安氏三类错（牙合）伴颞下颌关节功能紊乱病患者髁突运动研究
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摘要
【目的】测量分析恒牙(牙合)AngleⅢ类错(牙合)伴TMD患者的髁突运动，探讨AngleⅢ类错(牙合)畸形伴TMD的髁突运动轨迹特征，为错(牙合)畸形及颞下颌关节疾病预防和诊治提供参考。
【方法】选择恒牙(牙合)AngleⅢ类错(牙合)伴TMD患者30名为实验组，单纯AngleⅢ类错(牙合)患者30名，正常(牙合)患者30名为两个对照组，采用计算机化的髁状突轴图描记仪(CADIAXⅢ)记录最大开闭口、前伸后退及侧方运动时的髁状突运动，比较其各项测量指标并将其定性、定量分析。
【结果】
1．AngleⅢ类错(牙合)伴TMD组：
1)不同性别间比较：右侧髁突运动：除开闭口运动中男性在垂直向和最大空间位移上大于女性，差异有显著性外，其余均无统计学意义；左侧髁突运动：开闭口运动及前伸后退运动差异无统计学意义；左右侧方运动中Y轴(左右向)上最大位移差别有统计学意义，男性大于女性，差异有显著性。其余均无统计学意义。
2)左右髁突比较：开闭口运动、前伸后退运动中的Y轴上最大位移差别均有统计学意义(p＜0.01)，右侧小于左侧。侧方运动的非工作侧与工作侧髁突间比较，工作侧均小于非工作侧，差别均有统计学意义。其余无统计学意义。
2．AngleⅢ类错(牙合)伴TMD组和AngleⅢ类错(牙合)组(对照组1)相比
在开闭口、前伸后退及侧方运动均大于对照组，尤其在垂直向差异有显著性，其它均无统计学意义。
3．AngleⅢ类错(牙合)伴TMD组与正常(牙合)者(对照组2)相比
各项运动，在Y轴上变异最大，除左右侧方运动工作侧大于正常组外，其他各个方向运动范围均小于正常组，尤其在开闭口运动水平向上和最大空间位移上、右侧方向运动中最大空间位移上，差异有显著性(p＜0.01)。
【结论】
1．恒牙合AngleⅢ类错(牙合)伴TMD患者髁状突运动轨迹闭合道不在一个运动轨迹上，重合性差，开闭口轨迹交叉率高，对称、光滑流畅程度均较差，图形在个体间不尽相同，但同一个体轨迹相对稳定。有侧位位移。
2．得出本研究AngleⅢ类错(牙合)伴TMD患者人群的髁状突最大位移范围。
3．AngleⅢ类错(牙合)伴TMD组和AngleⅢ类错(牙合)组、正常(牙合)组各个体之间髁突各方向的运动范围变异较大。
4在AngleⅢ类错(牙合)伴TMD组和对照组(AngleⅢ类错(牙合)组、正常(牙合)组)相比：各项运动在Y轴上位移变异最大，在开闭口运动和前伸后退及侧方运动非工作侧中髁突运动最大位移范围基本上是正常(牙合)组＞AngleⅢ类错(牙合)伴TMD组＞AngleⅢ类错(牙合)组。侧方运动工作侧中髁突运动最大位移范围基本上是AngleⅢ类错(牙合)伴TMD组＞正常(牙合)组＞AngleⅢ类错(牙合)组。
Objective: To analyze condyle movement in AngleⅢmalocclusion with TMD and toknow the differentia of the range and style and to offer the guidelines for clinicaldiagnosis and plan of treatment.
