功能矫治器复位可复性盘移位后颞下颌关节间隙的改变  

Changes in temporomandibular joint space after disk repositioning with functional appliance

作　　者：马志贵[1] 沈宇清[1] 杨驰[1] 谢千阳[1] 张善勇[1] 蔡协艺[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院·口腔医学院口腔外科,上海市口腔医学重点实验室,上海200011

出　　处：《中国口腔颌面外科杂志》2014年第3期233-238,共6页China Journal of Oral and Maxillofacial Surgery

基　　金：上海高校青年教师培养资助计划(jdy11027);上海市卫生局科研计划项目(20134Y061);上海交通大学医学院附属第九人民医院院级基金(2012-12)~~

摘　　要：目的：应用MRI定量分析功能矫治器在颞下颌关节（temporomandibular joint,TMJ） 可复性盘移位（disc displacement with reduction,DDWR）治疗中对关节间隙的影响,初步探讨间隙改变的实质及意义。方法：选择42例应用功能矫治器复位单侧DDWR 的Ⅱ类错畸形,以正常侧作为对照,在斜矢状MRI图像上,计算治疗前、后关节间隙指数（joint space index,JSI）的改变。定量测量功能矫治器治疗前（T1）、戴用功能矫治器初期（T2）和治疗结束（T3）后关节间隙的变化。采用SPSS16.0软件包对数据进行t检验。结果：T2与T1的平均间隔时间为3周（2周~1个月）,T3与T1的平均间隔时间为9个月（6~14个月）。年龄小者治疗周期短。对DDWR患者,治疗前患侧JSI显著大于对照侧;治疗结束,患侧JSI与对照侧相似。表明在T1阶段患侧关节前间隙明显大于后间隙。在T2阶段,患侧前间隙减小,后上间隙明显增加。与T2比较,T3阶段关节前间隙变大,后上间隙明显变小。与T1相比,患侧治疗后前间隙变小,无显著差异;后上间隙变大,有显著差异。结论：DDWR患者通过矫形治疗前移下颌骨,复位关节盘,关节间隙分布更趋均匀。矫形治疗主要改变后上间隙,对前间隙影响较小。PURPOSE： This study was aimed to evaluate the changes of temporomandibular joint （TMJ） space after treatment of disc displacement with reduction （DDWR） for Class Ⅱ malocclusions. METHODS： Disc repositioning was obtained with functional appliance for 42 adolescent patients diagnosed as unilateral DDWR. MRI scans were used before treatment （T1）, at the start of treatment （T2） and after functional treatment （T3）. Comparing with the normal joint, the change of joint space index （JSI） was calculated between T1 and T3. The anterior, posterior, and superior joint spaces were analyzed on the largest sagittal plane among T1, T2 and T3. Student＇s t test was performed using SPSS 16.0 software package for data analysis. RESULTS： The average treatment duration was 9 months. Short duration was seen in younger patients. During the phase of T1, the value of JSI of DDWR was significantly higher than that of the control （P〈0.05）. This indicated the anterior space was larger than the posterior space for DDWR. There was a decrease in the anterior space （P〈0.01） and an increase in the post-superior space at T2 （P〈0.01）. A significant increase in the anterior space （P=0.01） and a remarkable reduction in the post-superior space （P〈0.01） were observed at T3 compared with T2. There was a significant increase in the post-superior space and no significant decrease in the anterior space at T3 compared with T1 for DDWR. CONCLUSIONS： This study indicates that the TMJ space is well-distributed after functional treatment and disc repositioning for DDWR. Supported by Research Fund for Young College and University Teachers of Shanghai Municipal Education Commission （jdy11027）, Research Fund of Shanghai Municipal Health Bureau （20134Y061） and Scientific Research Fund of Ninth People＇s Hospital, Shanghai Jiao Tong University School of Medicine （2012-12）.

关 键 词：可复性盘移位 功能矫治器 盘复位 磁共振 关节间隙 

分 类 号：R782.6[医药卫生—口腔医学]