成年女性高角骨性突面畸形患者颞下颌关节髁突锥形束CT三维影像研究  

Three-dimensional cone-beam CT study on temporomandibular condylar changes before and after orthodontic treatment in adult female patients with high-angle protrusive malocclusion

作　　者：黄辉[1] 魏雅芹[2] 陈玉婷[1] 吴敏婷 林嘉豪 Huang Hui;Wei Yaqin;Chen Yuting;Wu Minting;Lin Jiahao(Department of Orthodontics,The Sixth Affiliated Hospital of South China University of Technology,Foshan 528200,China;Department of Stomatology,The Second People's Hospital of Foshan,Foshan 528000,China)

机构地区：[1]华南理工大学附属第六医院口腔正畸科,佛山528200 [2]佛山市第二人民医院口腔科,佛山528000

出　　处：《中华口腔医学研究杂志(电子版)》2025年第1期41-48,共8页Chinese Journal of Stomatological Research(Electronic Edition)

基　　金：佛山市自筹经费类科技创新项目(2220001004517)。

摘　　要：目的研究成年女性高角骨性突面畸形患者在正畸前后颞下颌关节(TMJ)髁突的锥形束计算机体层摄影术(CBCT)三维形态学变化,并探讨正畸治疗对TMJ结构的潜在影响。方法本研究为对照研究,纳入2018年1月至2023年12月期间在华南理工大学附属第六医院和佛山市第二人民医院口腔科就诊的27例Ⅰ类高角骨性突面畸形和28例Ⅱ类高角骨性上颌前突突面畸形的成年女性。所有患者在治疗前后均接受了颅颌面CBCT检查。测量参数包括关节上间隙、关节前间隙、关节后间隙、髁顶高度/表面积/体积、髁突高度/表面积/体积、关节窝高度/表面积/体积、下颌平面角(MP-SN)、后前面高比(S-Go/N-Me)和Y轴角,用以评估正畸治疗前后TMJ髁突的位置及形态变化。采用配对t检验(组内比较)和独立样本t检验(组间比较)对数据进行分析。结果本研究成年女性Ⅰ类高角骨性突面畸形患者正畸治疗前后TMJ参数均未出现显著变化。Ⅱ类高角骨性上颌前突突面畸形患者治疗后,髁突高度从(16.28±2.57)mm降低至(14.00±2.56)mm,差异有统计学意义(t=3.168,P=0.004);体积从(1512.46±223.50)mm^(3)减少至(1360.96±230.94)mm^(3),差异有统计学意义(t=2.377,P=0.025);MP-SN角度从(40.99±3.97)°降低至(36.96±4.05)°,差异有统计学意义(t=3.580,P=0.001);Y轴角从(69.72±3.38)°下降至(62.82±3.36)°,差异有统计学意义(t=7.145,P<0.001);关节后间隙从(2.23±0.40)mm增加至(2.50±0.36)mm,差异有统计学意义(t=-2.476,P=0.020);关节前间隙从(2.83±0.36)mm缩小至(2.55±0.34)mm,差异有统计学意义(t=2.843,P=0.008);关节窝形态参数无显著变化。组间对比显示,Ⅱ类患者的髁突高度变化量(P=0.011)、体积变化量(P=0.031)及Y轴角变化量(P<0.001)均大于Ⅰ类患者,差异均有统计学意义。结论高角突面畸形患者的正畸治疗通过垂直向控制改善咬合关系。Ⅰ类患者的TMJ结构在治疗后保持稳定,关节间隙、�Objective To investigate the three-dimensional morphological changes of the temporomandibular joint(TMJ)condyle in adult females with high-angle skeletal maxillary protrusion before and after orthodontic treatment using cone-beam computed tomography(CBCT),and to assess the structural adaptation of TMJ induced by orthodontic treatment.Methods This controlled study enrolled 27 classⅠand 28 classⅡhigh-angle skeletal maxillary protrusion patients treated between January 2018 and December 2023 in the Sixth Affiliated Hospital of South China University of Technology and the Second People&apos;s Hospital of Foshan.Pre-and post-treatment CBCT scans were analyzed for joint spaces,condylar/articular fossa morphology(height/volume/surface area),and skeletal parameters(MP-SN angle,S-Go/N-Me ratio,Y-axis angle).Paired and independent t-tests were applied for within-and between-group comparisons(α=0.05).Results In classⅠhigh-angle patients,no significant post-treatment changes were observed in TMJ parameters:Superior joint space[(3.19±0.62)mm vs.(3.02±0.67)mm,t=0.998,P=0.328],anterior joint space[(2.44±0.32)mm vs.(2.52±0.48)mm,t=-0.859,P=0.398],posterior joint space[(2.48±0.34)mm vs.(2.43±0.28)mm,t=0.603,P=0.552],condylar apex height[(6.54±0.74)mm vs.(6.69±0.74)mm,t=-0.801,P=0.431],condylar apex volume[(452.91±35.90)mm^(3)vs.(472.18±57.97)mm^(3),t=-1.407,P=0.171],condylar height[(18.18±2.44)mm vs.(18.92±4.30)mm,t=-0.819,P=0.420],and condylar volume[(1690.07±214.94)mm^(3)vs.(1754.38±348.92)mm^(3),t=-0.869,P=0.393].Articular fossa morphology and skeletal parameters also remained stable.In classⅡhigh-angle patients,significant post-treatment reductions were observed:Condylar height[(16.28±2.57)mm vs.(14.00±2.56)mm,t=3.168,P=0.004],condylar volume[(1512.46±223.50)mm^(3)vs.(1360.96±230.94)mm^(3),t=2.377,P=0.025],MP-SN angle[(40.99±3.97)°vs.(36.96±4.05)°,t=3.580,P=0.001],Y-axis angle[(69.72±3.38)°vs.(62.82±3.36)°,t=7.145,P<0.001],with concurrent adjustments in joint spaces[posterior:(2.23±0.40)mm

关 键 词：骨性突面畸形 成人女性 高角 颞下颌关节 髁突 锥束计算机体层摄影术 

分 类 号：R78[医药卫生—口腔医学]