下颌后缩伴颞下颌关节重度骨关节病患者正颌术后颌骨稳定性及髁突体积变化的评价

doi:10.19723/j.issn.1671-167X.2020.01.018

摘要/Abstract

摘要：

目的:探讨下颌后缩伴颞下颌关节重度骨关节病患者正颌手术前的髁突表面骨质结构完整性对术后颌骨稳定性及髁突体积变化的影响。方法:选择2014年至2019年就诊于北京大学口腔医院诊断为下颌后缩畸形伴颞下颌关节重度骨关节病,并接受正颌手术且满足条件的患者37例进行回顾性分析,其中男性1例,女性36例,年龄(28.03±6.52)岁(21~34岁),依据术前髁突表面骨质情况分为表面光滑组和表面不光滑组,其中光滑组19例,不光滑组18例,分别于术前1周,术后1周、3个月、6个月及1年拍摄头颅侧位片及锥形束CT(cone-beam computed tomography,CBCT), 对头颅侧位片进行坐标系建立及头影测量分析明确术后颌骨稳定性,对CBCT进行三维重建分割获取髁突的三维模型及体积,评价术后髁突体积的变化,通过CBCT影像资料评估术后髁突骨质改变情况,明确术后髁突骨质改变与颌骨稳定性的相关性,应用SPSS 20.0软件,采用Fisher确切概率法、Spearman相关系数分析及Mann-Whitney检验对所获数据进行统计学分析。结果:术前髁突表面光滑组在术后3个月(T1)、术后6个月(T2)、术后12个月(T3)颌骨复发率分别为36.85%、47.37%、42.11%,术前髁突表面不光滑组T1、T2、T3颌骨复发率分别为27.78%、44.44%、55.56%,两组在各时间段的复发率差异无统计学意义,术前髁突表面光滑组与不光滑组在各时间段的髁突体积的变化差异无统计学意义,不光滑组术后3个月的髁突进展与颌骨的稳定性有相关性。结论:对于下颌后缩伴颞下颌关节重度骨关节病且术前观察髁突一年无显著变化者,术前髁突表面是否光滑对于术后颌骨的稳定性没有确切影响,对于术前髁突不光滑的重度骨关节病患者,术后3个月出现髁突吸收会引起正颌术后颌骨位置的不稳定,术前髁突表面是否光滑对术后髁突体积的改建没有明确的影响。

关键词: 重度骨关节病, 下颌后缩, 正颌手术, 复发

Abstract:

Objective: To investigate the effect of preoperative condylar condition for mandible retrognathism deformities with severe temporomandibular joint osteoarthrosis on the stability of the jaw after orthognathic surgery and on the postoperative condylar volume changes. Methods: In this retrospective study, from 2014 to 2019, 37 patients including 1 male and 36 female, aged between 21 to 34 years old with an average age of (28.03±6.52) years, were diagnosed with mandible retrognathism deformities with severe temporomandibular joint osteoarthrosis by Peking University School and Hospital of Stomatology and received orthognathic surgery, meeting the inclusion criteria were included. According to the preoperative condylar condition. There were divided into smooth group and non-smooth group, the lateral cephalometric films 1 week (T0), 3 months (T1), 6 months (T2) and 1 year (T3) after surgery were used to establish the coordinate system and cephalometric analysis to determine the stability of the jaw after operation. The three-dimensional model of the condyle was segmented by cone beam computed tomography (CBCT) 1 week (T0), 3 months (T1), 6 months (T2) and 1 year (T3) after surgery and the volume was obtained to evaluate the change of the condyle volume after surgery. CBCT image data was used to evaluate the changes of the condylar condition after surgery, and to clarify the correlation between the postoperative condylar condition and jaw stability. SPSS 20.0 statistical software was used for statistical analysis, Fisher’s exact probability methods were used to compare whether there were statistically significant differences in the stability of the mandibular joint at stages T1, T2 and T3 with different preoperative condylar condition.Spearman correlation coefficient analysis and Mann-Whitney test were used to compare whether there were statistically significant differences in the volume changes at stages T1, T2 and T3 after surgery between the two groups. Results: The recurrence rates of the mandible in the condylar smooth group were T1 36.85%, T2 47.37% and T3 42.11%, respectively. The recurrence rates in the non-smooth condylar group were T1 27.78%, T2 44.44% and T3 55.56%, respectively. There was no statistical difference in the recurrence rates between the two groups at different time points. There was no significant difference in the condylar volume change between smooth group and non-smooth group. Conclusion: For patients with mandible retrognathism deformities with severe temporomandibular joint osteoarthrosis and no significant changes in the condyle observed for one year before surgery, there is no difference in the influence of the preoperative condylar condition on the stability of jaw after operation, and no definite influence on the volume of the condyle after operation. Condylar resorption 3 months after surgery can cause instability of the jaw after orthognathic surgery.

