50例颞下颌关节紊乱患者的CBCT测量值分析
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摘要
目的：本研究利用锥形束CT(Cone Beam Computer Tomagr-aphy,CBCT)获得颞下颌关节紊乱病(temporomandibulardisorders,TMD)患者的颞下颌关节(temporomandibular joint,TMJ)的3D重建图像,应用CBCT软件系统对TMD患者的颞下颌关节参数进行测量,来探讨颞下颌关节紊乱病对颞下颌关节骨性形态的影响,为临床诊断颞下颌关节紊乱病提供一定的诊断依据。
方法：选择2011到2012年在兰州大学口腔医院就诊的50例患有TMD的病人作为实验组,选择10名健康的无颞下颌关节症状的正常人作为对照组,使用CBCT进行影像扫描,重建所扫描的影像,而后选择需要的参考平面。在选定的轴位影像上测量颞下颌关节半径值、髁突水平角、髁状突的前后径、髁状突的内外径；在选定的矫正矢状位上测量关节间隙、关节凹深度、关节结节斜度Q。在选定的矫正冠状位上测得髁状突垂直角β、髁状突受力角α,对所有研究对象进行三次测量,(三次测量工作均由实验者者本人完成)取平均值,所有数据均采用SPSS17.0统计软件进行处理,检验水准选取a=0.05。资料均以均数±标准差表示,同一样本左右两侧采用配对t检验进行统计分析。不同样本间采用独立样本t检验进行统计分析。
结果：1、病例组和对照组做比较其髁状突的形态在左右两侧矢状位关节前间隙、矢状位关节上间隙、关节结节斜度、关节凹深度,在两组间差别均有统计学意义(P<0.05),左侧髁状突的受力角α在两组间差别有统计学意义(P<0.05),其余各组间尚不能认为有差别(P<0.05)。2、对病例组的同一个体左右两侧不同投影位置颞下颌关节测量结果进行比较：轴位水平角、关节结节斜度、关节凹深度在两侧间差别有统计学意义(P<0.05),其余项目差别均尚不能认为有统计学意义(P>0.05)。对对照组的左右两侧测量结果进行比较,均不能认为有统计学意义(P>0.05)。
结论：TMD的病人颞下颌关节的骨性形态与正常人相比有差异,说明TMD可导致颞下颌关节骨性结构的改变,利用CBCT可以给临床诊断TMD提供一定的诊断依据。
Objective:
In this study, we obtained3D reconstructed images of temporomandibular joint of patients with temporomandibular joint disorders by cone beam CT (CBCT), measured temporomandibular joint space parameters of patients with TMD by CBCT software and AutoCAD software system. The purpose of the study is to explore the effect of temporomandibular joint disorder on temporomandibular joint morphology, and provide diagnostic basis for clinical diagnosis of temporomandibular joint disorders.
Methods:
We selected50patients suffering from temporomandibular disorder as the experimental group which are all from the clinic of Stomatology Hospital of Lanzhou University during from2011to2012, Selecting10cases of healthy people without temporomandibular joint symptoms as the control group, conducted image scanning by CBCT, reconstructed the scanned images, and then selected the required reference plane. in the selected axial images, measured the radius value of temporomandibular joint, the short axis diameter of the condyle, the long axis diameter of the condyle and condyle horizontal angle.In the selected correction of sagittal, measured the joint space, the depth of the joint concave, the angle a of articular eminence, oblique measuring. In the selected correction of coronal, measured the angle (3of condyle vertical and the angle a of condyle stress. all subjects were measured three times by the experimenter himself, all data were analyzed by SPSS17.0statistical software, expressed as M±SD, the same sample were analyzed by paired t test,the different sample were analyzed by independent sample t test, and P<0.05, indicated statistical significance.
Results:
1.compared with the condylar morphology on the left and right sagittal joint gap, sagittal joint clearance, articular eminence inclination, joint concave depth, The case group and the control group, the difference were statistically significant(P<0.05), The left condyle diameter width and the stress angle a condylar difference between two groups was statistically significant (P<0.05).other groups could not believe that there was a difference(P>0.05).
2.Compared to the same individual cases on the left and the right sides of different projection position of temporomandibular joint measurement results, the axial horizontal angle, the articular tubercle angle, joint concave depth, sagittal condylar axis angle in vertical joint gap between the two sides of the difference was statistically significant (P<0.05). the remaining items were not statistically significant (P>0.05). Comparison of left and right sides of measurement results of the control group, were not considered statistically significant (P>0.05).
Conclusion:
The temporomandibular joint bone morphology of Patients with temporomandibular joint disorder,compared with normal people are different,. Description TMD can lead to temporomandibular joint bone change in the structure.The condyle, articular fossa with ical differences,using CBCT can provide diagnostic basis for clinical diagnosis of temporomandibular joint disorder.
