颞下颌关节盘前移位青少年患者的下颌偏斜特征

Characteristics of mandible deviation in adolescent patients with temporomandibular joint anterior disc displacement

目的·评价颞下颌关节盘前移位青少年患者的下颌偏斜特征,探索颞下颌关节盘前移与下颌偏斜之间的关系。方法·回顾性分析2019年1—12月于上海交通大学医学院附属第九人民医院口腔外科就诊的12~15岁青少年患者资料。根据临床症状以及磁共振表现,将患者分为单侧颞下颌关节盘前移位组、双侧颞下颌关节盘前移位组,以无关节症状且磁共振显示正常关节盘髁关系的患者为对照组。分别收集3组患者的头颅正侧位片,由2名测量者独立完成患者的头颅正位片头影测量。使用SPSS 23.0软件包进行统计学处理,使用Shapiro-Wilk检验其正态性,利用Pearson′s chi-square检验分析患者下颌偏斜的分布情况,比较其颏下点水平偏斜程度。通过对比颞下颌关节盘前移位青少年患者与正常盘髁关系的患者下颌偏斜的差异,观察颞下颌关节盘前移位患者下颌偏斜的分布特征。结果·共收集得到1011例研究对象的资料,根据磁共振检查结果,分为单侧颞下颌关节盘前移位组患者192例,双侧颞下颌关节盘前移位组患者255例,对照组患者564例。3组下颌偏斜程度(Me_(H))均呈偏态分布。其中对照组Me_(H)平均值为2.1 mm。将对照组Me_(H)第75百分位数(3.6 mm)作为区分下颌偏斜与非偏斜的界值,下颌偏斜患者在对照组、单侧颞下颌关节盘前移位组以及双侧颞下颌关节盘前移位组中所占的比例分别为25.53%、27.08%、19.22%,单侧颞下颌关节盘前移位组和双侧颞下颌关节盘前移位组的下颌偏斜发病率比较差异有统计学意义(P=0.049)。以3.6 mm、5.8 mm、8.2 mm作为界值,所有偏斜患者中,68.16%(167/245)为轻度偏斜(3.6 mm≤Me_(H)<5.8 mm),21.22%(52/245)为中度偏斜(5.8 mm≤Me_(H)<8.2 mm),10.61%(26/245)为重度偏斜(Me_(H)≥8.2 mm)。结论·约75%青少年人群的下颌偏斜在3.6 mm以内,单侧关节盘前移患者较一般人群偏斜概率更大。

Objective·To explore the characteristics of mandibular deviation(MD)in adolescent patients with anterior disc displacement(ADD)and the relationship between temporomandibular joint(TMJ)anterior disc displacement and mandibular deviation.Methods·Consecutive cases aged 12 to 15 who has been treated in the Department of Oral Surgery of Shanghai Ninth People's Hospital from January 2019 to December 2019 were reviewed.Among them,cases with TMJ symptoms,having been diagnosed by MRI as unilateral or bilateral TMJ ADD,were separately included into unilateral displacement group and bilateral displacement group.Cases without TMJ symptoms,showing a normal disc-condyle relationship with MRI,were included into the control group.The posteroanterior cephalometric radiographs of the three groups were collected respectively before orthodontic treatment,which were measured independently by two surveyors.SPSS 23.0 software package was used for statistical processing,and Shapiro-Wilk was used to test its normality.Pearson chi-square test was used to analyze the distribution of mandibular deviation in the three groups,and the degrees of horizontal deviation of submental point in the three groups were compared.The distribution characteristics of mandibular deviation in cases with disc displacement were observed by comparing the mandibular deviation between juvenile patients with TMJ anterior disc displacement and those with normal disc-condyle relationship.Results·A total of 1011 cases of 12-15-year-old adolescent patients in our hospital were collected,including 192 cases of unilateral disc displacement group and 255 cases of bilateral disc displacement group.A total of 564 cases were collected in the control group.Both the control group and the disc displacement group showed a skewed distribution.The mean value of Me_(H)in the control group was 2.1 mm.While 3.6 mm was taken as the critical value to distinguish deviation and non-deviation,the proportion of patients with mandibular deviation in the control group,unilateral displacement group and bilateral displacement group was respectively 25.53%,27.08%and 19.22%.The incidence rate of mandibular deviation was significantly different between the unilateral displacement group and bilateral displacement group(P=0.049).Among all cases with mandible deviation,68.16%(167/245)were mild deviation(3.6 mm≤Me_(H)<5.8 mm),21.22%(52/245)were moderate deviation(5.8 mm≤Me_(H)<8.2 mm),and 10.61%(26/245)were severe deviation(Me_(H)≥8.2 mm).Conclusion·It is found that about 75%of adolescents have mandibular deviation within 3.6 mm;Patients with unilateral anterior disc displacement have a greater probability of deviation than the general population.