Key words: Severe osteoarthrosis, Retrognathia, Orthognathic surgery, Relapse

中图分类号:

R782

侯磊,叶国华,刘筱菁,李自力. 下颌后缩伴颞下颌关节重度骨关节病患者正颌术后颌骨稳定性及髁突体积变化的评价[J]. 北京大学学报（医学版）, 2020, 52(1): 113-118.

Lei HOU,Guo-hua YE,Xiao-jing LIU,Zi-li LI. Evaluation of mandibular stability and condylar volume after orthognathic surgery in patients with severe temporomandibular joint osteoarthrosis[J]. Journal of Peking University(Health Sciences), 2020, 52(1): 113-118.

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参考文献 30

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Landmark	Definition
S	Geometric center of pituitary fossa
N	Most anterior point on fronto-nasal suture
A	The most posterior point in the concavity between ANS and prosthion
B	The most posterior midline point in the concavity of the mandible between the most superior point on the alveolar bone overlying the mandibular incisors (infradentale) and Pg
Pg	The most anterior point on the symphysis
Ar	The intersection of the lower margin of the skull base and the posterior margin of the mandibular condyle neck

Measurement items	Definition
SNA	The angle formed by point S, point N and point A
SNB	The angle formed by point S, point N and point B
MP-SN	The angle of intersection of the MP plane and the SN plane
B-x	The forward and backward distance of point B
B-y	The vertical distance of point B
Pg-x	The forward and backward distance of point Pg
Pg-y	The vertical distance of point Pg

Group	T1			T2			T3
Group	Stable	Unstable	P	Stable	Unstable	P	Stable	Unstable	P
Smooth	63.15% (12/19)	36.85% (7/19)	0.73	52.63% (10/19)	47.37% (9/19)	1.00	57.89% (11/19)	42.11% (8/19)	0.57
Non-smooth	72.22% (13/18)	27.78% (5/18)		55.56% (10/18)	44.44% (8/18)		44.44% (8/18)	55.56% (10/18)

Group		Smooth	Non-smooth	P
Left condylar	T1	0.00(-8.00, 8.00)	5.00 (-0.75, 10.00)	0.12
	T2	3.00 (-4.00, 14.00)	10.00 (-1.00, 13.25)	0.36
	T3	9.00 (4.00, 17.00)	12.00 (-0.75, 16.25)	0.96
Right Condylar	T1	-2.00 (-5.00, 10.00)	1.00 (-2.05, 5.75)	0.65
	T2	6.00 (-4.00, 19.00)	2.00 (-3.75, 6.00)	0.09
	T3	1.00 (1.00, 19.00)	8.50 (-0.25, 21.00)	0.64

Group		T1			T2					T3
Group		Stable	Unstable	P	Stable	Unstable		P		Stable	Unstable	P
Smooth	Condylar Stable	8	3	1.00	5	5	0.64		6		7	1.00
Smooth	Condylar progress	5	2		5	3			2		3
Non smooth	Condylar Stable	11	3	0.03	3	7	0.07		7		4	0.65
Non smooth	Condylar progress	1	4		7	2			4		4