前后平面与颞下颌骨关节病关系的影像研究

doi:10.7518/hxkq.2023.2023032

华西口腔医学杂志 ›› 2023, Vol. 41 ›› Issue (3): 297-304.doi: 10.7518/hxkq.2023.2023032

前后平面与颞下颌骨关节病关系的影像研究

钟嘉伟(), 范佩迪, 胡首杉, 高新林, 李奕君, 王军, 熊鑫()

口腔疾病研究国家重点实验室国家口腔疾病临床医学研究中心四川大学华西口腔医院正畸科，成都 610041

收稿日期:2023-02-02 修回日期:2023-04-20 出版日期:2023-06-01 发布日期:2023-06-02
通讯作者: 熊鑫 E-mail:2066722294@qq.com;drxiongxin@scu.edu.cn
作者简介:钟嘉伟，学士，E-mail：2066722294@qq.com
基金资助:
成都市科技局技术创新研发项目(2022-YF05-01691-SN);四川大学华西口腔医院新技术项目(LCYJ-2023-YY-2)

Imaging study on the relationship between anterior and posterior occlusal planes and temporomandibular osteoarthrosis

Zhong Jiawei(), Fan Peidi, Hu Shoushan, Gao Xinlin, Li Yijun, Wang Jun, Xiong Xin.()

State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China

Received:2023-02-02 Revised:2023-04-20 Online:2023-06-01 Published:2023-06-02
Contact: Xiong Xin. E-mail:2066722294@qq.com;drxiongxin@scu.edu.cn
Supported by:
Technological Innovation Research and Development Project of Chengdu Science and Technology Bureau(2022-YF05-01691-SN);New Technology Project of West China Hospital of Stomatology, Sichuan University(LCYJ-2023-YY-2);Correspondence: Xiong Xin, E-mail: drxiongxin@scu.edu.cn

摘要/Abstract

摘要：

目的比较不同颞下颌关节骨质情况患者的前后𬌗平面等指标。方法纳入306例患者的初诊锥形束CT（CBCT）和头颅侧位片，根据关节骨质情况分为3组：双侧正常组、骨关节病（OA）组、疑似OA组。比较3组患者前牙𬌗平面（AOP）、后牙𬌗平面（POP）等指标，去除混杂因素影响后建立回归方程，并进行𬌗平面与其余指标的相关性分析。结果 SNA、SNB、FMA、SN-MP、Ar-Go、S-Go与𬌗平面指标具有相关性；与双侧正常及疑似OA组相比，OA组患者FH-OP平均增加1.67°；FH-POP平均增加1.42°；FH-AOP平均增加2.05°。结论 OA患者的𬌗平面较陡，下颌骨向下后旋转，下颌升支、下颌体部、后面高较小，临床上对于这类患者应注意颞下颌OA的潜在危险；SNB、FMA、SN-MP、Ar-Go、S-Go与𬌗平面指标有较好相关性。

关键词: 颞下颌骨关节病, 咬合平面, 头影测量, 下颌骨, 牙颌面形态

Abstract:

Objective The aim of this study was to compare the anterior and posterior occlusal plane characteristics of patients with different temporomandibular joint osseous statuses. Methods A total of 306 patients with initial cone beam CT (CBCT) and cephalograms were included. They were divided into three groups on the basis of their temporomandibular joint osseous status: bilateral normal (BN) group, indeterminate for osteoarthrosis (I) group, and osteoarthrosis (OA) group. The anterior and posterior occlusal planes (AOP and POP) of the different groups were compared. Then, the regression equation was established after adjusting for confounding factors, and a correlation analysis between the occlusion planes and other parameters was performed. Results SNA, SNB, FMA, SN-MP, Ar-Go, and S-Go were correlated with the occlusal planes. Relative to the BN and I groups, the FH-OP of the OA group increased by 1.67° on the average, FH-POP increased by 1.42° on the average, and FH-AOP increased by 2.05° on the average. Conclusion The occlusal planes were steeper in the patients with temporomandibular osteoarthrosis than in the patients without it, and the mandible rotated downward and backward. The height of the mandibular ramus, the mandibular body length, and the posterior face height were small. In clinical practice, attention should be given to the potential risk of temporomandibular joint osteoarthrosis in such patients. In addition, SNB, FMA, SN-MP, Ar-Go, S-Go, and occlusal planes had moderate correlations.

