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颞下颌关节骨关节炎与冠突之间的相关性

[Correlation between temporomandibular joint osteoarthrosis and coronoid process].

作者信息

Yang S L, He Q M, Xu H, Nie D H, Yin Q H, Pu Qihong

机构信息

Department of Oral and Maxillofacial Surgery, Kunming Medical University School and Hospital of Stomatology, Yunnan Key Laboratory of Stomatology, Kunming 650106, China.

Department of Radiology, Kunming Medical University School and Hospital of Stomatology, Yunnan Key Laboratory of Stomatology, Kunming 650106, China.

出版信息

Zhonghua Kou Qiang Yi Xue Za Zhi. 2022 Jul 2;57(7):694-700. doi: 10.3760/cma.j.cn112144-20220430-00233.

Abstract

To investigate the morphological characteristics of coracoid process in different stages of temporomandibular joint osteoarthrosis (TMJOA), and to provide theoretical data for clinical and anatomic study. A total of 290 patients who were diagnosed with TMJOA in the Department of Temporomandibular Joint, Kunming Medical University School and Hospital of Stomatology from January 2015 to February 2021 were collected, including 69 males and 221 females, with an average age of 35.1±13.7 years (16-69 years old), 64 cases of unilateral lesions (64 sides), and 226 cases of bilateral lesions (452 sides). According to the TMJOA X-ray staging standard put forward by Ma Xuchen in 2005, the affected joints were divided into stage I (227 sides), stage Ⅱ (38 sides), stage Ⅲ (164 sides) and stage Ⅳ (87 sides). Twenty-six patients without clinical and imaging manifestations of temporomandibular disorders in the Department of Radiology, Kunming Medical University School and Hospital of Stomatology from October 2020 to June 2021 were selected as the control group, including 8 males and 18 females. The average age was (34.3±13.9) years (17-60 years). The dicom data of each group were imported into SimplantPro11.04 software to measure the height of coracoid process, anteversion angle and the ratio of coracoid vertex to mandibular corner to condylar vertex to mandibular angle. R 3.6.1 was used to analyze the difference of the morphological characteristics of coracoid process between in the affected side of TMJOA and in the both sides of the control group, in the healthy side and the affected side of unilateral patients and in different stages of TMJOA. The height of the coracoid process [(16.26±2.81 mm)], the ratio of the coracoid process vertex-mandibular angle point and the condyle vertex-mandibular angle point distance [0.96(0.92,1.01)] on the affected side of TMJOA were significantly higher than those in the control group [(15.31±3.03)mm;0.95(0.89、0.99)] (=2.18, =0.033; =2.87, =0.004). There was no significant difference between the ante-version angle and the control group (=-1.37, =0.176). The ratio of the distance between the apex of the coracoid process and the apex of the mandibular angle to the apex of the condyle and the angle of the mandible in the affected side of unilateral patients was significantly greater than that in the healthy side (=-3.46, =0.001). There was no significant difference in coracoid height, coracoid anteversion angle and the healthy side (=-1.85, =0.069; =-0.06, =0.955) in different periods. The intra-group analysis showed that there was no significant difference in the height of the coracoid process in different stages (=0.37, =0.774). There was no significant difference in the ante-version angle of the coracoid process: stage I, stage Ⅱ, and stage Ⅲ (>0.008), but all were significantly smaller than stage Ⅳ (<0.001, =0.009, <0.001). The ratio of the distance between coracoid apex-mandibular angle and condyle apex-mandibular angle: there was no significant difference in stage I, stage Ⅱ, and stage Ⅲ (>0.008), and stage I and stage Ⅲ were significantly smaller than stage Ⅳ (<0.001). The coracoid height and the ratio of the coracoid apex-mandibular angle to the condyle apex-mandibular angle distance on the TMJOA side were significantly greater than those without temporomandibular joint disorders. The bone deposition was mainly concentrated in the upper and posterior part of the condyle. TMJOA had a certain correlation with the height of the coracoid process.

摘要

探讨颞下颌关节骨关节炎(TMJOA)不同阶段喙突的形态学特征,为临床及解剖学研究提供理论依据。收集2015年1月至2021年2月在昆明医科大学附属口腔医院颞下颌关节科确诊为TMJOA的患者290例,其中男性69例,女性221例,平均年龄35.1±13.7岁(16 - 69岁),单侧病变64例(64侧),双侧病变226例(452侧)。根据马绪臣2005年提出的TMJOA X线分期标准,将患侧关节分为Ⅰ期(227侧)、Ⅱ期(38侧)、Ⅲ期(164侧)和Ⅳ期(87侧)。选取2020年10月至2021年6月在昆明医科大学附属口腔医院放射科无颞下颌关节紊乱临床及影像学表现的26例患者作为对照组,其中男性8例,女性18例,平均年龄(34.3±13.9)岁(17 - 60岁)。将每组的dicom数据导入SimplantPro11.04软件,测量喙突高度、前倾角度以及喙突顶点至下颌角与髁突顶点至下颌角的比值。采用R 3.6.1分析TMJOA患侧与对照组双侧、单侧患者健侧与患侧以及TMJOA不同阶段喙突形态学特征的差异。TMJOA患侧喙突高度[(16.26±2.81)mm]、喙突顶点 - 下颌角点与髁突顶点 - 下颌角点距离比值[0.96(0.92,1.01)]显著高于对照组[(15.31±3.03)mm;0.95(0.89,0.99)](=2.18,=0.033;=2.87,=0.004)。前倾角度与对照组差异无统计学意义(=-1.37,=0.176)。单侧患者患侧喙突顶点至下颌角与髁突顶点至下颌角距离比值显著大于健侧(=-3.46,=0.001)。不同时期喙突高度、喙突前倾角度与健侧差异无统计学意义(=-1.85,=0.069;=-0.06,=0.955)。组内分析显示,不同阶段喙突高度差异无统计学意义(=0.37,=0.774)。喙突前倾角度:Ⅰ期、Ⅱ期和Ⅲ期差异无统计学意义(>0.008),但均显著小于Ⅳ期(<0.001,=0.009,<0.001)。喙突顶点 - 下颌角与髁突顶点 - 下颌角距离比值:Ⅰ期、Ⅱ期和Ⅲ期差异无统计学意义(>0.008),Ⅰ期和Ⅲ期显著小于Ⅳ期(<0.001)。TMJOA侧喙突高度及喙突顶点 - 下颌角与髁突顶点 - 下颌角距离比值显著大于无颞下颌关节紊乱者。骨质沉积主要集中在髁突的上部和后部。TMJOA与喙突高度有一定相关性。

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