Methods: We recorded condyle movement of 30 AngleⅢmalocclusion with TMDselected as a trial group、30 AngleⅢmalocclusion and 30 Normal occlusion selectedas two control groups. during mandible open and close, protrusion and reptrusion,medio-free movement with the Computer Aided Axiography (CADIAⅫ), then to studythe qualitative and quatitative characters among AngleⅢmalocclusion with TMD and toanalyze the style and range of the condyle movement and to Compare with 30 normalocclusion and 30 AngleⅢmalocclusion
Results:
1 AngleⅢmalocclusion with TMD:1) both mandibular open and close in verticaland maximum space displacement about the right sides and mandibular medio-free inleft-and-right, the condyle pathways of the male are bigger than that of the female therehave greatly significant differences, the ranges of condyle movement of both sexes andsides in another directions, there are no sigificant differences.2)Compared with thecondyle movements of the left and the right sides,. During mandibular open andclose, protrusion and reptrusion in right-and-left, the movements of the right condyle arebigger than that of the left side, there are significant differences. During mandibularmedio movement, the ranges of condyle movement of the no-work sides are bigger thanthat of work sides, the differences are greatly significant. in other directions, there are nosigificant difference.
2. Compared between AngleⅢmalocclusion with TMD and AngleⅢmalocclusiongroup
During mandible open and close, protrusion and reptrution and mediomovement, the range of condyle pathways of AngleⅢmalocclusion with TMD in anydirections are bigger than that of the normal group, especially in vertical there havegreatly significant differences.
3. Compared between AngleⅢmalocclusion with TMD and Normal group
There are greatly variation in the range of condyle pathways transversely, except inwork sides during mandible medio-free, the condyle movements of AngleⅢmalocclusionwith TMD are bigger than that of Normal group, the condyle movements ranges in anydirections are smaller than those of Normal group, especially during protrusion and reptrution in horizon and maximum space displacement and medio-right movements inmaximum space displacement.
Conclusion:
1. AngleⅢmalocclusion with TMD condyle movement static traces are asymmetriccurve. Open and close traces intercross are high. The condyle movements are scatteredamong individuals in any directions. But to the individuals condyle movement statictraces are stabilization. There are found side displacements.
2.. Find out the movement range of AngleⅢmalocclusion with TMD of people in thisstudy.
3 the condyle movements of AngleⅢmalocclusion with TMD、AngleⅢmalocclusionand normal occlusion are scattered among individuals in any directions.
4. AngleⅢmalocclusion with TMD Compared with AngleⅢmalocclusion and thenormal group.
In AngleⅢmalocclusion with TMD. there have greatly significant variations,transversely. During mandible open and close, the protrusion and reptrution in anydirections and medio movement in no-work sides,the range of condyle pathways of AngleⅢmalocclusion with TMD are bigger than the AngleⅢmalocclusion but shorterthan that of the normal group. During medio movement in work sides, the range ofcondyle pathways of AngleⅢmalocclusion with TMD are biggest in the AngleⅢmalocclusion and the normal group.
【方法】选择恒牙(牙合)AngleⅢ类错(牙合)伴TMD患者30名为实验组，单纯AngleⅢ类错(牙合)患者30名，正常(牙合)患者30名为两个对照组，采用计算机化的髁状突轴图描记仪(CADIAXⅢ)记录最大开闭口、前伸后退及侧方运动时的髁状突运动，比较其各项测量指标并将其定性、定量分析。
【结果】
1．AngleⅢ类错(牙合)伴TMD组：
1)不同性别间比较：右侧髁突运动：除开闭口运动中男性在垂直向和最大空间位移上大于女性，差异有显著性外，其余均无统计学意义；左侧髁突运动：开闭口运动及前伸后退运动差异无统计学意义；左右侧方运动中Y轴(左右向)上最大位移差别有统计学意义，男性大于女性，差异有显著性。其余均无统计学意义。