Key words: temporomandibular joint osteoarthrosis, occlusal plane, cephalometrics, mandible, dentoskeletal morphology

中图分类号:

R 782.6

钟嘉伟, 范佩迪, 胡首杉, 高新林, 李奕君, 王军, 熊鑫. 前后平面与颞下颌骨关节病关系的影像研究[J]. 华西口腔医学杂志, 2023, 41(3): 297-304.

Zhong Jiawei, Fan Peidi, Hu Shoushan, Gao Xinlin, Li Yijun, Wang Jun, Xiong Xin.. Imaging study on the relationship between anterior and posterior occlusal planes and temporomandibular osteoarthrosis[J]. West China Journal of Stomatology, 2023, 41(3): 297-304.

图/表 8

图 1

表 1

头影测量参数及定义

测量参数	定义
角度测量指标
??平面角?（FH-OP）	眶点（Or）与耳点（P）的连线（眶耳平面）与上、下第一恒磨牙的咬合中点与上下中切牙切端间中点的连线（OP）的交角
后牙??平面角（FH-P-OP）	眶点（Or）与耳点（P）的连线（眶耳平面）与上颌第二前磨牙颊尖到上颌第二磨牙颊尖的连线（POP）的交角
前牙??平面角（FH-A-OP）	眶点（Or）与耳点（P）的连线（眶耳平面）与上前牙切端到上颌第二前磨牙的颊尖连线（AOP）的交角
MP-OP	颏下点（Me）与下颌角下缘相切的线条（下颌平面）与上、下第一恒磨牙的咬合中点与上下中切牙切端间中点的连线（OP）的交角
PP-OP	前鼻棘（ANS）与后鼻棘（PNS）的连线（腭平面）与上、下第一恒磨牙的咬合中点与上下中切牙切端间中点的连线（OP）的交角
SNA角	由上牙槽座点（A）至鼻根点（N）连线与蝶鞍点（S）至鼻根点（N）（前颅底平面）构成
SNB角	由下牙槽座点（B）至鼻根点（N）连线与蝶鞍点（S）至鼻根点（N）（前颅底平面）所构成
FMA角	眶耳平面-下颌平面角，眶点（Or）与耳点（P）的连线（眶耳平面）与通过颏下点（Me）与下颌角下缘相切的线条（下颌平面）的夹角
SN-MP	蝶鞍点（S）至鼻根点（N）（前颅底平面）与颏下点（Me）与下颌角下缘相切的线条（下颌平面）的夹角
下颌角（Ar-Go-Me）	由关节点（Ar）至下颌角点（Go）的连线（升支平面）与颏下点（Me）颌角下缘相切的线条（下颌平面）构成
线距测量指标
下颌升支高度（Ar-Go）	从关节点（Ar）至下颌角点（Go）的实际距离
下颌体长度（Go-Me）	从下颌角点（Go）至颏下点（Me）的实际距离
前面高（N-Me）	从鼻根点（N）至颏下点（Me）的实际距离
后面高（S-Go）	从蝶鞍点（S）至下颌角点（Go）的实际距离

表 1

表 2

图 2

表 3

表 4

图 3

表 5

参考文献 27

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测量指标	BN组	I组	OA组	P值
平均年龄±标准差/岁	28.52±5.65	30.32±9.29	31.02±9.49	0.401
性别				<0.001
男	13（44.83%）	25（16.89%）	13（10.08%）
女	16（55.17%）	123（83.11%）	116（89.92%）
矢状向分组				0.130
骨性Ⅰ类	18（62.07%）	75（50.68%）	50（38.76%）
骨性Ⅱ类	9（31.03%）	63（42.57%）	67（51.94%）
骨性Ⅲ类	2（6.90%）	10（6.76%）	12（9.30%）
垂直向分组				0.006
低角	13（44.83%）	66（44.59%）	33（25.58%）
均角	15（51.72%）	68（45.95%）	74（57.36%）
高角	1（3.45%）	14（9.46%）	22（17.05%）

