不同垂直骨面型骨性Ⅱ类青少年女性颞下颌关节锥形束CT测量分析

doi:10.19723/j.issn.1671-167X.2021.01.017

摘要/Abstract

摘要：

目的: 探讨不同垂直骨面型骨性Ⅱ类青少年女性颞下颌关节形态和位置特征。方法: 纳入北京大学口腔医院正畸科初诊拍摄大视野锥形束CT(cone-beam CT,CBCT)的11~14岁女性80例,按照上牙槽座点-鼻根点-下牙槽座点角(subspinale-nasion-supramental angle,ANB)和下颌平面角(Frankfort horizontal plane-gonion-gnathion angle,FH-GoGn)大小分为骨性Ⅰ类均角组(组1,0°≤ANB<4°,22°≤FH-GoGn≤32°),骨性Ⅱ类低角组(组2,ANB≥4°,FH-GoGn<22°)、均角组(组3,ANB≥4°,22°≤FH-GoGn≤32°)和高角组(组4,ANB≥4°,FH-GoGn>32°),每组20例,导入Dolphin软件进行头影测量和关节形态、位置测量。分别使用配对t检验、方差分析和卡方检验比较双侧关节对称性和关节形态及位置的组间差异,采用相关性分析探索骨性Ⅱ类人群头影测量值与关节测量项目间相关关系。结果: (1)关节对称性分析中,四组都存在少量差异有统计学意义的测量项目;组4双侧髁突位置不对称的样本量最多(65%), 其余三组比例相近,但差异无统计学意义。(2)对比组1和组3,关节形态学测量差异无统计学意义;髁突位置组1以前位和中位为主,组3居于后位者明显多于组1(χ²=6.936,P<0.05)。(3)在组2、3、4中,组2关节窝深度最深(H_2&4=10.517,P=0.002),关节上间隙(LSD-t_2&3=3.408,LSD-t_2&4=5.369,P<0.001)、外间隙(LSD-t_2&3=2.767,LSD-t_2&4=3.350,P=0.001)最大;组4髁突长轴径最小(H_2&4=13.374,P<0.001),关节窝垂直距最大(LSD-t_2&4=4.561,P<0.001;LSD-t_3&4=2.713,P=0.007),关节内间隙(LSD-t_2&4=-4.083,P<0.001)、中间隙(LSD-t_2&4=-4.201,P<0.001)最小。从组2、组3到组4,后位髁突所占比例逐渐升高。相关性分析显示,ANB与关节前间隙呈显著正相关(r=0.270,P=0.037),与髁突长轴角呈显著负相关(r=-0.296,P=0.022);FH-GoGn与关节上间隙(r=-0.488,P<0.001)、后间隙(r= -0.272,P=0.035)、内间隙(r=-0.390,P=0.002)、中间隙(r=-0.425,P=0.001)、外间隙(r=-0.331,P=0.010)、关节窝深度(r=-0.363,P=0.004)、关节结节后斜面倾斜度(r=-0.259,P=0.046)、髁突长轴径(r=-0.327,P=0.011)呈显著负相关,与关节窝垂直距呈显著正相关(r=0.370,P=0.004)。结论: Ⅱ类矢状骨面型的关节特征主要体现在髁突位置而非关节形态。Ⅱ类不同垂直骨面型关节形态及位置的差异更多地体现在关节间隙以及髁突和关节窝位置,从低角到高角关节窝位置逐渐增高,髁突后位比例逐渐增大。Ⅱ类高角的关节窝位置最高,髁突后位比例最大,关节间隙最小,关节窝深度最浅,髁突长轴径最短,关节不稳定因素最多,在进行正畸治疗时要尤其注意。

关键词: 颞下颌关节, 锥形束计算机体层摄影术, 骨性Ⅱ类, 垂直骨面型, 青少年

Abstract:

Objective: To compare temporomandibular joint (TMJ) morphology and position among skeletal class Ⅱ female adolescents with different vertical patterns using cone-beam CT (CBCT). Methods: Diagnostic CBCT images of 80 female patients aged 11 to 14 years were assessed retrospectively. According to subspinale-nasion-supramental angle (ANB) and Frankfort horizontal plane-gonion-gnathion angle (FH-GoGn), the participants were categorized into four groups (20 subjects each), i.e. class Ⅰ normal angle (group 1, 0°≤ANB<4°, 22°≤FH-GoGn≤32°), class Ⅱ low (group 2, ANB≥4°, FH-GoGn<22°), normal (group 3, ANB≥4°, 22°≤FH-GoGn≤32°) and high angle (group 4, ANB≥4°, FH-GoGn>32°). Cephalometrics, morphology and position of TMJ were measured in Dolphin software. Using paired-samples t test to analyze TMJ symmetry, One-way analysis of variance (One-way ANOVA) and Chi-square tests to detect differences among the groups. The correlations between cephalometrics and TMJ measurements were also analysed within the skeletal class Ⅱ patients.Results: (1) Analysing TMJ morphologic symmetry, some measurements differed statistically although the mean diffe-rences were negligibly relative to their values. No statistically significant difference was found among the groups though group 4 showed the highest probability of condylar position asymmetry (65%). (2) Comparing group 1 with group 3, statistical difference was found in condylar position (χ²=6.936, P<0.05) instead of morphologic measurements. Anterior and concentric condylar position were more frequently observed in group 1, yet posterior position was more prevalent in group 3. (3) In groups 2, 3, and 4, statistically, group 2 had the deepest glenoid fossa depth (H_2&4=10.517,P=0.002), biggest superior (LSD-t_2&3=3.408, LSD-t_2&4=5.369, P<0.001) and lateral (LSD-t_2&3=2.767, LSD-t_2&4=3.350, P=0.001) joint spaces, whereas group 4 showed the shortest condylar long axis diameter (H_2&4=13.374, P<0.001), largest glenoid fossa vertical distance (LSD-t_2&4=4.561, P<0.001, LSD-t_3&4=2.713, P=0.007), smallest medial (LSD-t_2&4=-4.083, P<0.001) and middle (LSD-t_2&4=-4.201, P<0.001) joint spaces. The posterior condylar position proportion gradually increased from groups 2 to 3 to 4. Correlation analysis revealed ANB correlated with anterior joint space positively (r=0.270, P=0.037) and condylar long axis angle negatively (r=-0.296, P=0.022). FH-GoGn correlated with superior (r=-0.488, P<0.001), posterior (r= -0.272, P=0.035), mesial (r=-0.390, P=0.002), middle (r=-0.425, P=0.001), and lateral (r=-0.331, P=0.010) joint spaces, articular eminence inclination (r=-0.259, P=0.046), as well as condylar long axis diameter (r=-0.327, P=0.011) negatively, and glenoid fossa depth (r=0.370, P=0.004) positively. Conclusion: TMJ characteristics of skeletal class Ⅱ sagittal pattern mainly reflected in condylar position rather than morphology. TMJs of different vertical patterns differed more in joint spaces, position of condyle and glenoid fossa than in morphologic measurements. Vertical position of glenoid fossa and proportion of posterior condyle increased gradually from hypodivergent to hyperdivergent. Highest glenoid fossa position, maximum ratio of posterior positioned condyle, smallest joint spaces, shallowest glenoid fossa depth, and narrowest condylar long axis diameter were found in skeletal class Ⅱ high angle group, which means that patients with this facial type have considerable joint instable factors, and we should especially pay attention when orthodontic treatment is carried out on them.

Key words: Temporomandibular joint, Cone-beam computed tomography, Skeletal class Ⅱ, Vertical skeletal pattern, Adolescent

中图分类号:

R783.5

周境,刘怡. 不同垂直骨面型骨性Ⅱ类青少年女性颞下颌关节锥形束CT测量分析[J]. 北京大学学报（医学版）, 2021, 53(1): 109-119.

