国际口腔医学杂志

国际口腔医学杂志 ›› 2024, Vol. 51 ›› Issue (4): 456-466.doi: 10.7518/gjkq.2024058

• 论著 • 上一篇    

青少年颞下颌关节形态特征与下颌骨三维方向生长的相关性研究

韩婧文1(),王蕾1,任诗琦1,王红宇1,黄颖怡1,李佳敏1,郑艳1,2()   

  1. 1.兰州大学口腔医学院 兰州 730000
    2.兰州大学口腔医院正畸科 兰州 730000
  • 收稿日期:2023-11-10 修回日期:2024-04-10 出版日期:2024-07-01 发布日期:2024-06-24
  • 通讯作者: 郑艳
  • 作者简介:韩婧文，学士，Email：hanjw19@lzu.edu.cn
  • 基金资助:
    甘肃省牙颌面重建与生物智能制造重点实验室项目(20JR10-RA653-ZDKF20210101)

Correlation between morphological characteristics of the temporomandibular joint and three-dimensional mandi-bular growth in adolescents

Jingwen Han1(),Lei Wang1,Shiqi Ren1,Hongyu Wang1,Yingyi Huang1,Jiamin Li1,Yan Zheng1,2()   

  1. 1.School of Stomatology, Lanzhou University, Lanzhou 730000, China
    2.Dept. of Orthodontics, Hospital of Stomatology, Lanzhou University, Lanzhou 730000, China
  • Received:2023-11-10 Revised:2024-04-10 Online:2024-07-01 Published:2024-06-24
  • Contact: Yan Zheng
  • Supported by:
    Open Subject Foundation of Key Laboratory of Dental Maxillofacial Reconstruction and Biological Intelligence Manufacturing, Gansu Province(20JR10RA653-ZDKF20210101)

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摘要：

目的 通过测量具有不同颞下颌关节形态特征的青少年生长高峰期前后下颌骨在三维方向的生长量，探索颞下颌关节形态特征与下颌骨生长潜力的关系。 方法 选取生长发育正常、未经正畸治疗的青少年横向样本226例，收集各样本的锥形束计算机断层扫描（CBCT）资料，根据蝶枕软骨联合融合程度分为生长期前组及生长期后组，测量并计算髁突位置、髁突高颈比、髁突角、髁头直立角，根据结果分为具有不同颞下颌关节形态特征的各组，测量分析各组下颌骨在三维方向的生长量。 结果 无论髁突在关节窝中处于何种位置，生长高峰期前后，均可观察到下颌长度及高度显著增长，仅在髁突非正中位时，观察到下颌宽度增长差异具有统计学意义；髁突短而粗，可观察到下颌在三维方向生长均显著，髁突长而细，可观察到下颌骨长度与高度显著增长而宽度增长差异无统计学意义；髁突角较大，可观察到下颌在三维方向生长均显著，髁突角较小，可观察到下颌长度与高度增长显著而宽度增长差异无统计学意义；髁头直立角较大，可观察到下颌的长度及高度增长显著而宽度增长差异无统计学意义，髁头直立角较小，可观察到下颌长度与宽度增长显著而高度增长差异无统计学意义。 结论 颞下颌关节形态特征可作为预测下颌骨生长潜力的参考指标，具有不同颞下颌关节形态特征的下颌骨在生长高峰期间在各方向的生长量存在差异。

关键词: 青少年, 颞下颌关节, 髁突, 下颌骨, 生长发育

Abstract:

