国际口腔医学杂志

国际口腔医学杂志 ›› 2022, Vol. 49 ›› Issue (2): 153-162.doi: 10.7518/gjkq.2022038

• 论著 • 上一篇    下一篇

成人不同垂直及矢状骨面型髁突特征的研究

韩婧文(),任诗琦,刘星宇,郎鑫,储梦诗,Waseem Saleh Abdo Kaid Algumaei,郑艳()   

  1. 兰州大学口腔医学院 兰州 730000
  • 收稿日期:2021-08-23 修回日期:2021-11-15 出版日期:2022-03-01 发布日期:2022-03-15
  • 通讯作者: 郑艳
  • 作者简介:韩婧文,学士,Email： hanjw19@lzu.edu.cn

Features of condyles of adult patients with different vertical and sagittal skeletal facial types

Han Jingwen(),Ren Shiqi,Liu Xingyu,Lang Xin,Chu Mengshi,Waseem Saleh Abdo Kaid Algumaei,Zheng Yan()   

  1. School of Stomatology, Lanzhou University, Lanzhou 730000, China
  • Received:2021-08-23 Revised:2021-11-15 Online:2022-03-01 Published:2022-03-15
  • Contact: Yan Zheng

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摘要：

目的 通过测量分析具有不同垂直和矢状骨面型的成人髁突特征的差异,研究成人骨面型与髁突特征的相关性。方法 选取颞下颌关节正常的成人患者180例,根据∠ANB、∠MP-FH和∠MP-SN将患者分为不同的垂直及矢状骨面型,共9组,每组20例。使用Invivo6软件测量所有样本的髁突长轴径、髁突短轴径、髁突最大横截面积、髁突颈部宽度、髁突上部高度、髁突高度、下颌升支高度,关节前、后、上、内侧间隙,关节结节后斜面角度和关节窝深度、宽度。使用SPSS 23.0软件进行统计学分析,比较各组测量指标的差异。结果 低角患者髁突粗大,关节间隙大,关节窝深而窄,关节结节后斜面角度大,升支长;高角患者则相反。骨性Ⅲ类患者髁突粗大,关节间隙小,关节窝浅而宽,关节结节后斜面角度小;而骨性Ⅱ类患者则相反。结论 骨性Ⅱ类高角、骨性Ⅲ类低角患者髁突特征明显,与下颌发育有关;髁突特征与垂直骨面型、矢状骨面型之间存在关联;垂直骨面型与髁突特征的关联程度比矢状骨面型更强。在临床治疗过程中要加强对髁突及其周围结构的关注。

关键词: 髁突, 颞下颌关节, 垂直骨面型, 矢状骨面型, 成人

Abstract:

Objective This study aimed to explore the correlation between the skeletal facial types and features of condyles of adult patients and provide a reference for clinical treatments by measuring and analyzing the differences in the features of condyles of adult patients with different vertical and sagittal skeletal facial types. Methods A total of 180 adult patients with a normal temporomandibular joint (TMJ) were selected and divided into nine groups according to different vertical and sagittal skeletal types according to certain criteria, including ∠ANB, ∠MP-FH and ∠MP-SN, and 20 cases were included in each group. The following parameters were measured using Invivo6: the length axis diameter of the condyle; its short axis diameter; maximum cross-sectional area; neck width; upper height; height; ramus height; ante-rior, posterior, upper, and medial joint space; posterior angle of the articular tubercle; and fossa depth and width of all the samples. Data were statistically analyzed using SPSS 23.0 to compare the differences in measurement indices among the groups. Results The patients with a low angle had a larger condyle, a larger joint space, a deeper and narrower joint fossa, a more oblique articular tubercle, and a longer ramus, whereas the patients with a high angle had opposite findings. The patients in skeletal class Ⅲ had a larger condyle, a smaller joint space, a shallower and wider articular fossa, and a flatter articular tubercle. By contrast, the patients in skeletal Ⅱ class had opposite results. Conclusion Patients in skeletal Ⅱ class with a high angle and skeletal Ⅲ class with a low angle have typical condyles related to mandibular growth. Condyle features are correlated with vertical and sagittal skeletal facial types. Vertical skeletal facial types are more strongly associated with condyle features than sagittal skeletal facial types. In clinical treatments, further stu-dies should be performed on the condyle and its surrounding structures.

