颞下颌关节振动异常的下颌运动相关因素分析

发布时间：2018-05-03 06:11

本文选题：颞下颌关节功能紊乱病 + 关节振动　；参考：《皖南医学院》2017年硕士论文

【摘要】：目的:通过对颞下颌关节振动、临床症状、咬合和咀嚼肌肌电的观察,分析颞下颌关节振动与下颌运动相关因素之间的关系,为进一步探讨牙合、咀嚼肌与颞下颌关节之间的相互关系提供实验依据。方法:(1)筛选受试者:采用系统抽样方法抽取皖南医学院口腔医学专业2013~2016级学生120人,简单检查排除明显错牙合畸形、不良习惯者后余72人(男34人,女38人,平均年龄19.47±1.83岁)。(2)采用BioJVA颞下颌关节振动分析仪对受试者进行关节振动检测,异常者记为JVA(+),正常者记为JVA(-)。(3)对受试者进行TMD相关性问卷调查,并由同一名检查者对受试者进行颞下颌关节(temporomandibular joint,TMJ)耳屏前触诊,根据有无关节弹响、张口受限、张口偏斜、咀嚼肌疼痛等症状,将受试者分为临床(+)和临床(-)。(4)根据临床症状及关节振动情况将受试者分为以下4组:A组.临床(+)JVA(+),B组.临床(-)JVA(+),C组.临床(-)JVA(-),D组.临床(+)JVA(-)。其中,A组可初步诊断为TMD患者,B组为仅出现关节异常振动而未表现出临床症状人群,C组为对照组正常人群,D组出现临床症状却未见关节异常振动。(5)采用T-ScanⅢ咬合分析系统及BioEMGⅢ肌电分析系统同步检查各组受试者牙尖交错位(intercuspal position,ICP)、下颌前伸运动、左右侧方运动时的咬合接触特征和肌电情况,并进行统计学分析。所有受试者均知晓实验内容,签署知情同意书。结果:(1)受试者的JVA关节振动分析仪检测结果提示出现异常的关节振动者35人,左右侧振动参数无差异,且与性别无关(P0.05)。关节振动在下颌运动过程中的发生位置普遍集中在开口末期和闭口初期,异常的关节振动较正常的关节振动分布更为分散。(2)结合患者主诉及同一名检查者对受试者进行颞下颌关节相关检查,出现TMD临床症状者23人(男11人,女12人),TMD阳性率31.9%。其中,关节弹响出现频率最高,往下依次为张口偏斜,咀嚼肌疼痛和张口受限。(3)对比临床症状及JVA关节记录情况,可见出现异常关节振动者35人中有21人出现了明显的TMD临床症状,14人仅见关节异常改变未表现出明显临床症状,确定分组情况:A组21人,B组14人,C组35人,D组2人。(4)ICP最大紧咬MIP帧咬合接触结果显示各组受试者COF位置有差别(P0.05),关节异常振动者的早接触情况高于对照组,AOF、OT、DT具有统计学差异(P0.05);肌电情况显示LTA、RTA、LMM、RMM、LDA、RDA的平均表面肌电幅值具有统计学差异(P0.05),左右侧TA、MM、DA的对称性各不相同(P0.05),而同侧TA和MM的协同性无统计学差异(P0.05)。(5)下颌前伸运动时关节异常振动者的前伸牙合干扰情况高于对照组,四组受试者前伸牙合分离时间、LTA、RTA、LMM、RMM、LDA、RDA的平均表面肌电幅值均具有统计学差异(P0.05)。(6)下颌左侧运动时关节异常振动者的侧方牙合干扰情况高于对照组,四组受试者左侧牙合分离时间、LTA、RTA、LMM、RMM、LDA、RDA的平均表面肌电幅值均具有统计学差异(P0.05)。(7)下颌右侧运动时关节异常振动者的侧方牙合干扰情况高于对照组,四组受试者右侧牙合分离时间、LTA、RTA、LMM、RMM、LDA、RDA的平均表面肌电幅值均具有统计学差异(P0.05)。结论:(1)关节异常振动者的咬合稳定性差,牙合干扰、早接触率高;肌电显示ICP紧咬时咀嚼肌功能下降,边缘运动时更易发生异常咀嚼肌收缩。(2)咬合的失调可能造成咀嚼肌和颞下颌关节的紊乱,即使对于没有明显临床症状的“正常”人群,也要提高重视,时刻警惕TMD的发生。(3)咬合失调是否是引起关节异常改变的原因以及与肌功能紊乱的关系,需要咬合干预实验进一步验证。
[Abstract]:Objective: to analyze the relationship between temporomandibular joint vibration and the related factors of mandibular movement by observing the vibration of temporomandibular joint, clinical symptoms, occlusal and masticatory muscle electromyography, and to provide an experimental basis for further exploring the relationship between occlusion and masticatory muscles and temporomandibular joint. Methods: (1) screening subjects: using systematic sampling method 120 students from the 2013~2016 class of stomatology in Wangnan Medical College were selected to check out the abnormal malocclusion and the remaining 72 people (34 men, 38 women, 19.47 + 1.83 years old). (2) the BioJVA temporomandibular joint vibration analyzer was used to detect the joint vibration of the subjects, the abnormality was recorded as JVA (+), and the normal person was recorded as JVA (3) (3) the subjects were investigated with a questionnaire, and the same examiner performed the TMJ (temporomandibular joint, TMJ) palpation before the TMJ (TMJ), and the subjects were divided into clinical (+) and clinical ((-)) according to the symptoms of joint projectile response, opening restriction, mouth opening deviation and masticatory muscle pain. (4) according to clinical symptoms and joints The vibration situation was divided into 4 groups: group A. Clinical (+) JVA (+), group B. Clinical (-) JVA (+), group C. Clinical (-) JVA (-), D group. Clinical (+) JVA (-). The A group can be diagnosed as TMD patients initially, B group is only abnormal vibration of the joint, not showing clinical symptoms, C group is normal group, but there is no joint clinical symptoms but no joints in the group. Abnormal vibration. (5) the T-Scan III occlusion analysis system and the BioEMG III electromyography system were used to