Objective The aim of the study was to explore the correlation between temporomandibular joint (TMJ) morphological characteristics and mandibular growth potential by measuring the three-dimensional growth of the mandible before and after the growth spurt in adolescents with different TMJ morphological characteristics. Methods A transverse sample of 226 adolescents with normal growth and without orthodontic treatment was selected, and the cone beam computed tomography (CBCT) image of each patient was collected. All the samples were divided into pre-growth groups and post-growth groups based on the stages of spheno-occipital synchondrosis fusion. The condylar position, condylar height-neck ratio, condylar angle, and condylar head vertical angle were measured and calculated. According to the measurement results, all the samples were divided into groups with different TMJ morphological characteristics, and each group’s mandibular three-dimensional growth was measured and analyzed. Results Regardless where the condyle was located in the joint fossa, a significant increase in mandibular length and height was observed during the growth spurt. When the condyle was not in the median position, the growth of mandibular width was statistically significant. The growth of mandibles with short and thick condyles was significant in all directions, whereas the growth of those with long and thin condyles was statistically significant in length and height but not in width. The growth of mandibles with relatively large condyle angle was statistically significant in all three-dimensional directions, whereas those with relatively small condyle angle showed statistical significance in length and height but not in width. Mandibles with relatively large condylar head vertical angle showed significant growth in the length and height but not in width, whereas mandibles with relatively small condylar head vertical angle had statistically significant length and width growth, with no statistical significance in height. Conclusion 　The morphological characteristics of the TMJ can be used as a reference index to predict the growth potential of the mandible. The growth volume of mandibles with different TMJ characteristics changes in various directions.

Key words: adolescent, temporomandibular joint, condyle, mandible, growth

中图分类号: 

  • R783.5

图1

调整三维图像至眶耳平面与水平面平行、左右侧基本重合A：三维视图中眶耳平面；B：CT视图中眶耳平面；FH：眶耳平面。"

图2

SOS融合阶段A、B：第1阶段（SOS1）；C、D：第2阶段（SOS2）；E、F：第3阶段（SOS3）；G、H：第4阶段（SOS4）。"

图3

颞下颌关节形态测量项目A：三维视图中关节间隙、髁突高度、髁突颈部宽度及标志点；B：CT视图中髁突角；C：三维视图中髁头直立角。"

图 4

下颌骨三维测量项目A：三维视图中下颌总长度、下颌体长度、下颌升支高度及标志点；B：三维视图中下颌角处、角前切迹处下颌宽度及标志点；C：三维视图中髁突处下颌宽度及标志点；D：三维视图中升支前高度及标志点、标志线。"

表 1

SOS分期的重复性与一致性检验"

测量项目重复性检验一致性检验
人员研究者1研究者2—
Weighted Kappa系数0.9820.9640.979
P值<0.001<0.001<0.001

表 2

颞下颌关节形态与下颌生长的重复性与一致性检验"

测量项目重复性检验-ICC值一致性检验-ICC值
人员研究者3研究者4—
AJS0.9560.9430.910
PJS0.9330.9130.904
CW0.9880.9840.983
CH0.9070.8990.891
CA0.8620.9160.919
CVA0.9270.9530.924
ML0.9980.9660.995
MBL0.9830.9950.967
BAgW0.9980.9940.933
BGoW0.9900.9860.984
BCdSW0.9940.9810.982
MRH0.9980.9920.973
MAH0.9930.9990.985

表 3

具有不同髁突位置的下颌骨生长期前后三维方向尺寸大小"

测量项目/mmPⅠ类PⅡ类PⅢ类
生长期前组生长期后组P值生长期前组生长期后组P值生长期前组生长期后组P值
ML100.94±4.81105.63±4.670.003*101.69±4.86105.23±4.640.002*100.21±5.50104.07±5.99<0.001*
MBL61.95±3.8866.06±3.15<0.001*62.21±3.5565.51±3.80<0.001*61.45±3.7364.74±4.25<0.001*
BAgW81.10±3.2182.26±4.490.37581.24±4.0881.95±4.360.46378.32±3.8181.27±3.97<0.001*
BGoW87.52±4.3589.74±5.990.19688.40±5.0288.60±4.810.85686.54±4.9889.44±5.890.007*
BCdSW96.32±4.19100.10±5.460.021*96.14±4.6398.28±6.030.07894.83±4.6997.85±5.030.002*
MRH50.14±4.6354.71±4.640.004*51.74±3.9554.19±4.460.011*50.24±3.8553.03±4.54<0.001*
MAH59.52±4.0564.99±4.36<0.001*60.38±3.8164.33±5.19<0.001*59.67±4.0563.27±4.62<0.001*

