天津医药

天津医药 ›› 2021, Vol. 49 ›› Issue (7): 735-741.doi: 10.11958/20203347

• 临床研究 • 上一篇    下一篇

颞下颌关节紊乱病患者经再定位咬合板治疗前后的影像学分析

郭隽，曹菁，李程，李泽奎，高思文，张娟   

  1. 天津医科大学口腔医院口腔修复科（邮编300070）
  • 收稿日期:2020-12-02 修回日期:2021-03-07 出版日期:2021-07-15 发布日期:2021-07-12
  • 通讯作者: 郭隽 E-mail:kqzhangjuan@126.com
  • 作者简介:郭隽（1989），女，硕士在读，主要从事口腔修复工作。E-mail：511658604@qq.com

Imaging analysis of patients with temporomandibular joint disorder before and after repositioning splint treatment

GUO Jun, CAO Jing, LI Cheng, LI Ze-kui, GAO Si-wen, ZHANG Juan   

  1. Department of Prosthodontics, Stomatology Hospital of Tianjin Medical University, Tianjin 300070, China
  • Received:2020-12-02 Revised:2021-03-07 Published:2021-07-15 Online:2021-07-12

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摘要： 目的　应用锥形束CT（CBCT）及MRI分析颞下颌关节紊乱病（TMD）患者经再定位咬合板（ARS）治疗前后的影像学差异，探讨ARS治疗TMD的临床疗效及意义。方法　将86例TMD患者根据是否接受ARS治疗分为ARS组（60例）和非ARS组（26例）。非ARS组使用肌功能训练6个月，ARS组在肌功能训练的配合下经ARS治疗6个月，分析2组TMD患者治疗前后的最大开口度（MMO）、关节弹响和疼痛视觉模拟评分（VAS），颞下颌关节的CBCT三维数据，MRI测得的关节盘长度和盘-髁距离。对ARS组中20例和非ARS组中10例退行性关节病患者，分析其治疗前后CBCT所显示的髁突骨质的变化。结果　与非ARS组比较，治疗后ARS组MMO增大，关节弹响和疼痛VAS评分降低（P＜0.05）；CBCT显示髁突水平角减小，关节前间隙变窄，关节后间隙增宽（P＜0.05）；关节上间隙，髁突前后径、内外径比较差异无统计学意义（P＞0.05）。ARS组中20例退行性关节病患者经ARS治疗后髁突骨质得到明显改善，骨质评分较非ARS组降低（P＜0.05）。MRI显示ARS组治疗前后关节盘长度未发生明显变化（P＞0.05），而治疗后盘-髁距离较非ARS组缩短（P＜0.05）。结论　CBCT及MRI检查能够明确ARS对恢复TMD患者髁突和关节盘的位置及形态的临床效果。

关键词: 颞下颌关节功能紊乱综合征, 锥束计算机体层摄影术, 磁共振成像, 颞下颌关节盘, 再定位咬合板

Abstract: Objective　To apply Cone-Beam CT (CBCT) and MRI to analyze the imaging differences of patients with temporomandibular joint disorder (TMD) before and after the anterior repositioning splint (ARS), and to explore the clinical effects of ARS in the treatment of TMD. Methods　A total of 86 TMD patients were collected and divided into ARS group (n=60) and non ARS group (n=26). The non ARS group used muscle function training for six months, and the ARS group was treated with ARS for 6 months with the cooperation of muscle function training. The average maximal mouth opening (MMO), joint snapping percentage, pain visual analogue scale (VAS), CBCT three-dimensional data of temporomandibular joint, joint disc length and disc-condyle distance measured under MRI scan of TMD patients were analyzed before and after treatment in the two groups. The changes in bone quality and morphology of the condyle before and after treatment were analyzed in the ARS group (20 patients) and the non-ARS group with degenerative joint disease (10 patients). Results　Compared with the non ARS group, the MMO increased and the joint snapping and pain VAS decreased after treatment in the ARS group (P＜0.05). Results of CBCT showed that the horizontal angle of the condyle decreased, the anterior joint space narrowed and the posterior joint space widened (P＜0.05). There were no significant differences in the supra-joint space, the anteroposterior diameter of the condyle, the internal and external diameter between the two groups (P＞0.05). Compared with the non ARS group, 20 patients with degenerative joint disease showed a significant improvement in condyle bone quality after ARS treatment in the ARS group, and the bone change score decreased (P＜0.05). MRI results showed that there was no significant difference in the length of the joint disc before and after treatment in the ARS group (P＞0.05), whereas the length of the joint disc was significantly shorter after treatment than that in the non ARS group (P＜0.05). Conclusion　CBCT and MRI can confirm the clinical effect of ARS on the position and morphology of the condyles and articular discs in TMD patients.

Key words: temporomandibular joint dysfunction syndrome, cone-beam computed tomography, magnetic resonance imaging, temporomandibular joint disc, anterior repositioning splint