Key words: condyle, temporomandibular joint, vertical skeletal facial types, sagittal skeletal facial types, adults

中图分类号: 

  • R783.5

表 1

不同骨面型的分组标准"

∠MP-FH和∠MP-SN分级 0°<∠ANB<5° ∠ANB≥5° ∠ANB≤0°
∠MP-FH<22°且∠MP-SN<29° 骨性Ⅰ类低角 骨性Ⅱ类低角 骨性Ⅲ类低角
22°≤∠MP-FH≤32°且29°≤∠MP-SN≤ 40° 骨性Ⅰ类均角 骨性Ⅱ类均角 骨性Ⅲ类均角
∠MP-FH>32°且∠MP-SN>40° 骨性Ⅰ类高角 骨性Ⅱ类高角 骨性Ⅲ类高角

表 2

各组患者的年龄及单因素方差分析"

组别 年龄/岁 P值
骨性Ⅰ类低角 21.35±2.11 0.417
骨性Ⅰ类均角 21.20±1.96
骨性Ⅰ类高角 21.30±2.18
骨性Ⅱ类低角 21.15±1.90
骨性Ⅱ类均角 20.90±1.86
骨性Ⅱ类高角 21.55±2.06
骨性Ⅲ类低角 22.00±2.08
骨性Ⅲ类均角 21.15±2.50
骨性Ⅲ类高角 20.25±2.07

表 3

测量项目及定点"

测量项目 定义 定点
髁突长轴径 髁突长轴的最大长度 外侧髁点、内侧髁点
髁突短轴径 髁突短轴的最大长度 髁突宽部最前点、髁突宽部最后点
髁突颈部宽度 髁突颈部的宽度 前颈点、后颈点
髁突上部高度 髁突顶点至髁突最宽处的垂直距离 髁突宽部最前点、髁突宽部最后点、髁突顶点
髁突高度 髁突顶点至髁突颈部的垂直距离 前颈点、后颈点、髁突顶点
升支高度 髁突顶点到升支下颌角点的距离 髁突顶点、下颌角点
关节前间隙 髁突前部与关节窝前壁的距离 关节前间隙髁点、关节前间隙窝点
关节后间隙 髁突后部与关节窝后壁的距离 关节后间隙髁点、关节后间隙窝点
关节上间隙 髁突上部与关节窝上壁的距离 髁突顶点、关节窝顶点
关节内侧间隙 髁突内侧与关节窝内侧壁的距离 关节内侧间隙髁点、关节内侧间隙窝点
关节结节后斜面角度 前关节窝线与法兰克福水平面的前角 前关节窝线上点、前关节窝线下点、眶点（左侧）、耳点
关节窝深度 关节窝顶点至关节结节最低点与耳道最低点的连线的垂直距离 关节窝顶点、关节结节最低点、耳道最低点
关节窝宽度 关节窝最前点至关节窝最后点的距离 关节窝最前点、关节窝最后点

图1

应用Invivo6软件的面积测量功能测量髁突最大横截面积"

图2

应用Invivo6 软件的3DAnalysis功能进行定点及测量 a、b、c、d、e为三维重建后“Teeth”视图图像;f为三维重建后“Bone”视图图像。1：髁突长轴径;2：髁突短轴径;3：髁突颈部宽度;4：髁突上部高度;5：髁突高度;6：升支高度;7：关节前间隙;8：关节后间隙;9：关节上间隙;10：关节窝深度;11：关节窝宽度;12：关节内侧间隙;α：关节结节后斜面角度。A：外侧髁点;B：内侧髁点;C：髁突宽部最前点;D：髁突宽部最后点;E：前颈点;F：后颈点;G：髁突顶点;H：下颌角点;I：关节前间隙髁点;J：关节前间隙窝点;K：关节后间隙髁点;L：关节后间隙窝点;M：关节窝顶点;N：关节结节最低点;O：耳道最低点;P：关节窝最前点;Q：关节窝最后点;R：关节内侧间隙髁点;S：关节内侧间隙窝点;T：前关节窝线上点;U：前关节窝线下点;V：眶点;W：耳点。"

表 4

各测量项目左、右两部分配对样本t检验结果（P值）"

