X射线测量青少年骨性Ⅲ类患者前牵引治疗后颞下颌关节结构的改变  

Structural changes of the temporomandibular joint in adolescents with skeletal Class Ⅲ malocclusions after maxillary protraction: an X-ray measurement analysis

作　　者：刘亚非[1] 王雅淋 左艳萍[1] 孙琦 尉静[1] 赵利霞[1] Liu Yafei;Wang Yalin;Zuo Yanping;Sun Qi;Wei Jing;Zhao Lixia(Department of Orthodontics,First Hospital of Hebei Medical University,Shijiazhuang 050031,Hebei Province,China;Department of Stomatology,Baoding No.2 Hospital,Baoding 071000,Hebei Province,China;Department of Stomatology,Hebei Children’s Hospital,Shijiazhuang 050031,Hebei Province,China)

机构地区：[1]河北医科大学第一医院口腔正畸科,河北省石家庄市050031 [2]保定市第二医院口腔科,河北省保定市071000 [3]河北省儿童医院口腔科,河北省石家庄市050031

出　　处：《中国组织工程研究》2021年第8期1154-1159,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:骨性Ⅲ类错牙合不正常的上下颌骨位置关系和不正常的咬合接触可影响髁突和关节窝的形态,同时影响下颌运动及咀嚼肌的功能。前牵引矫治器作为治疗青少年骨性Ⅲ类错牙合的有效手段之一,通过矫形力可以重建颌骨位置关系,改善骨性Ⅲ类错牙合患者的关节窝-盘-突关系。目的:研究青少年骨性Ⅲ类错牙合患者前牵引矫治后颞下颌关节的改变,探讨前牵引矫治对青少年颞下颌关节紊乱结构产生的影响。方法:29例年龄12-14岁青少年骨性Ⅲ类错牙合患者,男18例,女11例;平均年龄(12.90±0.99岁),均采用牙支持式固定前牵引矫治器治疗。在前牵引治疗前后拍摄X射线头颅侧位定位片,在矢状方向和垂直方向上,定量分析矫治前后颞下颌关节窝、髁状突的改变及前牵引治疗前后颞下颌关节间隙的改变。结果与结论:在前方牵引矫治后,矢状方向上颞下颌关节窝和髁状突整体均未发生位移(P>0.05);垂直方向上颞下颌关节窝和髁状突后缘和上缘无明显移动(P>0.05),但髁状突前缘发生向上移位(P<0.05)。颞下颌关节前、上、后间隙治疗前后比较未发生明显变化(P>0.05)。结果表明青少年骨性Ⅲ类错牙合前牵引矫治后颞下颌关节会发生适应性改建,但是关节间隙在治疗前后没有显著性改变,因此不会对颞下颌关节功能产生不利影响。BACKGROUND: For skeletal Class Ⅲ malocclusions, the positional relationship between the upper and lower jaws and abnormal occlusion can impact the shape of the condyle and the glenoid fossa, as well as the movement of the mandible and the function of the masticatory muscles. Maxillary protraction appliances are one of the effective methods for the treatment of skeletal Class Ⅲ malocclusion in adolescents, which can reconstruct the positional relationship of the jaws and improve the glenoid fossa-disc-protrusion relationship in patients with skeletal Class Ⅲ malocclusion.OBJECTIVE: To evaluate the temporomandibular joint changes in adolescents with skeletal Class Ⅲ malocclusions treated with maxillary protraction.METHODS: Twenty-nine patients(11 girls and 18 boys;age range from 12-14, with a mean age of(12.90±0.99) years were treated with maxillary protraction. Lateral cephalograms were taken before and after treatment. A coordinate system was set to quantitatively analyze the changes of temporomandibular joint fossa, condyle and temporomandibular joint spaces in sagittal and vertical directions.RESULTS AND CONCLUSION: After maxillary protraction, no displacement of the gleniod fossa and the condyle in the sagittal direction was observed(P > 0.05). Simultaneously, in the vertical direction, there was no significant displacement of the gleniod fossa as well as no posterior and superior condyle displacement(P > 0.05). However, the anterior condyle moved upward(P < 0.05). No significant changes in the anterior, superior and posterior space of the temporomandibular joint were observed(P > 0.05). These findings indicate that maxillary protraction treatment can adaptively remodel the temporomandibular joint in adolescents with skeletal Class Ⅲ malocclusion will undergo adaptive remodeling, but will not adversely affect the function of the temporomandibular joint due to the unchanged joint space.

关 键 词：骨 颞下颌关节 Ⅲ类 错牙合 前牵引 青少年 X射线 髁状突 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]