2)左右髁突比较：开闭口运动、前伸后退运动中的Y轴上最大位移差别均有统计学意义(p＜0.01)，右侧小于左侧。侧方运动的非工作侧与工作侧髁突间比较，工作侧均小于非工作侧，差别均有统计学意义。其余无统计学意义。
2．AngleⅢ类错(牙合)伴TMD组和AngleⅢ类错(牙合)组(对照组1)相比
在开闭口、前伸后退及侧方运动均大于对照组，尤其在垂直向差异有显著性，其它均无统计学意义。
3．AngleⅢ类错(牙合)伴TMD组与正常(牙合)者(对照组2)相比
各项运动，在Y轴上变异最大，除左右侧方运动工作侧大于正常组外，其他各个方向运动范围均小于正常组，尤其在开闭口运动水平向上和最大空间位移上、右侧方向运动中最大空间位移上，差异有显著性(p＜0.01)。
【结论】
1．恒牙合AngleⅢ类错(牙合)伴TMD患者髁状突运动轨迹闭合道不在一个运动轨迹上，重合性差，开闭口轨迹交叉率高，对称、光滑流畅程度均较差，图形在个体间不尽相同，但同一个体轨迹相对稳定。有侧位位移。
2．得出本研究AngleⅢ类错(牙合)伴TMD患者人群的髁状突最大位移范围。
3．AngleⅢ类错(牙合)伴TMD组和AngleⅢ类错(牙合)组、正常(牙合)组各个体之间髁突各方向的运动范围变异较大。
4在AngleⅢ类错(牙合)伴TMD组和对照组(AngleⅢ类错(牙合)组、正常(牙合)组)相比：各项运动在Y轴上位移变异最大，在开闭口运动和前伸后退及侧方运动非工作侧中髁突运动最大位移范围基本上是正常(牙合)组＞AngleⅢ类错(牙合)伴TMD组＞AngleⅢ类错(牙合)组。侧方运动工作侧中髁突运动最大位移范围基本上是AngleⅢ类错(牙合)伴TMD组＞正常(牙合)组＞AngleⅢ类错(牙合)组。
Objective: To analyze condyle movement in AngleⅢmalocclusion with TMD and toknow the differentia of the range and style and to offer the guidelines for clinicaldiagnosis and plan of treatment.
Methods: We recorded condyle movement of 30 AngleⅢmalocclusion with TMDselected as a trial group、30 AngleⅢmalocclusion and 30 Normal occlusion selectedas two control groups. during mandible open and close, protrusion and reptrusion,medio-free movement with the Computer Aided Axiography (CADIAⅫ), then to studythe qualitative and quatitative characters among AngleⅢmalocclusion with TMD and toanalyze the style and range of the condyle movement and to Compare with 30 normalocclusion and 30 AngleⅢmalocclusion
Results:
1 AngleⅢmalocclusion with TMD:1) both mandibular open and close in verticaland maximum space displacement about the right sides and mandibular medio-free inleft-and-right, the condyle pathways of the male are bigger than that of the female therehave greatly significant differences, the ranges of condyle movement of both sexes andsides in another directions, there are no sigificant differences.2)Compared with thecondyle movements of the left and the right sides,. During mandibular open andclose, protrusion and reptrusion in right-and-left, the movements of the right condyle arebigger than that of the left side, there are significant differences. During mandibularmedio movement, the ranges of condyle movement of the no-work sides are bigger thanthat of work sides, the differences are greatly significant. in other directions, there are nosigificant difference.
2. Compared between AngleⅢmalocclusion with TMD and AngleⅢmalocclusiongroup
During mandible open and close, protrusion and reptrution and mediomovement, the range of condyle pathways of AngleⅢmalocclusion with TMD in anydirections are bigger than that of the normal group, especially in vertical there havegreatly significant differences.
3. Compared between AngleⅢmalocclusion with TMD and Normal group
There are greatly variation in the range of condyle pathways transversely, except inwork sides during mandible medio-free, the condyle movements of AngleⅢmalocclusionwith TMD are bigger than that of Normal group, the condyle movements ranges in anydirections are smaller than those of Normal group, especially during protrusion and reptrution in horizon and maximum space displacement and medio-right movements inmaximum space displacement.
Conclusion:
1. AngleⅢmalocclusion with TMD condyle movement static traces are asymmetriccurve. Open and close traces intercross are high. The condyle movements are scatteredamong individuals in any directions. But to the individuals condyle movement statictraces are stabilization. There are found side displacements.
2.. Find out the movement range of AngleⅢmalocclusion with TMD of people in thisstudy.