ZHOU Jing,LIU Yi. Cone-beam CT evaluation of temporomandibular joint in skeletal class Ⅱ female adolescents with different vertical patterns[J]. Journal of Peking University (Health Sciences), 2021, 53(1): 109-119.

图/表 12

图1

图2

图3

图4

图5

图6

表1

各组样本年龄及头影测量分布"

Variable	Group 1	Group 2	Group 3	Group 4
Age/months, $\bar{x}$ $x -$ ±s	154.20±10.07	152.55±12.70	153.20±12.03	151.65±11.47
ANB/(°), $\bar{x}$ $x -$ ±s	2.51±1.01^#△§	4.98±0.89^*§	5.43±1.21^*	6.36±1.48^*#
FH-GoGn/(°), $\bar{x}$ $x -$ ±s	26.18±2.10^△§	19.47±2.74^*△§	27.06±2.20^#§	33.71±1.89^*#△

表1

表2

表3

表4

表5

表6

参考文献 36

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Measurements	Group 1	Group 2	Group 3	Group 4
Condylar length/mm	-0.72±1.30^*	-0.10±1.35	-0.29±1.50	-0.31±1.45
Condylar height/mm	-0.50±1.12	-0.12±1.38	-0.22±1.36	-0.51±1.43
Condylar neck inclination/(°)	1.88±4.17	-0.91±4.20	1.72±3.67^*	-0.60±3.90
Condylar head angle/(°)	-1.51±7.10	-2.23±11.13	-1.95±12.44	-4.60±9.72^*
Anterior joint space/mm	-0.04±0.40	-0.16±0.46	-0.26±0.47^*	-0.21±0.49
Superior joint space/mm	-0.08±0.47	-0.12±0.55	0.03±0.36	-0.01±0.70
Posterior joint space/mm	0.11±0.38	0.01±0.38	0.13±0.42	0.16±0.60
Glenoid fossa width/mm	-0.11±1.96	0.45±1.23	0.41±1.37	-0.18±1.36
Glenoid fossa depth/mm	0.14±0.92	0.06±0.64	0.24±0.72	-0.27±0.74
Articular eminence inclination/(°)	3.16±8.46	-4.24±7.55^*	-3.01±6.28^*	-6.40±7.84^*
Mesial joint space/mm	-0.07±0.52	-0.11±0.55	0.10±0.55	-0.06±0.51
Middle joint space/mm	-0.14±0.63	-0.02±0.60	0.02±0.54	-0.43±0.63^*
Lateral joint space/mm	-0.05±0.68	-0.09±0.52	-0.07±0.74	-0.03±0.62
Condylar long axis diameter/mm	0.05±1.12	0.36±0.95	0.22±1.50	-0.04±1.53
Condylar short axis diameter/mm	0.10±0.56	0.35±0.82	0.30±0.75	0.23±0.87
Glenoid fossa vertical distance/mm	-0.15±0.95	-0.13±0.88	0.77±0.87^**	0.00±0.75
Glenoid fossa coronal distance/mm	1.22±2.32^*	1.73±2.37^*	1.11±1.86^*	1.25±2.04^*
Glenoid fossa sagittal distance/mm	-0.31±1.95	0.69±1.36^*	0.22±1.16	0.27±2.21
Condylar long axis angle/(°)	-0.19±7.56	-2.58±4.59^*	-1.53±7.25	-0.98±7.44

Condylar position	Group 1	Group 2	Group 3	Group 4
Symmetrical	10 (50)	13 (65)	12 (60)	7 (35)
Asymmetrical	10 (50)	7 (35)	8 (40)	13 (65)

