关节盘锚固术联合正畸功能性矫治器治疗青少年双侧颞下颌关节盘前移位伴骨性Ⅱ类错畸形临床效果评价  

Evaluation of clinical effect of articular disc repositioning combined with orthodontic functional appliance in the treatment of juvenile bilateral temporomandibular joint anterior disc displacement and skeletal class Ⅱ malocclusion

作　　者：朱慧敏[1] 何冬梅[1] 杨秩[1] 宋欣羽 ZHU Hui-min;HE Dong-mei;YANG Zhi;SONG Xin-yu(Department of Oral Surgery,Ninth People＇s Hospital,Shanghai Jiao Tong University School of Medicine ＆ Shanghai Key Laboratory of Stomatology ＆ Shanghai Re-search Institute of Stomatology ＆ National Clinical Research Center of Stomatology,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院口腔外科上海市口腔医学重点实验室上海市口腔医学研究所口腔疾病临床研究中心,上海200011 [2]上海交通大学医学院附属第九人民医院口腔外科上海市口腔医学重点实验室上海市口腔医学研究所国家口腔疾病临床研究中心,上海200011

出　　处：《中国实用口腔科杂志》2018年第9期538-543,共6页Chinese Journal of Practical Stomatology

基　　金：国家自然科学基金(81472117);上海市科学技术委员会科研项目(17441900300);上海申康医学发展中心项目(16CR3045A);上海交通大学医学院第十一期大学生创新训练项目(1117591)

摘　　要：目的评价关节盘锚固术联合正畸功能性矫治器治疗青少年双侧颞下颌关节盘前移位伴骨性Ⅱ类错畸形的临床效果。方法选取2016年3月至2018年3月上海交通大学医学院附属第九人民医院口腔外科收治的青少年双侧颞下颌关节盘前移位伴骨性Ⅱ类错畸形患者14例(28侧关节),收集患者术前及术后随访期间的颞下颌关节MRI和头颅侧位片,对患者术前及术后随访期间的髁突高度及相关头影指标进行测量,比较手术前后的差异并进行统计学分析。结果 MRI测量显示:术后随访髁突高度比术前平均增加(1.74±0.98)mm(P<0.001)。28侧髁突均有新骨形成,主要位于髁突的顶端和前后缘(占84.61%)。头影指标测量显示:由蝶鞍中心、鼻根点及上齿槽座点所构成的角(SNA角)、软组织鼻根点到经额点且垂直于前颅底平面直线的垂直距离(Sn-G)、Y轴角(Y-Axis)、上中切牙-前颅底平面角(U1-SN)、下中切牙-下颌平面角(L1-MP)及上下中切牙角(U1-L1)手术前后差异无统计学意义;而由蝶鞍中心、鼻根点及下齿槽座点所构成的角(SNB角)比术前增加(1.83±1.56)°(P<0.001),下颌颏前点(Gn)术后前移(2.18±3.13)mm(P=0.028),前牙覆盖(overjet)比术前平均缩小(3.55±1.86)mm(P<0.001)。结论关节盘锚固联合术后正畸功能性矫治器治疗青少年颞下颌关节盘前移位伴骨性Ⅱ类错畸形,可以促进其髁突生长,减轻牙颌面畸形的程度。Objective To evaluate the effect of articular disc repositioning combined with orthodontic functional appliance in the treatment of juvenile bilateral temporomandibular joint（TMJ）anterior disc displacement（ADD）and skeletal class Ⅱmalocclusion. Methods Fourteen juvenile patients with bilateral TMJ ADD and skeletal class Ⅱ malocclusion were selected from March 2016 to March 2018 in the Department of Oral Surgery,Ninth People＇s Hospital,Shanghai Jiao Tong University School of Medicine. Magnetic resonance imaging（MRI）and cephalometric radiographs beforesurgery and follow-ups were performed for all patients. Condylar height and relevant cephalometric radiographs were measured and compared by statistical analysis. Results Compared with pre-surgery,MRI showed the condylar height increased（1.74 ± 0.98）mm during follow-ups after surgery（P〈0.001）. New generated bone was observed on all condyles. About 84.61% of the new bone formed at superior and posterior-anterior surface. Cephalo-metric radiographs showed that SNB increased（1.83±1.56）°（P〈0.001）,pogonion position（pog-G）moved（2.18±3.13）mm（P = 0.028）forward and incisor overjet decreased（3.55 ± 1.86）mm（P〈0.001）,whereas no significant changes were found in SNA,Sn-G Vert,Y-Axis,U1-SN、IMPA（L1-MP）or U1-L1（P〉0.05）. Conclusion Articular disc repositioning combined with postoperative orthodontic functional appliances can effectively promote condylar growth and reduce oral-maxillofacial deformities in juvenile patients with bilateral TMJ ADD and skeletal classⅡmalocclusion.

关 键 词：颞下颌关节 关节盘前移位 骨性Ⅱ类错畸形 青少年 关节盘锚固术 正畸功能性矫治器 

分 类 号：R78[医药卫生—口腔医学]