3 the condyle movements of AngleⅢmalocclusion with TMD、AngleⅢmalocclusionand normal occlusion are scattered among individuals in any directions.
4. AngleⅢmalocclusion with TMD Compared with AngleⅢmalocclusion and thenormal group.
In AngleⅢmalocclusion with TMD. there have greatly significant variations,transversely. During mandible open and close, the protrusion and reptrution in anydirections and medio movement in no-work sides,the range of condyle pathways of AngleⅢmalocclusion with TMD are bigger than the AngleⅢmalocclusion but shorterthan that of the normal group. During medio movement in work sides, the range ofcondyle pathways of AngleⅢmalocclusion with TMD are biggest in the AngleⅢmalocclusion and the normal group.
引文
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[28] Peck CC, Murray GM, Johnson CWL, et al. Trajectories of condylar points during nonworking side and protrusive movements of the mandible[J]. J Prosthed Dent, 1999, 82: 322～331
[29] Yatabe M, Zwijnenburg A, Megens CC, et al. The kinematic center: a reference point for temporomandibular condyle movements[J]. J Dent Res, 1995, 74:1644～1648
[30] Yatabe M, Zwijnenburg A, Megens CCEJ, et al. Movements of the mandibular condyle kinematic center during jawopening and closing[J]. J Dent Res, 1997, 76:714～719
[31] 冯海兰，Proschel P．前伸髁道与切道的关系．中华口腔医学志，1994， 29：629．
[32] 冯海兰1关于下颌侧方运动旋转中心的研究．中华口腔医学杂志，1994，29：3092311．
[33] Peck CC, Murray GM, Johnson CWL, et al. Trajectories of condylar points during nonworking side and protrusive movements of the mandible[J]. J Prosthed Dent, 1999, 82: 322～331
[34] Yatabe M, Zwijnenburg A, Megens CC, et al. The kinematic center: a reference point for temporomandibular condyle movements[J]. J Dent Res, 1995, 74: 1644～1648
[35] Yatabe M, Zwijnenburg A, Megens CCEJ, et al. Movements of the mandibular condyle kinematic center during jawo pening and closing[J]. J Dent Res, 1997, 76: 714～719
[36] Peck CC, Murray GM, Johnson CWL, et al. Trajectoriesof condylar points during working-side excursive movementsof the mandible[J]. J Prosthed Dent, 1999, 81: 444～452
[37] Kohno S. A study on condylar movements with reference to the mandibular movement in sagittal plane, Part 2:Analysis of sagittal axis with the multiple electronic flush apparatus. J Jpn Prosthet Soc, 1968, 12: 350-238
[38] Kurth L E, Feinstein IK. The hinge axis of the mandible. J Pro sthet Dent, 1951, 1: 327.
[39] Harper RP, Schneiderman E. Condylar movement and centric relation in patients with internal derangement of the tempo romandibular jo int. J Pro sthet Dent, 1996, 75: 67.
[40] 冯海兰，周崇阳，李平．下颌绞链运动轴点稳定性及位置的探讨．中华口腔医学杂志，1997，32：1392142．
[41] Po sselt U. Term inal hinge movement of the mandible. JP ro sthet Dent, 1957, 7: 787.
[42] 徐樱华1实用医学成都：四川大学出版社，1990，83，841
[43] M cCo llum BB. Fundamentals invo Ived in prescribing restorative dental remedies. Part Ⅲ. Dent Item s of Inter2est, 1939, 61: 852.
[44] W instanley RB. The h inge axis: a review of the literature. J Oral Rehabil, 1985, 12: 135.
[45] M cM illan A S, M cM illan DR, Darvell BW. Centers of rotation during jaw movements. A cta Odonto 1 Scand, 1989, 47: 323.
[46]Grant PG. Biomechanical significance of the instantaneouscenter of ro tation: the human tempo romandibular jo int. JBiomechan, 1973, 6: 103.
