偏侧咀嚼患者的下颌运动特性分析

发布时间：2018-06-14 15:46

本文选题：偏侧咀嚼 + 咀嚼肌　；参考：《皖南医学院》2014年硕士论文

【摘要】：目的：通过口腔流行病学调查筛选出偏侧咀嚼患者，分析偏侧咀嚼发生率；通过下颌运动轨迹描记(Electrognathography，简称EGN)和咀嚼肌表面肌电图（Electromyogram，简称EMG）同步检测技术，比较偏侧咀嚼和正常咀嚼人群在下颌运动中的运动轨迹和肌电情况，分析偏侧咀嚼患者的下颌运动特性，为进一步研究偏侧咀嚼的运动控制机制奠定基础，并为临床诊断、预防和尽早纠正患者偏侧咀嚼习惯提供相应的实验依据。方法：1）流行病学调查：采取整群抽样的方法抽取皖南医学院口腔医学专业2011～2012级在校本科学生263人（男性127人，女性136人，年龄19.64±1.17岁）进行口腔检查，分析偏侧咀嚼的检出率。2）筛选病例并分组，进行肌电图与下颌运动轨迹的同步检测与分析：在检查出的89例偏侧咀嚼者中随机选择30例（男15例，女15例）作为实验组，同时随机选择双侧咀嚼30例（男15例，，女15例）作为对照组。用PowerLab8/30八通道多用途生理记录仪和下颌运动轨迹描记仪（Mandibular kinesiograph，简称MKG）同步记录双侧咀嚼组和偏侧咀嚼者在下颌姿势位、最大张闭口运动和咀嚼运动时的咬肌、二腹肌前腹的肌电图和下颌切点运动轨迹，进行统计学分析。结果：1）263名学生中有89人（男性44人，女性45人，平均年龄19.53±1.13岁）存在偏侧咀嚼习惯，发生率为33.84%；不同性别检出率差异无统计学意义。2）双侧咀嚼组不同性别间咬肌、二腹肌前腹的不对称指数差异无统计学意义，偏侧咀嚼组不同性别间咀嚼运动中咬肌活动不对称指数有显著性差异（P＜0.01）。双侧咀嚼组不同性别间同名咬肌、二腹肌前腹的平均肌电峰值（Amp）差异无统计学意义，偏侧咀嚼组不同性别间大张口运动中左二腹肌前腹平均肌电峰值有显著性差异（P＜0.01）。3）偏侧咀嚼组在下颌姿势位、最大张闭口运动和咀嚼运动中咬肌活动不对称指数高于双侧咀嚼组（P0.05），下颌姿势位、咀嚼运动时二腹肌前腹活动对称性低于双侧咀嚼组（P0.05）。偏侧咀嚼组大张口运动中LDA、RDA平均肌电峰值低于双侧咀嚼组（P＜0.05），咀嚼运动中LMM平均肌电峰值低于双侧咀嚼组（P＜0.05）。4）偏侧咀嚼组在大张口运动时开闭口轨迹多数分离，开口型、开牙合时间与与双侧咀嚼组相比差异有统计学意义（P0.05）；咀嚼运动时下颌切点运动轨迹形态不顺畅，开口相与闭口相轨迹分布不均，开牙合时间与双侧咀嚼组相比差异有统计学意义（P0.05），闭牙合至牙尖交错位的形态与双侧咀嚼组相比差异有统计学意义（P0.05）。5）双侧咀嚼组不同性别间下颌姿势位、最大张闭口运动和咀嚼运动时下颌切点运动轨迹参数差异无统计学意义，偏侧咀嚼组不同性别间在大张口运动时水平位移差异有统计学意义（P0.05）。6）偏侧咀嚼组张闭口运动时垂直向位移和矢状向位移显著低于双侧咀嚼组（P0.01）、咀嚼运动左侧位移低于双侧咀嚼组（P0.05）；偏侧咀嚼组咀嚼运动时前后向位移高于双侧咀嚼组（P0.05）。7）双侧咀嚼组咀嚼运动时咬肌Amp与最大闭口速度、垂直向位移呈显著正相关关系；偏侧咀嚼组MPP时左二腹肌前腹Amp与最大闭口速度、前后向位移呈显著正相关关系，大张口运动中咬肌Amp与右侧方位移呈显著正相关关系，咀嚼运动中左咬肌Amp与最大闭口速度、垂直向位移、水平向位移、矢状向位移呈显著正相关关系。结论：1）偏侧咀嚼的检出率是33.84%，不同性别检出率差异无统计学意义。2）偏侧咀嚼者在下颌姿势位、大张口运动和咀嚼运动中的咬肌活动存在不对称性，下颌姿势位、咀嚼运动中二腹肌前腹活动存在不对称性。3）偏侧咀嚼组LDA、RDA、LMM的平均肌电峰值降低。4）偏侧咀嚼组咀嚼运动中轨迹形态曲线相对紊乱，开闭口相也集中于一侧，67%的人群近牙尖交错位时闭口相呈凹面型，开牙合时间缩短；大张口运动中开口型多数偏向工作侧，50%的人群开闭口轨迹分离，开口度减小。5）偏侧咀嚼组大张口运动中咬肌Amp与右侧方位移，咀嚼运动中左咬肌Amp与垂直向位移、水平向位移、矢状向位移存在正相关性，说明偏侧咀嚼导致肌肉性能的改变的同时引起运动轨迹的异常。
[Abstract]:Objective: to screen the lateral masticatory patients through the oral epidemiological survey and analyze the incidence of lateral mastication, and to compare the movement track in the mandibular movement by the Electrognathography (EGN) and the Electromyogram (EMG). The characteristics of mandibular movement in patients with lateral mastication are analyzed to provide a basis for further study of the mechanism of lateral mastication, and to provide the basis for clinical diagnosis, prevention and early correction of patients' lateral masticatory habits.
Methods: 1) epidemiological investigation: 263 students (127 men, 136 women, 19.64 + 1.17 years old) in stomatology of Wangnan Medical College were selected by cluster sampling. The oral examination was performed, the detection rate of partial mastication was.2) and the cases were divided into groups. Electromyography and mandibular movement were carried out. Synchronous detection and analysis: 30 cases (15 men and 15 women) were selected as the experimental group randomly, and 30 cases (15 men and 15 women) were selected as the control group at random. The PowerLab8/30 eight channel multipurpose physiological recorder and the mandibular motion tracer (Mandibular kinesiograph, MKG) were used as the control group. The simultaneous recording of bilateral masticatory and lateral masticator at the position of the mandibular position, the masseter muscles at the maximum closure and masticatory movement, the electromyography of the anterior abdomen of the two abdominal muscles and the trajectory of the mandibular incisor point, were statistically analyzed.
Results: 1) of the 263 students, 89 (male 44, female 45, 19.53 + 1.13 years old) had partial chewing habits, the incidence rate was 33.84%, the difference of gender detection rate was not statistically significant.2). There was no difference between the same sex masseter muscle in the bilateral masticatory group and the asymmetric index of the anterior abdomen of two abdominal muscles, and the difference of the side masticatory group was different. There was a significant difference in the asymmetric index of the masseter muscle activity in the chewing exercise (P < 0.01). There was no significant difference in the average EMG peak (Amp) difference between the two masticatory groups in bilateral mastication group and the average EMG peak (Amp) in the anterior abdomen of the abdominal muscles. There was a significant difference in the average electromyography peak of the left two ventral muscles in the lateral masticatory group (P < 0.01). 