Measurements	Group 1	Group 2	Group 3	Group 4
Condylar length/mm	17.30±1.92	17.16±2.43	17.40±2.46	17.39±1.77
Condylar height/mm	16.48±1.76	16.39±2.42	16.54±2.39	16.63±1.76
Condylar neck inclination/(°)	73.48±6.07	73.23±6.01	72.46±4.95	73.99±6.47
Condylar head angle^ks/(°)	151.56±7.96	154.12±13.95	150.99±9.54	154.26±10.15
Anterior joint space/mm	1.55±0.56	1.71±0.40	1.56±0.54	1.82±0.60
Superior joint space/mm	2.23±0.63^#	2.91±0.77^*△§	2.38±0.64^#	2.07±0.74^#
Posterior joint space/mm	1.65±0.48	1.68±0.48	1.54±0.42	1.49±0.46
Glenoid fossa width/mm	17.35±2.08	17.41±1.52	1.54±0.42	17.07±1.78
Glenoid fossa depth^ks/mm	6.62±1.33	7.37±1.03^§	6.85±0.96	6.50±1.15^#
Articular eminence inclination/(°)	49.62±11.76	53.24±9.09	51.47±8.46	49.43±11.34
Mesial joint space/mm	2.11±0.62^#	2.50±0.74^*§	2.24±0.60	1.91±0.62^#
Middle joint space/mm	2.26±0.72	2.61±0.73^§	2.33±0.67	1.94±0.73^#
Lateral joint space/mm	2.09±0.61	2.34±0.52^△§	1.96±0.66^#	1.88±0.66^#
Condylar long axis diameter^ks/mm	16.99±2.61	17.37±1.76^§	16.47±1.85	15.54±2.51^#
Condylar short axis diameter/mm	7.73±1.01	7.85±1.14	7.53±0.89	7.55±1.00
Glenoid fossa vertical distance/mm	2.63±1.42^#	1.53±1.36^*§	2.09±1.27^§	2.90±1.32^#*
Glenoid fossa coronal distance/mm	49.02±2.44	48.56±1.87	48.74±2.08	48.59±2.40
Glenoid fossa sagittal distance^ks/mm	9.65±3.12	9.60±3.11	10.16±2.09	9.67±2.76
Condylar long axis angle^ks/(°)	68.24±8.43	68.15±5.38	67.36±7.72	65.79±9.03

Variables	ANB (n=60)		FH-GoGn (n=60)
Variables	r	P	r	P
Condylar length	-0.245	0.059	0.091	0.491
Condylar height	-0.228	0.080	0.091	0.487
Condylar neck inclination	0.074	0.572	0.038	0.771
Condylar head angle	0.143	0.275	-0.024	0.853
Anterior joint space	0.270	0.037^*	0.037	0.778
Superior joint space	-0.145	0.270	-0.488	<0.001^**
Posterior joint space	-0.196	0.133	-0.272	0.035^*
Glenoid fossa width	-0.114	0.386	-0.101	0.443
Glenoid fossa depth	-0.130	0.321	-0.363	0.004^**
Articular eminence inclination	0.120	0.363	-0.259	0.046^*
Mesial joint space	-0.149	0.256	-0.390	0.002^**
Middle joint space	-0.144	0.271	-0.425	0.001^**
Lateral joint space	-0.115	0.383	-0.331	0.010^*
Condylar long axis diameter	-0.154	0.240	-0.327	0.011^*
Condylar short axis diameter	-0.240	0.065	-0.143	0.276
Glenoid fossa vertical distance	0.161	0.220	0.370	0.004^**
Glenoid fossa coronal distance	0.050	0.706	0.051	0.697
Glenoid fossa sagittal distance	-0.170	0.193	-0.163	0.214
Condylar long axis angle	-0.296	0.022^*	-0.211	0.105

Condylar position	Group 1	Group 2	Group 3	Group 4
Anterior	11 (27.5)	4 (10.0)	14 (35.0)	6 (15.0)
Concentric	22 (55.0)	25 (62.5)	11 (27.5)	16 (40.0)
Posterior	7 (17.5)	11 (27.5)	15 (37.5)	18 (45.0)