[47]The Academy of Prosthodontics, Glossary of Prosthodontic Terms. 7ed[J]. J Prosthed Dent, 1999, 81:58
[48]Slavicek-R. Clinical and instrumental functional analysis for diagnosis and treatment planning:Part 8: Case studies in CADIAX. J-Clin-Orthod. 1989 Jan, 23 (1) : 42-47.
[49] Pullinger A, HollenderL. Variation in condyle - fossa relationship according to different methods of evaluation in tomograms. Oral Surg Oral Med Oral Pathol ,1986 ,62 :719.
[50]Toshio D , Setsudo U , Yoshiko K. Clinical evaluation of temporomandibular joint disorders ( TMD) in patients treated with chin cup. Angle Orthodontist ,1998 ,68 :91.
[51]Van Sichels J E , Tiner BD .Aider ME. Condylar torque as a possible cause of hypomobility after sagittal split osteotomy :repoth of three cases. J Oral Maxillofac Surg ,1997 ,55 :398.
[52]Amett GW. A redefinition of bilateral sagittal osteotomy (BSO) advancement relapse. Am J Orthod Dentofac Orthop , 1993 , 104 :506.
[53]Rebellato J ,Lindaner SJ , Sheats RD. Condylar positional changes after mandibular advancement surgery with rigid intemal fixation. Am J Orthod Dentofaccial Orthop ,1999 ,116 :93.
[54] 安薇薇,纪昌蓉．北京地区正常合成人颞下颌关节形态特点的研究3．北京口腔医学,2002,10(4)：163—167．
[55] Okeson JP. M anagement of tempo romandibular diso rders and occlusion. St. Louis:Mo sby 1993; 127: 287.
[56]Pullinger A G, So lberg W , Ho 1lender L , etal. Tomograph ic analysis of mandibular condyle po sition in diagno stic sub2 group s of tempo romandibular diso rders. J P ro sthet Dent1986; 57: 723.
[57]FarrarWB. Characteristics of the condylar path in internal derangement of the TMJ. J P ro sthet Dent 1978; 39: 319.
[58]Weinberg L. Ro le of condylar po sition in TMJ dysfunction2 pain syndrome. J P ro sthet Dent 1979; 41 (6) : 636.
[59]Piehslinger E , Schimmerl S , Celar A , et al . Comparison of magnetic resonance tomography with computerized axiography in diagnosis of temporomandibular joint disorders. Int . J . Oral Maxillofac. Surg 1995 ; 24: 13-19.
[60] Piehslinger E, Celar A, Futter K, et al. Orthopedic jaw movement observations. Part 1: Determination and analysis of the length of protrusion. J.Craniomandib Practice 1993;11: 113-117.
[61] 村居圣子1下颚开闭口运动时下颚头限界运动不正咬合性格关研究1神奈川齿学1993：27，4，465-4791
[62] 晋长伟，洼田光庆，佐藤贞雄，徐宝华，林久祥．错合与正常合之间的髁突运动轨迹的比较研究，口腔正畸学，2002 ，9(3) 501
[63] Bernd Zimmer, Andreas Jager, dietmar Kubein-Meesnburg. Comparison of 'normal' TMJ-function in Class Ⅰ, Ⅱand Ⅲ individuals. Euroean J. Orthodopntics 1991;13: 27-34.
[64] Stamm T, Vehring A, Ehmer U, Bollmann F. Computer-aided Axiography of Asymptomatic individual with Class Ⅱ/ 2. J. Orofac orthop/ Kiefer orthop 1998;59: 237-45.
[65] Singh GD.. Morphologic determinants in the etiology of class Ⅲ malocclusions: a review. Clin Anat. 1999;12(5): 382—405
[66] Gokalp H. Magnetic resonance imaging assessment of positional relationship between the disk and condyle in asymptomatic young adult mandibular prognathism. Angle Orth od. 2003 0ct;73(5): 550-555
[67] 周彦恒，傅民魁．成人骨性AngleⅢ类错合下颌边缘运动轨迹研究．现代口腔医学杂志，995；9(1)：65-67