双侧下颌骨升支矢状劈开截骨后退术对骨性Ⅲ类错[牙合]患者颞下颌关节症状及髁突位置影响的锥形束CT研究  

Effect of bilateral sagittal split ramus osteotomy on temporomandibular joint symptom and condylar position in patients with skeletal classⅢmalocclusion by cone beam computed tomography

作　　者：郭美玲[1] 黄臻[2] 王宠 王予江[4] Guo Meiling;Huang Zhen;Wang Chong;Wang Yujiang(Dept.of General Dentistry,The Affiliated Stomatological Hospital of Nanchang University,The Key Laboratory of Oral Biomedicine of Jiangxi Province,Nanchang 330006,China;Dept.of Orthodontics,The Affiliated Stomatological Hospital of Nanchang University,The Key Laboratory of Oral Biomedicine of Jiangxi Province,Nanchang 330006,China;Danshui Branch in Huizhou Stomatological Hospital,Huizhou 516001,China;Dept.of Oral and Maxillofacial Surgery,The Affiliated Stomatological Hospital of Nanchang University,The Key Laboratory of Oral Biomedicine of Jiangxi Province,Nanchang 330006,China)

机构地区：[1]南昌大学附属口腔医院综合科江西省口腔生物医学重点实验室,南昌330006 [2]南昌大学附属口腔医院正畸科江西省口腔生物医学重点实验室,南昌330006 [3]惠州市口腔医院淡水分院,惠州516001 [4]南昌大学附属口腔医院口腔颌面外科江西省口腔生物医学重点实验室,南昌330006

出　　处：《华西口腔医学杂志》2020年第5期519-524,共6页West China Journal of Stomatology

基　　金：江西省重点研发计划项目(20161BBG70154)。

摘　　要：目的探讨双侧下颌骨升支矢状劈开截骨后退术(BSSRO)对行正畸-正颌联合治疗的骨性Ⅲ类错[牙合]患者颞下颌关节(TMJ)症状及髁突位置的影响。方法选取24例行正畸-正颌联合治疗的骨性Ⅲ类错[牙合]患者,分别在BSSRO术前、术后1个月、术后12个月按Helkimo指数整理记录关节症状,并行锥形束CT(CBCT)扫描,在三维方向上测量髁突水平位及冠状截面最大径、髁突短轴径、髁突颈部宽度、髁突高度、不同角度(45°、90°、135°)下关节间隙宽度、双侧髁突间距及髁突角度(水平角、垂直角、受力角),分析不同时期TMJ症状及骨性结构的变化情况。结果BSSRO术前与术后的Helkimo指数均为Ai、Di 0级或1级,二者之间无差异。与术前相比,术后1个月时髁突水平角、45°及90°下关节间隙宽度增大,135°下关节间隙宽度减小(P<0.05);术后12个月时,除髁突水平角增大(P<0.05)外,其余测量项目间差异均无统计学意义(P>0.05)。结论在正畸-正颌联合治疗中,BSSRO不会对Helkimo指数为Ai、Di 0级或1级的骨性Ⅲ类错[牙合]患者的TMJ症状及髁突位置产生明显的影响。Objective To investigate the effect of bilateral sagittal split ramus osteotomy(BSSRO)on temporomandibular joint(TMJ)symptom and condylar position in patients with skeletal classⅢmalocclusion treated with orthodontic-orthognathic surgical treatment.Methods Twenty-four patients with skeletal classⅢmalocclusion who underwent orthodontic-orthognathic surgical treatment were included in the study.Their conebeam computed tomography scans and TMJ symptom were evaluated,and their Helkimo index before BSSRO,1 month after BSSRO,and 12 months after BSSRO was recorded.The maximum diameter of the horizontal and coronal sections,short axis diameters,neck width,height,joint space widths at different angles(45°,90°,and 135°)of the condylar joint,bilateral condylar spacing,and different condylar angles(horizontal angle,vertical angle,and stress angle)in three dimensions were measured.Then,the changes in TMJ symptom and bone structure at different periods were analyzed.Results The Helkimo index was anamnestic(Ai)or dysfunctional(Di)levels 0 or 1 before and after BSSRO,and no difference in Helkimo index was observed.The horizontal angle and joint space widths at 45°and 90°increased whereas the joint space width at 135°decreased at 1 month after BSSRO compared with before BSSRO(P<0.05).Except for the increase in condylar horizontal angle(P<0.05),no significant difference in other measurement items was noted(P>0.05)12 month after BSSRO.Conclusion BSSRO would not have a remarkable effect on the TMJ symptom and condylar position of patients with skeletal classⅢmalocclusion who underwent orthodontic-orthognathic surgical treatment procedure and whose Helkimo index ranked Ai0,Ai1,Di0,and Di1.

关 键 词：双侧下颌骨升支矢状劈开截骨后退术 骨性Ⅲ类错[牙合] 颞下颌关节 髁突 锥形束CT 

分 类 号：R783.5[医药卫生—口腔医学]