中国口腔颌面外科杂志

中国口腔颌面外科杂志 ›› 2025, Vol. 23 ›› Issue (1): 6-12.doi: 10.19438/j.cjoms.2025.01.002

• 论著 • 上一篇    下一篇

双颌手术对骨性Ⅲ类错畸形患者颞下颌关节盘-髁关系的影响

宋明洋1, 王丽婵1, 王育新1, 章茜1, 夏成万1, 王思齐2, 杨旭东1   

  1. 1.南京大学医学院附属口腔医院,南京市口腔医院, 南京大学口腔医学研究所,江苏 南京 210008;
    2.南京中医药大学附属中西医结合医院,江苏省中西医结合医院,江苏省中医药研究所,江苏 南京 210028
  • 收稿日期:2024-04-22 修回日期:2024-06-03 出版日期:2025-01-20 发布日期:2025-01-23
  • 通讯作者: 杨旭东,E-mail: yangxd66@163.com
  • 作者简介:宋明洋（1999-）,男,在读硕士研究生,E-mail: 976181521@qq.com
  • 基金资助:
    江苏省重点研发计划项目（BE2021609）

Clinical study on the effect of bimaxillary surgery on disc-condyle relationship of temporomandibular joint in patients with skeletal Class Ⅲ malocclusion

SONG Ming-yang1, WANG Li-chan1, WANG Yu-xin1, ZHANG Qian1, XIA Cheng-wan1, WANG Si-qi2, YANG Xu-dong1   

  1. 1. Nanjing Stomatological Hospital, Affiliated Hospital of Medical School; Institute of Stomatology, Nanjing University. Nanjing 210008;
    2. Nanjing University of Chinese Medicine Affiliated Hospital of Integrated Traditional Chinese and Western Medicine; Jiangsu Provincial Hospital of Integrated Traditional Chinese and Western Medicine; Jiangsu Institute of Traditional Chinese Medicine. Nanjing 210028, Jiangsu Province, China
  • Received:2024-04-22 Revised:2024-06-03 Online:2025-01-20 Published:2025-01-23

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摘要： 目的：分析正颌手术对骨性Ⅲ类患者颞下颌关节（temporomandibular joint,TMJ）盘-髁关系的影响。方法：选择2022年4月—2023年4月于南京大学医学院附属口腔医院行Le Fort I型截骨+双侧下颌骨矢状劈开截骨术的骨性Ⅲ类错畸形患者30例,于术前（T0）、术后3个月（T1）、术后正畸结束（T2）时获取TMJ以及下颌运动数据。另选择20例正常作为对照组,记录下颌运动轨迹。采用SPSS 26.0软件包对数据进行统计学分析。结果：T0时,14例骨性Ⅲ类错畸形患者存在颞下颌关节紊乱(temporomandibular disorder,TMD),术后8例改善。T0时,18侧关节盘髁关系正常,42侧盘前移位,其中30侧为可复性盘前移位（ADDwR）,12侧为不可复性盘前移位（ADDwoR）。12侧ADDwoR 中,T1时4侧转变为ADDwR,T2时6侧转变为ADDwR;30侧ADDwR中,T1时6侧恢复正常,1侧转为ADDwoR,T2时4侧恢复正常。盘-髁关系正常的关节,T1时3侧转为ADDwR,1侧转为ADDwoR;T2时2侧转为ADDwR。盘-髁关系正常组及ADDwoR组在正颌术后盘前移位角减小,ADDwR组正颌术后盘前移位角增大。T1期最大开口度[(37.38±8.24) mm]较T0期[(44.41±8.21) mm]下降,T2期[(43.01±6.02) mm]恢复至术前水平。两侧Bennett角对称性（|ΔBA|）T0期（6.27°±3.87°）较对照组（3.43°±3.07°）差,T1期（5.26°±7.21°）较T0期对称性增强,但T2期（9.97°±8.25°）有复发倾向。下颌边缘运动尤其是后退运动范围T0期[(0.35±0.31) mm]显著小于对照组[(0.89±0.71) mm]（P<0.05）,下颌边缘运动T1期较T0期有所下降。其中,开闭口髁突运动距离（CPL-L和CPL-R）较T0期显著下降（P<0.05）,T2期下颌运动基本恢复甚至超过术前水平。结论：正颌患者术后短期内,下颌边缘运动出现一定程度下降,但远期基本恢复甚至超过术前水平。正颌手术可以改善骨性Ⅲ类错畸形患者的TMD,对盘前移位有一定的积极作用。

关键词: 牙颌面畸形, 双侧下颌支矢状劈开截骨术, 颞下颌关节, 下颌运动

Abstract: PURPOSE: To analyze the effects of orthognathic surgery on disk-condylar relationship of temporomandibular joint (TMJ) in patients with skeletal Class Ⅲ malocclusion. METHODS: Thirty patients with skeletal Class Ⅲ malocclusion who underwent Le Fort I osteotomy + bilateral mandibular sagittal split osteotomy in the Affiliated Stomatology Hospital of Nanjing University School of Medicine from April 2022 to April 2023 were selected. TMJ and mandibular movement data were obtained before surgery (T0), 3 months after surgery (T1) and at the end of postoperative orthodontics (T2). In addition, 20 patients with normal occlusion were selected as the control group, and the mandibular movement trajectories were recorded. SPSS 26.0 software package was used for statistical analysis of the data. RESULTS: Temporomandibular disorder (TMD) existed in 14 patients with skeletal Class Ⅲ malocclusion at T0, 8 of whom improved after surgery. At T0, the condylar relationship was normal on 18 sides, 42 sides were anterior displacements, of which 30 sides were anterior disc displacement with reduction(ADDwR) and 12 sides were anterior disc displacement without reduction(ADDwoR). Among the 12 sides of ADDwoR, 4 sides were transformed into ADDwR at T1 and 6 sides were transformed into ADDwR at T2. In the 30 sides of ADDwR, 6 sides returned to normal at T1, 1 side turned to ADDwoR, and 4 sides returned to normal at T2. In normal disk-condylar joint T1, ADDwR on 3 sides, ADDwoR on 1 side, and ADDwR on 2 sides at T2. After orthognathic surgery, the displacement angle of the anterior disk decreased in the normal group and the ADDwoR group, and increased in the ADDwR group. The maximum mouth opening at T1[(37.38±8.24)mm] was lower than that at T0 [(44.41±8.21)mm], and recovered to the preoperative level at T2 [(43.01±6.02)mm]. The symmetry of Bennett angle on both sides (|ΔBA|) was worse in T0 stage (6.27°±3.87°) than in the control group (3.43°±3.07°), and more symmetric in T1 stage (5.26°±7.21°) than in T0 stage, but there was recurrence tendency in T2 stage(9.97°±8.25°). The mandibular marginal movement, especially the range of backward movement at T0[(0.35±0.31)mm], was significantly smaller than that of the control group [(0.89±0.71)mm](P<0.05). The mandibular marginal movement at T1 was lower than that at T0. The condylar movement distances (CPL-L and CPL-R) of opening and closing mouth were significantly lower than those of T0(P<0.05), and the mandibular movement recovered or even exceeded the preoperative level at T2. CONCLUSIONS: In the short term after orthognathic surgery, the mandibular marginal movement decreases to some extent, but it will recover or even exceed the preoperative level in the long term. Orthognatology surgery can improve the TMD of skeletal Class Ⅲ patients, and has certain positive effect on predisc displacement.

Key words: Dental maxillofacial deformity, Bilateral sagittal split ramus osteotomy of mandibular ramus, Temporomandibular joint, Mandibular movement

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