口腔疾病防治 ›› 2017, Vol. 25 ›› Issue (6): 369-374.DOI: 10.12016/j.issn.2096-1456.2017.06.006

• 临床研究 • 上一篇    下一篇

改良Twin-block 治疗颞下颌关节盘可复性前移位

胡欣欣1(), 朱耀旻1(), 沈佩2, 罗晓1, 何柳婷1, 顾颖1, 杨驰2   

  1. 1. 深圳市第二人民医院,深圳大学第一附属医院口腔科,广东深圳(518000)
    2. 上海交通大学医学院附属第九人民医院,口腔颌面外科,上海(200000)
  • 收稿日期:2017-01-19 修回日期:2017-03-06 出版日期:2017-06-20 发布日期:2018-09-03
  • 作者简介:

    【作者简介】 胡欣欣,主治医师,硕士,Email: 80332966@qq.com

  • 基金资助:
    国家自然科学基金(81601915);深圳市卫生和计划生育系统科研项目(201501017);深圳市科技创新项目(JCYJ20150330102401098);上海市科委西医引导项目 (16411960800)

Disc displacement with reduction treated by modified Twin-block

Xinxin HU1(), Yaomin ZHU1(), Pei SHEN2, Xiao LUO1, Liuting HE1, Ying GU1, Chi YANG2   

  1. 1.Department of Stomatology Shenzhen Second People's Hospital The First Affiliated Hospital of Shenzhen University. Shenzhen 518000 China
    2. Department of Oral and Maxillofacial Surgery Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200000 China
  • Received:2017-01-19 Revised:2017-03-06 Online:2017-06-20 Published:2018-09-03

摘要:

目的 探讨改良Twin?block治疗颞下颌关节盘可复性前移位前后关节盘形态和位置的变化。方法 将2015年7月~2016年6月就诊于深圳市第二人民医院口腔科,经临床及MRI检查诊断为单侧或双侧颞下颌关节盘可复性前移位,并接受改良Twin?block矫治器进行治疗者19例,共28侧关节纳入研究,治疗前后均拍摄MRI,测量治疗前后关节盘前后径、盘髁距离、盘髁角度并进行配对t检验,对治疗前后的关节盘形态进行Wilcoxon符号秩和检验,P<0.01为差异具有统计学意义。结果 19例患者28侧关节盘均存在可复性前移位,经过改良Twin?block治疗后,24侧关节盘位置恢复正常,4侧关节盘在闭口时仍处于前移位状态。治疗后关节盘前后径增加,盘髁距离、盘髁角度减小,差异均具有统计学意义(P<0.01)。关节盘形态治疗前以V形最多(16侧),其次为双面平滑形(9侧);治疗后以双凹形(16侧)和双面平滑形(10侧)为主;治疗后关节盘形变程度减小,且差异有统计学意义(P<0.01)。4侧关节盘复位失败者,治疗前盘髁距离及盘髁角度相对较大,关节盘形变相对较重。结论 改良Twin?block是治疗颞下颌关节盘可复性前移位的一种有效手段,可以使发生移位的关节盘前后径及位置恢复,使关节盘形变减小。但对于关节盘移位及形变程度较重者,其治疗效果可能不理想,还需进一步扩大样本量进行分层研究,并延长随访时间。

关键词: 关节盘可复性前移位, 改良Twin?block, 磁共振成像, 关节盘位置, 关节盘形态

Abstract:

Objective To investigate the morphology and position changes of displaced disk with reduction after treatment by modified Twin-block. Methods 19 patients were diagnosed as displaced disk with reduction and they were treated with modified Twin-block from July 2015 to June 2016. 28 temporomandibular joints (TMJ) of these patients were included in the analysis. The disk length, disk-condylar distance, and disk-condylar angle were measured with MRI before and after treatment. Paired t-test was used. Disk morphology before and after treatment was also documented and analyzed by Wilcoxon signed rank test. The statistical significance was set at P<0.01.Results 28 TMJ disks were anteriorly displaced with reduction. 24 of them were repositioned while the other 4 were still anteriorly positioned after treatment. The disk length was increased significantly (P<0.01) while the disk-condylar distance and disk-condylar angle were decreased significantly after treatment (P<0.01). The disk morphology as hemiconvex (16) and bi planar (9) were the majority before treatment, while biconcave (16) and biplanar (10) were changed to the larger part after treatment. There was improvement on the disk deformation with a statistical significance (P<0.01). Larger disk-condylar distance, disk-condylar angle and severer deformation of disks were observed in the 4 disks without reposition.Conclusion Modified twin-block is an effective appliance for disk displacement with reduction by repositioning the disk and modifying the disk deformation. However the effect is not good for disks with severer deformation and displacement. Further studies with larger sample and stratified group are still needed.

Key words: Anterior disc displacement with reduction, Modified Twin-block, Magnetic resonance imaging, Disk position, Disk morphology

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