测量项目 Ⅰ类低角 Ⅰ类均角 Ⅰ类高角 Ⅱ类低角 Ⅱ类均角 Ⅱ类高角 Ⅲ类低角 Ⅲ类均角 Ⅲ类高角
髁突长轴径 0.588 0.893 0.763 0.278 0.323 0.348 0.650 0.194 0.467
髁突短轴径 0.243 0.421 0.496 0.512 0.520 0.901 0.222 0.329 0.302
髁突最大横截面积 0.392 0.454 0.591 0.623 0.830 0.433 0.194 0.467 0.528
髁突颈部宽度 0.503 0.299 0.934 0.680 0.729 0.456 0.481 0.376 0.211
髁突上部高度 0.914 0.834 0.516 0.624 0.488 0.930 0.377 0.504 0.338
髁突高度 0.577 0.426 0.899 0.567 0.526 0.496 0.491 0.840 0.672
升支高度 0.089 0.146 0.176 0.532 0.546 0.082 0.253 0.413 0.294
关节前间隙 0.357 0.860 0.230 0.617 0.468 0.045* 0.764 0.670 0.923
关节后间隙 0.635 0.802 0.214 0.677 0.386 0.992 0.284 0.679 0.908
关节上间隙 0.376 0.251 0.362 0.121 0.062 0.530 0.074 0.167 0.344
关节内侧间隙 0.485 0.246 0.156 0.411 0.433 0.862 0.596 0.115 0.079
关节结节后斜面角度 0.041* 0.039* 0.447 0.080 0.730 0.092 0.164 0.162 0.348
关节窝深度 0.754 0.583 0.485 0.398 0.537 0.260 0.147 0.472 0.346
关节窝宽度 0.212 0.405 0.528 0.433 0.594 0.629 0.324 0.583 0.294

表 5

各组测量项目的测量结果"

测量项目 骨性Ⅰ类 骨性Ⅱ类 骨性Ⅲ类
低角 均角 高角 低角 均角 高角 低角 均角 高角
髁突长轴径/mm 19.47±2.51 19.24±2.18 17.75±2.20 19.68±1.89 19.05±2.11 19.57±2.71 20.64±2.86 19.75±1.51 18.43±1.84
髁突短轴径/mm 9.94±1.44 9.66±1.59 9.57±1.42 10.24±1.41 9.74±1.27 9.03±1.52 11.03±1.53 9.29±1.11 9.26±1.45
髁突最大横截面积/mm2 113.18±18.32 105.31±22.43 90.14±19.83 113.42±19.31 102.75±22.33 93.59±23.38 126.63±33.36 107.77±15.61 98.37±21.39
髁突颈部宽度/mm 8.24±1.06 7.57±0.98 7.79±1.23 8.31±1.15 7.97±1.17 7.43±1.33 8.78±0.83 7.94±1.00 8.13±1.06
髁突上部高度/mm 5.19±1.46 4.67±1.63 4.70±1.91 5.63±6.44 5.01±1.64 5.14±1.30 3.62±1.41 5.03±1.07 4.21±0.70
髁突高度/mm 8.95±2.20 9.65±2.06 9.28±1.82 9.41±1.37 9.69±1.81 9.40±1.18 8.92±0.90 10.86±2.42 8.85±0.76
升支高度/mm 58.32±3.99 53.38±7.40 54.40±3.90 58.86±3.37 52.78±3.56 52.56±1.87 60.55±2.03 53.37±3.40 53.50±2.42
关节前间隙/mm 2.54±0.64 2.34±0.77 2.41±0.70 2.72±0.78 2.56±0.78 2.28±0.67 2.46±0.83 2.21±0.75 2.06±0.64
关节后间隙/mm 2.93±0.88 2.51±0.64 2.63±0.80 2.99±0.91 2.76±0.85 3.07±1.25 2.68±0.79 2.50±0.66 2.67±0.71
关节上间隙/mm 3.65±0.69 3.32±0.86 2.94±0.96 4.07±0.85 3.41±0.97 3.53±1.21 3.47±0.90 3.11±0.77 2.52±0.75
关节内侧间隙/mm 3.09±1.08 2.56±0.67 2.65±0.93 3.79±1.58 2.77±0.91 2.60±0.74 2.67±0.84 2.51±0.87 2.19±0.68
关节结节后斜面角度/° 51.23±10.45 50.58±12.57 45.86±13.50 53.02±10.21 52.04±11.53 51.47±16.33 47.41±11.47 48.35±10.41 40.80±13.46
关节窝深度/mm 9.65±1.07 9.47±1.51 9.39±1.20 9.49±1.81 9.01±1.15 7.40±1.19 8.56±0.48 9.00±0.99 6.98±1.52
关节窝宽度/mm 16.04±2.10 16.49±2.32 17.45±1.53 15.94±1.52 16.07±1.40 15.46±1.87 16.92±1.33 15.60±1.64 18.11±1.46