synchronize the dislocation of the teeth (intercuspal position, ICP), the mandibular protrusion movement, the occlusal contact characteristics and EMG of the left and right lateral movements, and the analysis of the electromyography. All the subjects knew the content of the experiment and signed the information. Results: (1) the test results of the JVA joint vibration analyzer showed that there were 35 persons with abnormal joint vibration, and there was no difference between the left and right vibration parameters and no sex (P0.05). The joint vibration occurred in the stage of mandibular movement generally at the end of the opening and the early stage of the closure, and the abnormal joint vibration was more than normal. The vibration distribution of the joint was more scattered. (2) combined with the patient's main complaint and the same examiner to examine the TMJ, 23 people (11 men and 12 women) with TMD clinical symptoms, the positive rate of TMD 31.9%., the highest frequency of the joint elastic response, the downward deviation of the mouth, the pain of masticatory muscles and the limited opening of the mouth. (3) comparison of clinical symptoms 21 of the 35 people with abnormal joint vibration showed obvious TMD clinical symptoms in 35 people with abnormal joint vibration. 14 people only found abnormal changes in the joint. The group situation was 21 in A group, 14 in group B, 35 in group C and 2 in group D. (4) the result of ICP maximum clenched MIP frame occlusal contact showed COF position in each group. P0.05 was higher than the control group, AOF, OT, and DT had statistical difference (P0.05), and the electromyography showed that LTA, RTA, LMM, RMM, LDA, RDA were statistically different (P0.05). The difference (P0.05). (5) the interference of joint abnormal vibration was higher than that of the control group. The average surface electromyography amplitude of LTA, RTA, LMM, RMM, LDA, RDA had statistical difference (P0.05). (6) the lateral occlusion of abnormal vibrators in the left side of the mandible was higher than that in the left movement of the mandible (6). In the control group, the average surface electromyography amplitude of LTA, RTA, LMM, RMM, LDA, RDA were all statistically different (P0.05). (7) the interference of lateral occlusion of the abnormal vibration in the right side of the mandible was higher than that of the control group. The time of the right occlusal separation of the four subjects, LTA, RTA, LMM, RMM, LDA, and the average table The electrical amplitude of the facial muscle had statistical difference (P0.05). Conclusion: (1) the occlusion stability of the patients with abnormal vibration of the joints was poor, the occlusion and early contact rate were high; the EMG showed that the masticatory muscle function decreased while the ICP was clenched, and the abnormal masticatory muscle contraction during the edge movement. (2) the disorder of the masticatory muscles and the temporomandibular joint may be caused by the maladjustment of the occlusion, even if the maladjustment of the occlusion may cause the disorder of the masticatory muscles and the temporomandibular joint. For the "normal" people who have no obvious clinical symptoms, we should pay more attention to the occurrence of TMD. (3) whether the maladjustment of occlusion is the cause of abnormal changes of joints and the relationship with the disorder of muscle function.

【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R782.6

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