方法：选择2011到2012年在兰州大学口腔医院就诊的50例患有TMD的病人作为实验组,选择10名健康的无颞下颌关节症状的正常人作为对照组,使用CBCT进行影像扫描,重建所扫描的影像,而后选择需要的参考平面。在选定的轴位影像上测量颞下颌关节半径值、髁突水平角、髁状突的前后径、髁状突的内外径；在选定的矫正矢状位上测量关节间隙、关节凹深度、关节结节斜度Q。在选定的矫正冠状位上测得髁状突垂直角β、髁状突受力角α,对所有研究对象进行三次测量,(三次测量工作均由实验者者本人完成)取平均值,所有数据均采用SPSS17.0统计软件进行处理,检验水准选取a=0.05。资料均以均数±标准差表示,同一样本左右两侧采用配对t检验进行统计分析。不同样本间采用独立样本t检验进行统计分析。
结果：1、病例组和对照组做比较其髁状突的形态在左右两侧矢状位关节前间隙、矢状位关节上间隙、关节结节斜度、关节凹深度,在两组间差别均有统计学意义(P<0.05),左侧髁状突的受力角α在两组间差别有统计学意义(P<0.05),其余各组间尚不能认为有差别(P<0.05)。2、对病例组的同一个体左右两侧不同投影位置颞下颌关节测量结果进行比较：轴位水平角、关节结节斜度、关节凹深度在两侧间差别有统计学意义(P<0.05),其余项目差别均尚不能认为有统计学意义(P>0.05)。对对照组的左右两侧测量结果进行比较,均不能认为有统计学意义(P>0.05)。
结论：TMD的病人颞下颌关节的骨性形态与正常人相比有差异,说明TMD可导致颞下颌关节骨性结构的改变,利用CBCT可以给临床诊断TMD提供一定的诊断依据。
Objective:
In this study, we obtained3D reconstructed images of temporomandibular joint of patients with temporomandibular joint disorders by cone beam CT (CBCT), measured temporomandibular joint space parameters of patients with TMD by CBCT software and AutoCAD software system. The purpose of the study is to explore the effect of temporomandibular joint disorder on temporomandibular joint morphology, and provide diagnostic basis for clinical diagnosis of temporomandibular joint disorders.
Methods:
We selected50patients suffering from temporomandibular disorder as the experimental group which are all from the clinic of Stomatology Hospital of Lanzhou University during from2011to2012, Selecting10cases of healthy people without temporomandibular joint symptoms as the control group, conducted image scanning by CBCT, reconstructed the scanned images, and then selected the required reference plane. in the selected axial images, measured the radius value of temporomandibular joint, the short axis diameter of the condyle, the long axis diameter of the condyle and condyle horizontal angle.In the selected correction of sagittal, measured the joint space, the depth of the joint concave, the angle a of articular eminence, oblique measuring. In the selected correction of coronal, measured the angle (3of condyle vertical and the angle a of condyle stress. all subjects were measured three times by the experimenter himself, all data were analyzed by SPSS17.0statistical software, expressed as M±SD, the same sample were analyzed by paired t test,the different sample were analyzed by independent sample t test, and P<0.05, indicated statistical significance.
Results:
1.compared with the condylar morphology on the left and right sagittal joint gap, sagittal joint clearance, articular eminence inclination, joint concave depth, The case group and the control group, the difference were statistically significant(P<0.05), The left condyle diameter width and the stress angle a condylar difference between two groups was statistically significant (P<0.05).other groups could not believe that there was a difference(P>0.05).
2.Compared to the same individual cases on the left and the right sides of different projection position of temporomandibular joint measurement results, the axial horizontal angle, the articular tubercle angle, joint concave depth, sagittal condylar axis angle in vertical joint gap between the two sides of the difference was statistically significant (P<0.05). the remaining items were not statistically significant (P>0.05). Comparison of left and right sides of measurement results of the control group, were not considered statistically significant (P>0.05).
Conclusion:
The temporomandibular joint bone morphology of Patients with temporomandibular joint disorder,compared with normal people are different,. Description TMD can lead to temporomandibular joint bone change in the structure.The condyle, articular fossa with ical differences,using CBCT can provide diagnostic basis for clinical diagnosis of temporomandibular joint disorder.
引文
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[2]Badel T, Marotti M, Keros J, Kern J, Krolo I. Magnetic resonance imaging study on temporomandibular joint morphology[J].Coll Antropol.2009 Jun;33(2):455-60.
[3]田慧颖,周继林,田晓玲,古志辉,孟嘉惠,武文丽.薛氏位X线片与矢状位CT颞下颌关节骨性结构关系测量[J].中日友好医院学报,1997,11(1)：23-28.
[4]刘宁,周继林,刘洪臣,洪敏.老年颞下颌关节紊乱综合征患者合夹板治疗前后CT影像的三维分析[J].中华口腔医学杂志,1994,29(2)：91-93.
[5]胡敏,周继林,洪民,郁贤章,田晓玲,田慧颖,赵文前,李子勋.颞下颌关节三维影像重建与显示,1995,16(4)：256-259.
[6]张震康,赵福运,孙广熙.正常成人颞颌关节100侧X线分析[J]中华医学杂志,1975(2)：130-132.
[7]Knoernschild KL,Aquilino SA,Ruprecht A. Transcranial radiography and linear tomography:a comparative study.[J].J Prosthet Dent,1991,66(2):239-250.
[8]Meng F,Liu Y,Hu K, Zhao Y,Kong L, Zhou S.A comparative study of the skeletal morphology of the temporo-mandibular joint of children and adults[J].J Postgrad Med,2008,54:191-194.
[9]Wish-Baratz S,Hershkovitz I,Arensburg B,Latimer B,Jellema LM.Size and location of the human temporomandibular joint[J].Am J Phys Anthropol,1996,101 (3):387-400.
[10]Seward FS. Tooth attrition and the temporomandibular joint. [J].Angle Orthod,1976,46(2): 162-170.
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