[牙合]垫治疗颞下颌关节盘前移位患者髁突改建的影像评价

Imaging evaluation of condylar remodeling of patients receiving occlusal spint therapy with anterior disk displacement

目的通过比较口腔颌面锥形束CT(cone beam CT,CBCT)评价颞下颌关节髁突骨改建的定性、二维及三维定量测量方法,建立一种可靠的可用于临床评价髁突骨改建的定量评价方法。方法对2014年1月至2017年8月间,于北京大学口腔医院行[牙合]垫治疗且资料完整的盘前移位患者治疗前、治疗后6个月的临床及影像资料进行定性评价、二维定量测量、三维定量测量,并对三种评价方法进行比较。结果共纳入30名患者。30名患者中有24名(80%)患者在[牙合]垫治疗后CBCT影像中某一个或一个以上的层面上发现髁突骨改建的双线征。髁突的二维测量中,[牙合]垫治疗后症状侧髁突前后径、髁头高度、髁突高度较治疗前明显增加(P<0.05)。无症状侧髁突治疗后前后径近内侧、前后径中间侧、髁头高度较治疗前也明显增加(P<0.05)。计算机辅助三维测量法计算的髁突体积,[牙合]垫治疗后症状侧较治疗前有明显增加(P<0.05)。比较无骨改建组、部分骨改建组和显著骨改建组3组的髁突前后径、内外径、髁头高度、髁突高度与髁突体积的治疗前后差值,进行单因素方差分析。无骨改建组与显著骨改建组前后径、髁头高度、髁突体积有显著性差异。部分骨改建组和显著骨改建组只有髁突体积有显著性差异。结论二维测量指标中,髁突前后径和髁头高度可以反映髁突骨改建,三维测量体积变化可以敏感地反映出髁突的骨改建情况。

Objective To establish a reliable quantitative method for clinical evaluation of temporomandibular joint condylar bone reconstruction.Methods Clinical and imaging data of patients with temporomandibular joint anterior disk displacement who received anterior repositioning splint(ARS)therapy were collected.CBCT image data of bilateral joints were obtained before and 6 months after treatment,and were analyzed with three methods,qualitative evaluation,twodimensional quantitative measurement and 3D quantitative measurement.The results of these three methods were further compared and evaluated.Results Thirty patients were included.80%(24/30)of the patients showed a double-contour(condylar bone reconstruction)on one or more levels of CBCT images after treatment with ARS.In the two-dimensional measurement,the anteroposterior diameter of the lateral pole of the condylar,anteroposterior diameter of the middle pole of the condylar,anteroposterior diameter of the lateral pole of the condylar,condylar head height,and condylar height of the symptomatic side condyle increased significantly after treatment(P<0.05).The anteroposterior diameter,anteroposterior diameter,and condylar head height increased significantly after asymptomatic side condyle treatment(P<0.05).The volume of the symptomatic side and the asymptomatic side condylar with three-dimensional computer-assisted calculation increased significantly(P<0.05).Conclusions In two-dimensional measurement method,the incretion of anterior and posterior diameter and the height of the condyle head reflect the reconstruction of the condyle.The volume change measured in 3D can sensitively reflect the bone remodeling of the condyle.