表 6

不同垂直骨面型各测量项目的统计学结果（P值）"

测量项目 骨性Ⅰ类 骨性Ⅱ类 骨性Ⅲ类
P低-均 P低-高 P均-高 P低-均 P低-高 P均-高 P低-均 P低-高 P均-高
髁突长轴径/mm 0.895 0.003** 0.012* 0.343 0.000** 0.294 0.000** 0.002** 0.022*
髁突短轴径/mm 0.667 0.507 0.965 0.250 0.001** 0.000** 0.000** 0.992 0.068
髁突最大横截面积/mm2 0.196 0.002** 0.173 0.077 0.000** 0.006** 0.000** 0.206 0.148
髁突颈部宽度/mm 0.015* 0.148 0.606 0.420 0.005** 0.001** 0.010* 0.663 0.126
髁突上部高度/mm 0.354 0.392 0.997 0.755 0.840 0.000** 0.049* 0.003** 0.987
髁突高度/mm 0.272 0.744 0.694 0.674 1.000 0.000** 0.909 0.000** 0.665
升支高度/mm 0.002* 0.000** 0.809 0.000** 0.001** 0.000** 0.000** 0.993 0.442
关节前间隙/mm 0.417 0.674 0.908 0.605 0.025* 0.309 0.048* 0.629 0.212
关节后间隙/mm 0.048* 0.196 0.789 0.550 0.947 0.502 0.998 0.541 0.366
关节上间隙/mm 0.184 0.001* 0.114 0.013* 0.049* 0.111 0.000** 0.005** 0.872
关节内侧间隙/mm 0.026* 0.133 0.854 0.002** 0.000** 0.696 0.027* 0.171 0.630
关节结节后斜面角度/° 0.969 0.126 0.200 0.908 0.982 0.933 0.037* 0.014* 0.872
关节窝深度/mm 0.807 0.628 0.953 0.282 0.000** 0.173 0.000** 0.000** 0.000**
关节窝宽度/mm 0.577 0.006** 0.089 0.939 0.372 0.000** 0.001** 0.000** 0.212

表 7

不同矢状骨面型各测量项目的统计学结果（P值）"

测量项目 低角 均角 高角
PⅠ-Ⅱ PⅠ-Ⅲ PⅡ-Ⅲ PⅠ-Ⅱ PⅠ-Ⅲ PⅡ-Ⅲ PⅠ-Ⅱ PⅠ-Ⅲ PⅡ-Ⅲ
髁突长轴径/mm 0.911 0.131 0.182 0.914 0.454 0.210 0.942 0.288 0.220
髁突短轴径/mm 0.632 0.003** 0.046* 0.965 0.465 0.223 0.229 0.601 0.773
髁突最大横截面积/mm2 0.998 0.073 0.085 0.841 0.852 0.516 0.743 0.965 0.584
髁突颈部宽度/mm 0.942 0.052 0.110 0.207 0.252 0.993 0.366 0.408 0.025*
髁突上部高度/mm 0.864 0.177 0.059 0.556 0.510 0.997 0.442 0.292 0.000**
髁突高度/mm 0.502 0.998 0.156 0.996 0.048* 0.044* 0.931 0.353 0.038*
升支高度/mm 0.011* 0.009** 0.000** 0.810 1.000 0.569 0.438 0.427 0.990
关节前间隙/mm 0.170 0.952 0.289 0.412 0.740 0.113 0.663 0.059 0.323
关节后间隙/mm 0.938 0.414 0.244 0.287 0.998 0.258 0.153 0.726 0.037*
关节上间隙/mm 0.063 0.591 0.004* 0.884 0.518 0.263 0.025* 0.148 0.000**
关节内侧间隙/mm 0.061 0.121 0.001* 0.495 0.971 0.363 0.948 0.034* 0.033*
关节结节后斜面角度/° 0.897 0.269 0.112 0.607 0.663 0.168 0.074 0.170 0.000**
关节窝深度/mm 0.878 0.000** 0.008** 0.303 0.305 0.991 0.000** 0.000** 0.142
关节窝宽度/mm 0.968 0.074 0.009** 0.583 0.117 0.347 0.000** 0.174 0.000**
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