测量指标	BN组	I组	OA组	P值
垂直向指标
FH-OP/°	6.74±3.66	7.27±3.79	8.93±4.05	<0.001
FH-POP/°	10.03±3.76	11.06±4.47	12.57±4.25	0.002
FH-AOP/°	7.16±3.57	7.27±4.56	9.29±4.48	<0.001
MP-OP/°	15.01±4.11	15.70±3.91	16.41±4.10	0.145
PP-OP/°	6.54±3.35	7.70±3.58	8.93±3.62	<0.001
FMA/°	21.75±5.15	22.97±5.49	25.34±5.37	<0.001
SN-MP/°	30.69±5.32	32.72±6.03	35.67±6.06	<0.001
N-Me/mm	115.20±7.12	114.46±6.59	114.20±6.26	0.752
S-Go/mm	79.48±6.82	77.33±5.64	74.59±5.98	<0.001
上颌指标
SNA/°	83.62±4.96	82.31±3.92	80.62±4.44	<0.001
下颌指标
SNB/°	80.14±3.02	78.67±3.66	77.24±4.09	<0.001
Ar-Go-Me/°	117.46±6.40	117.03±6.33	118.67±6.22	0.096
Ar-Go/mm	47.82±4.94	46.85±4.27	44.94±4.73	<0.001
Go-Me/mm	71.42±5.44	69.48±4.54	67.89±4.17	<0.001

测量指标	I组-BN组	OA组-BN组	OA组-I组
FH-OP/°	0.53（-1.33，2.39）0.783 4	2.18（0.30，4.06）0.018 5	1.65（0.55，2.76）0.001 4
FH-POP/°	1.03（-1.03，3.10）0.466 4	2.54（0.45，4.63）0.012 4	1.51（0.28，2.73）0.011 2
FH-AOP/°	0.11（-2.01，2.24）0.991 5	2.14（-0.01，4.29）0.051 8	2.03（0.76，3.29）0.000 5
PP-OP/°	1.16（-0.55，2.87）0.249 5	2.39（0.66，4.12）0.003 7	1.23（0.22，2.25）0.012 7
FMA/°	1.22（-1.37，3.80）0.508 8	3.59（0.97，6.20）0.004 0	2.37（0.83，3.90）0.000 9
SN-MP/°	2.04（-0.82，4.90）0.215 4	4.99（2.09，7.88）0.000 2	2.95（1.26，4.65）0.000 2
S-Go/mm	-2.14（-4.97，0.67）0.173 7	-4.88（-7.74，-2.03）0.000 2	-2.73（-4.41，-1.06）0.000 4
SNA/°	-1.31（-3.34，0.72）0.282 3	-3.00（-5.06，-0.95）0.002 0	-1.69（-2.90，-0.49）0.003 0
SNB/°	-1.46（-3.28，0.35）0.141 2	-2.89（-4.73，-1.06）0.000 7	-1.43（-2.51，-0.35）0.005 5
Ar-Go/mm	-0.97（-3.13，1.20）0.546 3	-2.88（-5.07，-0.69）0.006 2	-1.91（1.26，4.65）0.000 2
Go-Me/mm	-1.94（-4.08，0.21）0.085 7	-3.53（-5.70，-1.36）0.000 4	-1.60（-2.87，0.32）0.009 4

分组	FH-OP/°	FH-POP/°	FH-AOP/°
BN、I组	0	0	0
OA组	1.67（0.77，2.56）0.0003	1.42（0.44，2.40）0.0048	2.05（1.02，3.07）0.0001

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前后平面与颞下颌骨关节病关系的影像研究

Imaging study on the relationship between anterior and posterior occlusal planes and temporomandibular osteoarthrosis

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