3) the asymmetry index of the masseter movement in the mandibular position was higher than that in the bilateral masticatory group (P0.05), the postural position of the mandible, and the symmetry of the anterior abdominal motion of the two abdominal muscles in the masticatory movement was lower than that of the bilateral mastication group (P0.05). The average peak of the muscle electromyography in the partial mastication group was lower than that of the bilateral mastication group (LDA), and the peak value of the EMG was lower than that of bilateral mastication. Group (P < 0.05), the average EMG peak of LMM in masticatory exercise was lower than that of bilateral chewing group (P < 0.05).4). Most of the opening and closing trajectories of the lateral masticatory group were separated, the opening type and opening time were statistically significant (P0.05) compared with the bilateral masticatory group (P0.05); the shape of the mandibular incisor movement was not smooth and the opening phase in the chewing movement. The difference between the opening time and the bilateral masticatory group was statistically significant (P0.05). There was a significant difference between the occlusion and the bilateral masticatory groups (P0.05).5). The mandibular position in the bilateral masticatory group, the maximum closure movement and the chewing movement of the mandibular point movement. There was no statistical significance in the difference of trajectory parameters. There was significant difference in horizontal displacement between the masticatory groups in the lateral mastication group (P0.05).6) the vertical displacement and sagittal displacement of the lateral masticatory group were significantly lower than that in the bilateral masticatory group (P0.01), the left displacement of masticatory movement was lower than that of the bilateral masticatory group (P0.05); The front and back displacement of chewing group was higher than that of bilateral masticatory group (P0.05).7) the masseter muscle Amp and maximum closure velocity were significantly correlated with the maximum closure velocity in the chewing group of bilateral chewing group. The anterior ventral Amp in the left two abdominal muscles and the maximum closing velocity, the front and back displacement showed significant positive correlation, and the A in the masseter muscle during the large mouth movement. There was a significant positive correlation between MP and the right azimuth movement. The Amp of the left masseter muscle was positively correlated with the maximum closure velocity, vertical displacement, horizontal displacement and sagittal displacement in the masticatory movement.
Conclusion: 1) the detection rate of lateral mastication is 33.84%, there is no significant difference in the detection rate of different sex.2) the lateral masticatory position in the mandibular position, the asymmetry of the masseter movement in the large mouth movement and masticatory movement, the mandibular position, the asymmetric.3 in the anterior belly of the two abdominal muscles in the masticatory movement, and the lateral masticatory group LDA, RDA, LMM level The peak of average EMG decreased.4) the trajectory shape curve of the masticatory movement in the lateral masticatory group was relatively disordered, and the opening and closing phase was also concentrated on one side. The closure phase of the proximal tooth tip in 67% of the population was concave, the opening time shortened; the open opening pattern in the large opening movement was biased toward the working side, the opening orbit of the 50% population was separated and the opening decreased.5). In the lateral masticatory group, the Amp and the right orientation of the masseter muscle were moved. There was a positive correlation between the left masseter Amp and the vertical displacement, the horizontal displacement and the sagittal displacement in the masticatory movement, which indicated that the lateral mastication resulted in the change of the muscle performance and the abnormal movement track.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R782.6

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