本文選題：青少年　切入點：雙側(cè)　出處：《上海交通大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的：研究青少年雙側(cè)顳下頜關(guān)節(jié)（Temporomandibular Joint, TMJ）盤前移位（Anterior Disc Displacement，ADD）與下頜后縮（Mandibular Retrusion MR）的相關(guān)性。分析青少年雙側(cè)ADD患者中MR的發(fā)生率及矢狀向面型特征，探討ADD與MR的相關(guān)因素；并通過青少年雙側(cè)ADD患者的隨訪研究，了解ADD的自然轉(zhuǎn)歸及其與青少年下頜骨生長發(fā)育的關(guān)系，初步探究ADD與MR的因果關(guān)系。 方法：收集自2009年9月至2013年12月間在上海交通大學附屬第九人民醫(yī)院口腔外科關(guān)節(jié)�？仆晃会t(yī)生處就診的經(jīng)顳下頜關(guān)節(jié)磁共振（MagneticResonance Image，MRI）檢查確診為雙側(cè)ADD的20歲以下（含20歲）青少年患者174例，對所有患者進行關(guān)節(jié)MRI和X線頭顱定位側(cè)位片檢查和測量，評價關(guān)節(jié)及下頜后縮情況；采用Pearson相關(guān)性分析研究病程、發(fā)病年齡與ADD病變程度及MR程度的相互關(guān)系。對其中部分患者進行至少半年的隨訪，復查關(guān)節(jié)MRI和X線頭顱定位側(cè)位片，重新評價關(guān)節(jié)病變及下頜后縮情況，采用配對t檢驗比較隨訪期前后的關(guān)節(jié)及面型的變化。 結(jié)果：患者平均年齡16.7歲，SNB角為76.04°±3.61°，其中MR患者89例(51.1%)。雙側(cè)ADD患者發(fā)病年齡越早，病程越長，則關(guān)節(jié)盤移位越嚴重，關(guān)節(jié)盤變短，下頜后縮也越明顯(p0.05)。對38例患者（平均年齡17.2歲）經(jīng)過13.0個月（6個月~49個月）隨訪，關(guān)節(jié)盤移位距離增加0.92mm(p0.05)，關(guān)節(jié)盤長度縮短0.58mm(p0.05)，髁突高度下降0.64mm(p0.05)，SNB角沒有明顯改變(p0.05)，下頜平面角和Y軸角均增大(p0.05)。 結(jié)論：青少年雙側(cè)ADD與MR具有顯著相關(guān)性。雙側(cè)ADD患者中MR發(fā)生率高于正常人群，，且ADD發(fā)病年齡越早，病程越長，則關(guān)節(jié)盤移位距離越大、關(guān)節(jié)盤變形越重，髁突生長發(fā)育受限，下頜后縮也越嚴重。雙側(cè)ADD的自然轉(zhuǎn)歸導致盤移位病變程度的加重，髁突高度降低，下頜呈順時針旋轉(zhuǎn)趨勢。由此推測雙側(cè)TMJADD可能是MR發(fā)生或加重的重要原因之一。
[Abstract]:Objective: to study the correlation between bilateral temporomandibular joint (TMJ) and mandibular posterior Disc displacement (ADDD) and to analyze the incidence and sagittal features of Mr in bilateral ADD, and to explore the correlation factors between ADD and Mr. The natural outcome of ADD and its relationship with the growth and development of juvenile mandible were studied by follow-up study of bilateral ADD in adolescents. The causal relationship between ADD and Mr was preliminarily explored. Methods: from September 2009 to December 2013, 20 cases of bilateral ADD diagnosed by magnetic resonance imaging (MRI) of temporomandibular joint (TMJ) were collected from 9th people's Hospital affiliated to Shanghai Jiaotong University. 174 cases of adolescent patients under the age of 20 years, All the patients were examined and measured with MRI and X-ray lateral radiographs to evaluate the joint and mandibular retraction, and the course of disease was studied by Pearson correlation analysis. The relationship between the age of onset and the degree of ADD and Mr. Some of the patients were followed up for at least half a year. The lateral radiographs of MRI and X-ray were reexamined to evaluate the joint lesion and mandibular retraction. T-test was used to compare the changes of joint and facial shape before and after follow-up. Results: the average age of the patients was 76.04 擄鹵3.61 擄, of which 89 cases with Mr were 51.1%. The earlier the onset age and the longer the course of bilateral ADD, the more severe the displacement of the articular disc and the shorter the joint disc. 38 patients (mean age 17.2 years) were followed up for 13.0 months (6-49 months). The displacement distance of the articular disc was increased by 0.92mm, the length of the articular disc was shortened by 0.58mm, the height of the condylar process was decreased by 0.64mm, the SNB angle was not changed significantly, the mandibular plane angle and the Y-axis angle were increased. Conclusion: there is a significant correlation between bilateral ADD and Mr in adolescents. The incidence of Mr in patients with bilateral ADD is higher than that in normal subjects. The earlier the onset age of ADD is and the longer the course of disease is, the greater the distance of displacement of joint disc is and the more severe the deformation of articular disc is. The condyle growth and development are limited and the mandibular retraction is more serious. The natural outcome of bilateral ADD results in the severity of disc displacement and the decrease of condylar height. The mandible rotates clockwise, which suggests that bilateral TMJADD may be one of the important causes of Mr.
【學位授予單位】：上海交通大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R782.6

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