南昌 330006
^3. 惠州市口腔医院淡水分院,惠州 516001
^4. 南昌大学附属口腔医院口腔颌面外科江西省口腔生物医学重点实验室,南昌 330006

收稿日期:2020-01-12 修回日期:2020-07-16 出版日期:2020-10-01 发布日期:2020-10-14
通讯作者: 王予江 E-mail:273412804@qq.com;wang9jiang@sina.com
作者简介:郭美玲,硕士,E-mail：273412804@qq.com
基金资助:
江西省重点研发计划项目(20161BBG70154)

Effect of bilateral sagittal split ramus osteotomy on temporomandibular joint symptom and condylar position in patients with skeletal class Ⅲ malocclusion by cone beam computed tomography

Guo Meiling¹(), Huang Zhen², Wang Chong³, Wang Yujiang⁴()

^1. Dept. of General Dentistry, The Affiliated Stomatological Hospital of Nanchang University, The Key Laboratory of Oral Biomedicine of Jiangxi Province, Nanchang 330006, China
^2. Dept. of Orthodontics, The Affiliated Stomatological Hospital of Nanchang University, The Key Laboratory of Oral Biomedicine of Jiangxi Province, Nanchang 330006, China
^3. Danshui Branch in Huizhou Stomatological Hospital, Huizhou 516001, China
^4. Dept. of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital of Nanchang University, The Key Laboratory of Oral Biomedicine of Jiangxi Province, Nanchang 330006, China

Received:2020-01-12 Revised:2020-07-16 Online:2020-10-01 Published:2020-10-14
Contact: Wang Yujiang E-mail:273412804@qq.com;wang9jiang@sina.com

摘要/Abstract

摘要： 目的探讨双侧下颌骨升支矢状劈开截骨后退术（BSSRO）对行正畸—正颌联合治疗的骨性Ⅲ类错牙合患者颞下颌关节（TMJ）症状及髁突位置的影响。方法选取24例行正畸-正颌联合治疗的骨性Ⅲ类错牙合患者,分别在BSSRO术前、术后1个月、术后12个月按Helkimo指数整理记录关节症状,并行锥形束CT（CBCT）扫描,在三维方向上测量髁突水平位及冠状截面最大径、髁突短轴径、髁突颈部宽度、髁突高度、不同角度（45°、90°、135°）下关节间隙宽度、双侧髁突间距及髁突角度（水平角、垂直角、受力角）,分析不同时期TMJ症状及骨性结构的变化情况。结果 BSSRO术前与术后的Helkimo指数均为Ai、Di 0级或1级,二者之间无差异。与术前相比,术后1个月时髁突水平角、45°及90°下关节间隙宽度增大,135°下关节间隙宽度减小（P<0.05）;术后12个月时,除髁突水平角增大（P<0.05）外,其余测量项目间差异均无统计学意义（P>0.05）。结论在正畸—正颌联合治疗中,BSSRO不会对Helkimo指数为Ai、Di 0级或1级的骨性Ⅲ类错牙合患者的TMJ症状及髁突位置产生明显的影响。

关键词: 双侧下颌骨升支矢状劈开截骨后退术, 骨性Ⅲ类错, 颞下颌关节, 髁突, 锥形束CT

Abstract:

Objective To investigate the effect of bilateral sagittal split ramus osteotomy (BSSRO) on temporomandibular joint (TMJ) symptom and condylar position in patients with skeletal class Ⅲ malocclusion treated with orthodontic-orthognathic surgical treatment. Methods Twenty-four patients with skeletal class Ⅲ malocclusion who underwent orthodontic-orthognathic surgical treatment were included in the study. Their cone-beam computed tomography scans and TMJ symptom were evaluated, and their Helkimo index before BSSRO, 1 month after BSSRO, and 12 months after BSSRO was recorded. The maximum diameter of the horizontal and coronal sections, short axis diameters, neck width, height, joint space widths at different angles (45°, 90°, and 135°) of the condylar joint, bilateral condylar spacing, and different condylar angles (horizontal angle, vertical angle, and stress angle) in three dimensions were measured. Then, the changes in TMJ symptom and bone structure at different periods were analyzed. Results The Helkimo index was anamnestic (Ai) or dysfunctional (Di) levels 0 or 1 before and after BSSRO, and no difference in Helkimo index was observed. The horizontal angle and joint space widths at 45° and 90° increased whereas the joint space width at 135° decreased at 1 month after BSSRO compared with before BSSRO (P<0.05). Except for the increase in condylar horizontal angle (P<0.05), no significant difference in other measurement items was noted (P>0.05) 12 month after BSSRO. Conclusion BSSRO would not have a remarkable effect on the TMJ symptom and condylar position of patients with skeletal class Ⅲ malocclusion who underwent orthodontic-orthognathic surgical treat?ment procedure and whose Helkimo index ranked Ai0, Ai1, Di0, and Di1.

Key words: bilateral sagittal split ramus osteotomy, skeletal class Ⅲ malocclusion, temporomandibular joint, condylar, cone beam computed tomography

中图分类号:

R783.5

郭美玲, 黄臻, 王宠, 王予江. 双侧下颌骨升支矢状劈开截骨后退术对骨性Ⅲ类错牙合患者颞下颌关节症状及髁突位置影响的锥形束CT研究[J]. 华西口腔医学杂志, 2020, 38(5): 519-524.

Guo Meiling, Huang Zhen, Wang Chong, Wang Yujiang. Effect of bilateral sagittal split ramus osteotomy on temporomandibular joint symptom and condylar position in patients with skeletal class Ⅲ malocclusion by cone beam computed tomography[J]. West China Journal of Stomatology, 2020, 38(5): 519-524.

图/表 5

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参考文献 17

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Helkimo指数		T0		T2
Helkimo指数		例数	比例/%	例数	比例/%
Ai	0级	17	70.8	17	70.8
	Ⅰ级	7	29.2	7	29.2
	Ⅱ级	0	0	0	0
Di	0级	17	70.8	17	70.8
	Ⅰ级	7	29.2	7	29.2
	Ⅱ级	0	0	0	0
	Ⅲ级	0	0	0	0

测量项目	T0组	T1组	T2组	P值
测量项目	T0组	T1组	T2组	T0-T1	T0-T2
d₁/mm	19.540±1.045	19.497±1.062	19.532±1.512	0.176	0.733
d₂/mm	8.191±0.377	8.192±0.917	8.193±0.374	0.553	0.628
D/mm	122.967±2.721	124.522±4.580	123.016±2.931	0.173	0.878
α角/°	14.831±2.809	20.836±2.435	17.657±2.774	0.001	0.044
L_1-45°/mm	1.815±0.346	2.266±0.534	1.833±0.290	0.006	0.603
L_1-90°/mm	1.702±0.150	2.255±0.767	1.726±0.167	0.011	0.755
L_1-135°/mm	2.487±0.206	2.158±0.315	2.398±0.258	0.038	0.693
h/mm	21.972±0.956	21.978±2.960	21.973±1.052	0.997	0.574
d₃/mm	8.013±0.532	8.012±0.927	8.008±0.583	0.985	0.905
L_2-45°/mm	1.970±0.260	2.952±0.481	2.012±0.314	0.000	0.651
L_2-90°/mm	2.064±0.211	2.643±0.635	2.108±0.231	0.001	0.736
L_2-135°/mm	2.017±0.206	1.682±0.372	1.995±0.333	0.007	0.536
d₄/mm	19.647±1.060	19.651±0.859	19.562±1.450	0.567	0.887
β角/°	9.961±2.576	9.125±5.446	10.216±2.040	0.113	0.609
γ角/°	65.906±4.880	64.856±5.082	63.261±5.136	0.656	0.838

双侧下颌骨升支矢状劈开截骨后退术对骨性Ⅲ类错牙合患者颞下颌关节症状及髁突位置影响的锥形束CT研究

Effect of bilateral sagittal split ramus osteotomy on temporomandibular joint symptom and condylar position in patients with skeletal class Ⅲ malocclusion by cone beam computed tomography

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