青少年前牵引后颞下颌关节改变的相关性分析  

Correlation analysis of temporomandibular joint changes after maxillary protraction in adolescent patients

作　　者：刘亚非[1] 王雅淋 杜娟 左艳萍[1] 冯丽芳 LIU Yafei;WANG Yalin;DU Juan;ZUO Yanping;FENG Lifang(Department of Orthodontics,the First Hospital of Hebei Medical University,Shijiazhuang 050031,China;Department of Stomatology,the Second Hospital of Baoding City,Baoding 071000,China;Department of Stomatology,Hebei Special Care Hospital,Shijiazhuang 050000,China;Department of Prosthodontics,College of Stomatology,North China University of Science and Technology,Tangshan 063210,China)

机构地区：[1]河北医科大学第一医院口腔正崎科,河北石家庄050031 [2]河北省保定市第二医院口腔科,河北保定071000 [3]河北省优抚医院口腔科,河北石家庄050000 [4]华北理工大学口腔医学院修复教研室,河北唐山063210

出　　处：《口腔疾病防治》2022年第10期718-723,共6页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：河北省自然科学基金项目(H2020209156);河北省卫生厅科研基金项目(20211450)。

摘　　要：目的 研究青少年骨性Ⅲ类错[牙合]患者前牵引对颞下颌关节的影响。方法 选择恒牙早期骨性Ⅲ类错[牙合]患者29例,于前牵引治疗前后进行头影测量及坐标系统测量,定量分析[牙合]颌面及颞下颌关节位置和结构的改变,并进行相关性分析。结果 在前牵引矫治后,头影测量发现[牙合]颌面发生明显改变,上齿槽座点-鼻根点-下齿槽座点角(subspinale-nasion-supramental angle,ANB)增加3.97°±2.32°(P<0.001),上中切牙长轴与前颅底平面相交的交角(upper incisor and sella-nasion line angle,U1-SN)增加4.97°±5.51°(P<0.001),下中切牙长轴与GoGn连线的交角(lower incisor and gonion-gnathion line angle,L1-MP)减小了1.26°±1.41°(P=0.008),GoGn连线与SN连线的交角(gonion-gnathion line and sella-nasion line angle,MP-SN)增加了1.02°±3.90°(P=0.003)。颞下颌关节坐标系统测量发现蝶鞍点到关节窝后缘点在X轴向的距离(sella to FP=distance on the X-axis,S-Fpx)减少了(0.16±1.52)mm(P=0.041),蝶鞍点到髁状突前缘点在Y轴向的距离(sella to Ci distance on the Y-axis,S-Ciy)距离显著减小(0.09±2.03)mm(P=0.028),但颞下颌关节间隙无显著改变。相关性分析发现,关节窝的后缘位置与U1-SN呈中等负相关关系(r=-0.427,P=0.042),髁状突的前缘位置与ANB有中等正相关关系(r=0.425,P=0.043),关节间隙与[牙合]颌面改变均无相关。结论 青少年骨性Ⅲ类错[牙合]前牵引矫治对关节窝及髁状突改变有一定影响,但对关节间隙没有影响。Objective To study the effect of anterior traction on the temporomandibular joint in adolescent patients with skeletal ClassⅢmalocclusion.Methods Twenty-nine patients with early permanent dentition with skeletal classⅢmalocclusions were measured by cephalometry and a coordinate system before and after maxillary protraction.The correlation between dentofacial structures and the temporomandibular joint was analyzed.Results After maxillary protraction,cephalometric measurements showed that the dentofacial structure changed significantly;ANB increased by 3.97°±2.32°(P<0.001);U1-SN increased by 4.97°±5.51°(P<0.001);L1-MP decreased by 1.26°±1.41°(P=0.008);and MP-SN increased by 1.02°±3.90°(P=0.003).The coordinate system measurement showed that the S-Fpx was decreased by 0.16±1.52 mm(P=0.041),the S-Ciy distance was significantly decreased by 0.09±2.03 mm(P=0.028),and there was no significant change in the temporomandibular joint spaces(A,P,and C)(P>0.05).Correlation analysis showed a moderate negative correlation between the posterior margin of the temporomandibular joint fossa and U1-SN(r=-0.427,P=0.042).There was a moderate positive correlation between the leading edge of the condyle and ANB(r=0.425,P=0.043);there was no correlation between the joint space and dentofacial changes.Conclusion After treatment with maxillary protraction for adolescent skeletal classⅢmalocclusion,maxillary protraction had some effect on changes in the temporomandibular joint fossa and condyle and had no effect on the joint space.

关 键 词：恒牙早期 青少年 骨性Ⅲ类错[牙合] 颞下颌关节 [牙合]颌面 前牵引矫治 相关性分析 

分 类 号：R783.5[医药卫生—口腔医学]