口腔正畸患者颞下颌关节骨关节病的临床分析  

Temporomandibular joint osteoarthrosis in patients receiving orthodontic treatments: a clinical investigation

作　　者：孙志鹏[1,2] 邹冰爽[3] 赵燕平[1,2] 马绪臣[1,2] 

机构地区：[1]北京大学口腔医学院·口腔医院颞下颌关节病及口颌面痛诊治中心,北京100081 [2]北京大学口腔医学院·口腔医院 口腔颌面放射科,北京100081 [3]北京大学口腔医学院·口腔医院 正畸科,北京100081

出　　处：《北京大学学报（医学版）》2008年第1期47-51,共5页Journal of Peking University:Health Sciences

基　　金：国家“十五”科技攻关项目(2004BA720A25)资助~~

摘　　要：目的:调查拟行口腔正畸治疗患者中颞下颌关节骨关节病(temporomandibular joint osteoarthrosis,TMJOA)的患病情况,探讨其临床及影像学特点。观察TMJOA患者进行正畸治疗后的关节骨质变化,评价正畸治疗对关节骨质的影响。方法:选取1998年1月至2003年12月就诊于北京大学口腔医学院正畸科的患者共10032例,将病例记录完整且无可累及颞下颌关节的全身系统性疾病、颌面部外伤史、正畸矫治史和颌骨手术史者纳入为研究对象。调查正畸矫治前患者中TMJOA的患病情况,并应用χ2检验及多元logistic回归分析正畸前患者中TMJOA检出率与年龄、性别、错类型等因素的关联性。研究TMJOA的临床及影像学特点,并对比分析TMJOA患者正畸前后关节骨质变化情况。结果:正畸前患者中TMJOA的检出率为1.6%(159/10032),女性检出率(1.9%,124/6409)高于男性(1.0%,35/3623)(χ2=13.925,P<0.01)。TMJOA检出率随年龄增加而增加(χ2=136.381,P<0.01)。安氏Ⅱ类错患者中TMJOA检出率是安氏Ⅰ类错患者的1.683倍(Waldχ2=9.007,OR=1.683,P<0.01),安氏Ⅲ类和Ⅰ类错患者相比差异无统计学意义(Waldχ2=0.266,OR=1.141,P>0.05)。完成正畸治疗的85例TMJOA患者中,63例(74.1%,63/85)在正畸中保持骨质病变稳定,9例(10.6%,9/85)骨质病变好转,13例(15.3%,13/85)骨质病变加重。结论:正畸前患者中TMJOA检出率与年龄、性别、错类型等因素相关。大部分TMJOA患者(74.1%,63/85)在正畸治疗中颞下颌关节骨质情况保持稳定。Objective： To investigate the clinical characteristics of temporomandibular joint osteoarthrosis （TMJOA） in patients with malocclusion before orthodontic treatment and evaluate the radiographic changes of temporomandibular joint during treatment. Methods： Complete clinical recordings of 10 032 patients referring to the Orthodontic Department of Peking University School and Hospital of Stomatology from January 1998 to December 2003 were reviewed in present study. Patients with a history of previous orthodontic treatment, jaw surgery, facial trauma or systemic diseases which could potentially involve temporomandibular joint were excluded. The detection rate of with the possible risk factors of age, gender and malocclusion TMJOA was calculated and its association classifications was analyzed using the method of chi-square and multivariate logistic regression analysis. The clinical and radiographic characteristics were investigated and the radiographic findings before and after treatment were compared to evaluate the orthodontic effect on the articular bony structures. Results： The detection rate of TMJOA in 10 032 patients＇before orthodontic treatment was 1. 6% （159/10 032 ） and significantly higher in females （ 1.9%, 124/6 409） than in males（ 1.0%, 35/3 623 ） （ x^2 = 13. 925 ,P 〈 0.01 ）. The detection rate increased positively with age （X^2 = 136. 381, P 〈 0. 01 ）. Multivariate logistic regression analysis showed that patients with Angle 11 malocclusion were 1. 683 times more likely to suffer from TMJOA compared with patients with Angle I malocclusion（Wald x^2 = 9. 007, OR = 1. 683, P 〈 0.01 ）, while there was no significantly difference between the patients with Angle Ⅲ and Ⅰ malocclusion. Among the 85 TMJOA patients who finished their orthodontic treatments, 63 patients （74. 1%, 63/85 ） maintained stable articular bony structure and the remaining 9 （ 1 0. 6 % , 9 / 8 5 ） and 1 3 （ 1 5. 3 % , 1 3 / 8 5 ） patients showed recovering and deteriorating signs

关 键 词：颞下颌关节 骨关节炎 正畸学 矫正 

分 类 号：R782.6[医药卫生—口腔医学]