颞下颌关节不可复性盘前移位复位与否对错 畸形正畸疗效的影响

A study on the arthroscopic temporomandibular joint disc reduction on the outcome of orthodontic patients with anterior disc displacement without reduction

目的:探讨颞下颌关节不可复性盘前移位患者关节盘复位与否对错 畸形正畸疗效的影响,为临床提供参考。 方法:回顾性纳入2012年1月至2021年12月于上海交通大学医学院附属第九人民医院口腔正畸科完成正畸治疗的错 畸形伴颞下颌关节不可复性盘前移位(单侧或双侧)且不伴髁突明显吸收的患者40例,患者年龄(17.5±3.8)岁(12~25岁),男性8例,女性32例。将完成关节镜下颞下颌关节盘复位术的20例患者纳入对照组,将未行颞下颌关节盘治疗的20例患者纳入未复位组。通过模型测量(包括覆盖等项目)、头影测量分析[包括ANB角(上牙槽座点、鼻根点与下牙槽座点构成的角)等项目]及颞下颌关节MRI检查(测量患侧髁突高度),比较两组各测量项目差异,通过客观评级系统评价两组正畸疗效。 结果:正畸治疗后未复位组和对照组均获得理想覆盖,分别为(2.19±0.76)和(1.92±0.94)mm,两组差异无统计学意义( t=1.02, P=0.314)。对照组ANB角治疗前后变化量(-1.97°±2.87°)显著大于未复位组(0.09°±1.82°)( t=2.72, P=0.010)。未复位组和对照组患侧髁突高度治疗前后变化量[分别为(0.30±1.11)和(0.82±1.25)mm]差异无统计学意义( t=1.80, P=0.076);客观评级系统总扣分分别为21.00(16.00,24.00)和21.00(17.00,25.00)分,两组差异无统计学意义( U=0.24, P=0.808)。 结论:对于伴颞下颌关节不可复性盘前移位且不伴髁突明显吸收的错 畸形患者,未进行患侧关节镜下关节盘复位治疗对错 畸形正畸疗效无明显影响。

Objective To investigate the arthroscopic temporomandibular joint disc reduction on the outcome of orthodontic patients with anterior disc displacement without reduction.Methods From January 2012 to December 2021,forty treated orthodontic patients with anterior disc displacement without reduction(unilateral/bilateral)and no obvious articular cartilage absorption were selected from Department of Orthodontics,Shanghai Ninth People′s Hospital,Shanghai Jiao Tong University School of Medicine.The patients were(17.5±3.8)years old(12-25 years old),including 8 males and 32 females.Twenty patients who had completed arthroscopic temporomandibular joint disc reduction were included in the control group,and twenty patients with untreated temporomandibular joint disc were included in the experimental group.Model measurement(including overjet,etc.),cephalometric analysis(including ANB angle,which was formed by subspinale,nasion and supramental,etc.)and temporomandibular joint magnetic resonance imaging(including measurement of the condyle height of the displacement sides)were used to compare the difference of two groups.Objective grading system was used to evaluate the efficacy of orthodontic treatment.Results The overjet of the experimental group and the control group after orthodontic treatment was(2.19±0.76)and(1.92±0.94)mm,respectively.Both two groups achieved ideal overjet with no statistical difference(t=1.02,P=0.314).The ANB angle difference before and after treatment in the control group(-1.97°±2.87°)was greater than that in the experimental group(0.09°±1.82°),and the difference was statistically significant(t=2.72,P=0.010).The variation of condyle height before and after treatment was(0.30±1.11)mm in the experimental group and(0.82±1.25)mm in the control group,with no statistical significance(t=1.80,P=0.076).The post-treatment objective grading system scores of the experimental group and the control group were 21.00(16.00,24.00)and 21.00(17.00,25.00),respectively,which had no statistical difference(U=0.24,P=0.808).Conclusions In orthodontic patients with anterior disc displacement without reduction and no obvious articular cartilage absorption,whether displaced discs are repositioned after arthroscopic surgery has no significant effect on the orthodontic treatment outcome.