表 4

具有不同髁突高颈比的下颌骨生长期前后三维方向尺寸大小"

测量项目/mmSⅠ类SⅡ类SⅢ类
生长期前组生长期后组P值生长期前组生长期后组P值生长期前组生长期后组P值
ML99.75±5.38106.55±4.99<0.001*101.57±4.66103.00±5.220.192100.78±5.35105.15±5.53<0.001*
MBL62.20±3.3767.09±3.33<0.001*62.23±2.9763.57±3.810.07461.16±4.3765.36±3.57<0.001*
BAgW79.39±4.2282.80±4.160.005*79.53±4.1680.45±3.950.31080.32±4.3481.44±4.730.268
BGoW86.99±4.9690.94±6.140.017*86.83±4.6187.67±4.190.40087.97±5.2889.22±5.230.295
BCdSW96.69±5.99100.57±5.300.002*94.34±3.2596.86±4.850.011*96.19±4.6897.81±5.790.159
MRH51.10±4.4355.10±5.030.004*50.90±4.2353.14±3.510.012*50.44±3.7353.05±4.720.006*
MAH60.38±4.4765.19±5.10<0.001*59.95±4.1063.49±3.50<0.001*59.64±3.6363.97±5.58<0.001*

表 5

具有不同髁突角的下颌骨生长期前后三维方向尺寸大小"

测量项目/mmAⅠ类AⅡ类AⅢ类
生长期前组生长期后组P值生长期前组生长期后组P值生长期前组生长期后组P值
ML100.79±5.73104.40±5.470.007*101.07±5.19104.93±5.280.002*100.67±4.58105.08±5.24<0.001*
MBL61.94±3.6965.32±3.34<0.001*61.39±3.5065.07±4.05<0.001*61.71±3.6865.26±3.95<0.001*
BAgW80.87±3.8781.68±4.190.38379.99±4.4181.03±3.630.27378.12±4.3981.91±5.060.001*
BGoW88.56±4.0790.06±5.620.17687.83±5.0988.53±5.150.56185.71±5.1288.37±4.970.031*
BCdSW95.89±4.8099.85±6.380.002*96.29±4.5596.83±5.000.63494.35±4.3098.76±4.31<0.001*
MRH50.41±4.1653.63±4.830.002*51.43±3.9753.47±4.510.044*50.56±3.9754.77±4.85<0.001*
MAH60.31±3.9963.97±5.09<0.001*59.78±3.8264.00±4.92<0.001*59.48±4.0864.48±4.95<0.001*

表 6

具有不同髁头直立角的下颌骨生长期前后三维方向尺寸大小"

测量项目/mmVⅠ类VⅡ类VⅢ类
生长期前组生长期后组P值生长期前组生长期后组P值生长期前组生长期后组P值
ML99.76±4.94104.49±5.42<0.001*102.19±4.87106.11±5.920.003*100.79±5.58104.27±4.810.005*
MBL61.30±3.2164.83±4.22<0.001*61.75±3.9466.68±2.99<0.001*62.38±3.9364.71±3.840.011*
BAgW79.09±4.5981.34±3.400.021*81.32±4.2982.85±4.030.13279.30±3.4080.81±4.590.104
BGoW86.60±5.2988.77±3.600.037*89.20±4.5290.15±5.910.45586.71±4.3388.08±5.820.247
BCdSW96.15±5.1099.03±4.280.011*96.06±4.2199.84±5.660.002*93.93±3.6296.47±5.580.021*
MRH50.70±3.2552.18±2.890.06052.19±4.4954.24±4.320.05550.27±3.6354.04±5.66<0.001*
MAH58.85±3.5862.54±3.77<0.001*60.97±4.9064.66±4.970.002*60.40±3.5464.00±5.390.001*
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