青少年单侧颞下颌关节盘不可复性前移位对髁突高度的影响：磁共振评价

发布时间：2018-05-10 15:35

本文选题：青少年 + 颞下颌关节　；参考：《上海交通大学》2014年硕士论文

【摘要】：目的：基于颞下颌关节磁共振表现，观察青少年单侧颞下颌关节盘不可复性前移位患者髁突吸收情况，并随访观察其自然转归对髁突高度的影响，以期为制定治疗方案及探究其与牙颌面畸形的关系提供参考。病例和方法：收集于2010年1月至2013年6月于我院关节专科就诊的单侧颞下颌关节盘不可复性前移位的青少年患者，以健侧髁突为对照，在磁共振影像上观察患侧髁突骨质的吸收程度；进行至少6月的随访，观察髁突吸收的进展情况，并对患者随访前后的关节盘移位程度和髁突高度进行定量测量；按初诊年龄分组，测量分析年龄对盘移位程度和髁突高度改变的影响。对随访前后数据采用SAS9.13软件包进行统计分析。结果:共纳入124例患者，，平均初诊年龄16.4岁。初诊时患侧髁突无、轻、中和重度骨质吸收者分别为49例（39.52%）、47例（37.90%）、23例（18.55%）、和5例（4.03%）。平均随访时间13.6月。随访后患侧髁突无、轻、中和重度骨质吸收者分别为38例（30.65%）、44例（35.48%）、34例（27.42%）、和8例（6.45%），髁突骨质吸收程度较初诊时加重(P0.05)。初诊时,健侧平均髁突高度和关节盘长度分别26.07mm和12.48mm；患侧平均髁突高度、关节盘长度和盘前移距离分别为24.22mm、9.06mm和5.44mm。随访后,健侧平均髁突高度、关节盘长度分别为26.82mm和12.98mm；患侧平均髁突高度、盘长度和盘前移距离分别是23.81mm、8.12mm和6.83mm。初诊时,健患侧髁突高度差为1.85mm，随访后,健患侧髁突高度差为3.00mm。以上测量指标健患侧之间的差异、患侧随访前后之间的差异均有统计学意义（P0.05）。按初诊年龄分组，3组平均年龄分别为12.97岁、16.02岁和18.98岁:3组随访前后患侧关节盘前移距离分别增加1.19mm、1.81mm、1.01mm，3组间无统计差异（P0.05）。3组患侧随访前后关节盘缩短分别为0.85mm、1.26mm、0.65mm，3组间无统计差异（P0.05）；3组随访前后健患侧髁突高度差分别增加1.71mm、0.99mm、0.98mm，3组间无统计学差异（P0.05）。结论:在青少年单侧颞下颌关节盘不可复性前移位患者中，约60%会发生不同程度的髁突骨吸收。随病情的延续，盘移位逐渐加重，髁突吸收会进一步加剧，而健侧髁突继续生长，健患侧的髁突高度差增大。这可能是颞下颌关节盘移位患者发生牙颌面畸形的重要原因之一。故对于青少年颞下颌关节盘不可复性前移位，建议尽早治疗，纠正关节盘的位置，以减少髁突骨质吸收的发生和继发牙颌面畸形。
[Abstract]:Objective: to observe the condylar process absorption in unreducible anterior temporomandibular joint (TMJ) patients based on temporomandibular joint (TMJ) magnetic resonance imaging (TMJ), and to observe the effect of natural outcome on condylar height. In order to provide a reference for the establishment of treatment plan and explore its relationship with maxillofacial malformation. Cases and methods: patients with unilateral temporomandibular joint disc irreducible anterior displacement were collected from January 2010 to June 2013 in our hospital. The healthy condyle process was used as control. The degree of condylar bone resorption was observed on magnetic resonance imaging, the progress of condylar resorption was observed after at least 6 months follow-up, and the degree of displacement of articular disc and the height of condyle were measured quantitatively before and after follow-up. The effect of age on the degree of disc displacement and the change of condylar height was measured and analyzed according to the age at first visit. The data before and after follow-up were analyzed by SAS9.13 software package. Results: 124 patients with an average age of 16.4 years were enrolled. In the first diagnosis, 49 cases (39.52%) had no, mild, moderate or severe bone resorption on the affected side, and 47 cases (37.90%) were involved with 18.555.55 and 5 cases with 4.03g bone resorption. The mean follow-up time was 13.6 months. After follow-up, 38 cases with mild, moderate and severe bone resorption were found in 38 cases (30.65%), 44 cases (35.48%) and 34 cases (27.42%), and 8 cases (6.45%). The degree of bone resorption of condylar process was more severe than that of the first diagnosis (P 0.05). At first visit, the average condylar height and disc length were 26.07mm and 12.48 mm, respectively, and the average condylar height, disc length and disc forward distance were 24.22 mm, 9.06 mm and 5.44 mm, respectively. The average condylar height and disc length of the healthy side were 26.82mm and 12.98 mm, respectively, and the average condylar height, disc length and the distance of disc anterior movement were 23.81 mm and 6.83 mm respectively. The difference of condylar height was 1.85 mm in the first visit and 3.00 mm in the healthy side after follow-up. The difference between the health side and the affected side was statistically significant before and after follow-up (P 0.05). The average age of the 3 groups was 12.97 years old, 16.02 years old and 18.98 years old respectively. The distance of anterior displacement of articular disc was increased by 1.19 mm and 1.81 mm and 1.01mm respectively before and after follow up. There was no statistical difference among the three groups. The reduction of articular disc was 0.85 mm 1.26 mm and 0.65 mm before and after follow-up in P0.05.3 group. The difference of condylar height was increased by 1.71 mm to 0.99 mm and 0.98 mm respectively before and after follow up in the three groups. There was no statistical difference among the three groups (P 0.05). Conclusion: about 60% of the patients with unilateral temporomandibular joint disc irreducible anterior displacement have different degree of condylar bone resorption. With the extension of the disease, the disc displacement gradually aggravated, the condylar process absorption would be further aggravated, while the condylar process of the healthy side would continue to grow, and the condylar height difference of the healthy side would increase. This may be one of the important causes of maxillofacial malformation in patients with temporomandibular joint disc displacement. Therefore, the irreducible anterior displacement of temporomandibular joint disc in adolescents should be treated as early as possible to correct the position of articular disc so as to reduce the occurrence of condylar bone resorption and secondary maxillofacial malformation.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R782.6

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