MRI评价安氏Ⅰ类和Ⅱ类成年男性下颌逐步前伸中颞下颌关节盘的组织结构变化  

A magnetic resonance imaging study to compare structural changes of the temporomandibular joint disk during mandibular advancement between Angle Class I and Class II in adult males

作　　者：唐倩[1] 方志欣[1] 周嫣[1] 白彬 黄敏方[1] Tang Qian;Fang Zhi-xin;Zhou Yan;Bai Bin;Huang Min-fang(Department of Orthodontics,the People's Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,Guangxi Zhuang Autonomous Region,China;Liuzhou Worker’s Hospital,Liuzhou 545000,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]广西壮族自治区人民医院口腔正畸科,广西壮族自治区南宁市530021 [2]柳州市工人医院,广西壮族自治区柳州市545000

出　　处：《中国组织工程研究》2018年第12期1811-1816,共6页Chinese Journal of Tissue Engineering Research

基　　金：广西医疗卫生适宜技术研究与开发课题(桂卫S201315-02);广西科技攻关项目(桂科攻1140003B-72)~~

摘　　要：背景:下颌前伸式口腔矫治器对轻、中度阻塞性睡眠呼吸暂停低通气综合征患者疗效较好。但戴用下颌前伸式矫治后,下颌处于非正常生理位,必然会对颞下颌关节产生影响,关节盘是颞下颌关节的重要组织结构,那么下颌前伸时关节盘组织结构将发生怎样的变化,这些变化是否会对颞下颌关节造成损害?同时安氏Ⅰ类和Ⅱ类人群的颞下颌关节结构是否有差异,在下颌前伸过程中2种不同骨面型的颞下颌关节结构将发生怎样的变化,其发生的规律是否相同,此方面尚缺乏系统研究。目的:比较分析下颌逐步前伸过程中安氏Ⅰ类个别正常牙合及安氏Ⅱ类错牙合成年男性颞下颌关节盘组织的结构变化及其差异。方法:将40例成年无鼾男性志愿者,按安氏分类及矢状骨面型将其分为Ⅰ类组和Ⅱ类组,每组各20例。每位志愿者分别于正中咬合位(F_0)、下颌最大前伸位的75%位(F_75)及下颌最大前伸位(F_100)进行颞下颌关节的MRI扫描。利用MRI影像对2组志愿者不同下颌前伸位时关节盘组织的相关指标进行测量和计算,并对其进行统计分析。结果与结论:(1)在F_0位,安氏Ⅱ类组关节盘前移位发生率大于安氏Ⅰ类组(P<0.01);(2)两组盘髁角度随下颌前伸均减小(P<0.01);(3)安氏Ⅰ类及Ⅱ类组均表现为关节盘旋转角度从F_0至F_100位大于从F_0至F_75位,差异有显著性意义(P<0.05);(4)安氏Ⅰ类个别正常牙合和安氏Ⅱ类错牙合成年男性颞下颌关节盘组织结构存在差异。适度的下颌前伸对原有关节盘前移位者可产生积极作用,但下颌过度前伸则可能对颞下颌关节盘造成危害。BACKGROUND:Mandibular advancement devices are commonly used in patients with mild to moderate obstructive sleep apnea hypopnea syndrome.But wearing with mandibular protraction appliance makes the mandible in an abnormal position,and inevitably affects the temporomandibular joint(TMJ).As one of the important components of the TMJ,can structural changes of the joint disk impair the TMJ?Are there any differences in the TMJ structure between Angle Class I and Class II?What will happen to the TMJ structure in the Angle Class I and Class II during mandibular advancement?Is there a same law of TMJ changes for Angle Class I and Class II?All of these are undetermined systematically.OBJECTIVE:To compare the changes in the structure of TMJ disk and the differences during mandible advancement between Angle Class I and Class II adult males.METHODS:Forty non-apnea adult males were divided into two groups(n=20 per group),including Class I and Class II groups,according to the Angle’s classification and sagittal skeletal facial type.Each volunteer was scanned by MRI in three positions,including central occlusion(F0),75%of the maximum mandible advancement(F75)and maximum of the mandible advancement(F100).These indexes that were correlated with morphology of the joint disk in different mandible advancement positions were measured and calculated by MRI,and then analyzed statistically.RESULTS AND CONCLUSION:In F0,the ratio of disk anterior displacement in the Class II group was higher than that in the Class I group(P<0.01).The angle A was decreased as the mandible advanced in both groups from F0 to F75(P<0.01).The rotational angular dimension was increased as the mandible advanced,and the sizes from F0 to F100 were bigger than those from F0 to F75(P<0.05).Some differences existed in the structure of TMJ disk between Angle Class I and II adult males.In summary,appropriate mandibular advancement may play a positive role in patients with anterior displacement of the joint disk,but excessive mandible advancement is likely to impair the

关 键 词：阻塞性睡眠呼吸暂停低通气综合征 口腔矫治器 下颌前伸 颞下颌关节盘 磁共振成像 安氏Ⅱ类错牙合 组织构建 关节盘旋转角 颞下颌关节紊乱 颞下颌关节 颞下颌关节盘 矫形外科固定装置 组织工程 

分 类 号：R318[医药卫生—生物医学工程]