本文選題：顳下頜關節(jié)功能紊亂病 + 關節(jié)振動　； 參考：《皖南醫(yī)學院》2017年碩士論文

【摘要】：目的:通過對顳下頜關節(jié)振動、臨床癥狀、咬合和咀嚼肌肌電的觀察,分析顳下頜關節(jié)振動與下頜運動相關因素之間的關系,為進一步探討牙合、咀嚼肌與顳下頜關節(jié)之間的相互關系提供實驗依據。方法:(1)篩選受試者:采用系統(tǒng)抽樣方法抽取皖南醫(yī)學院口腔醫(yī)學專業(yè)2013~2016級學生120人,簡單檢查排除明顯錯牙合畸形、不良習慣者后余72人(男34人,女38人,平均年齡19.47±1.83歲)。(2)采用BioJVA顳下頜關節(jié)振動分析儀對受試者進行關節(jié)振動檢測,異常者記為JVA(+),正常者記為JVA(-)。(3)對受試者進行TMD相關性問卷調查,并由同一名檢查者對受試者進行顳下頜關節(jié)(temporomandibular joint,TMJ)耳屏前觸診,根據有無關節(jié)彈響、張口受限、張口偏斜、咀嚼肌疼痛等癥狀,將受試者分為臨床(+)和臨床(-)。(4)根據臨床癥狀及關節(jié)振動情況將受試者分為以下4組:A組.臨床(+)JVA(+),B組.臨床(-)JVA(+),C組.臨床(-)JVA(-),D組.臨床(+)JVA(-)。其中,A組可初步診斷為TMD患者,B組為僅出現(xiàn)關節(jié)異常振動而未表現(xiàn)出臨床癥狀人群,C組為對照組正常人群,D組出現(xiàn)臨床癥狀卻未見關節(jié)異常振動。(5)采用T-ScanⅢ咬合分析系統(tǒng)及BioEMGⅢ肌電分析系統(tǒng)同步檢查各組受試者牙尖交錯位(intercuspal position,ICP)、下頜前伸運動、左右側方運動時的咬合接觸特征和肌電情況,并進行統(tǒng)計學分析。所有受試者均知曉實驗內容,簽署知情同意書。結果:(1)受試者的JVA關節(jié)振動分析儀檢測結果提示出現(xiàn)異常的關節(jié)振動者35人,左右側振動參數無差異,且與性別無關(P0.05)。關節(jié)振動在下頜運動過程中的發(fā)生位置普遍集中在開口末期和閉口初期,異常的關節(jié)振動較正常的關節(jié)振動分布更為分散。(2)結合患者主訴及同一名檢查者對受試者進行顳下頜關節(jié)相關檢查,出現(xiàn)TMD臨床癥狀者23人(男11人,女12人),TMD陽性率31.9%。其中,關節(jié)彈響出現(xiàn)頻率最高,往下依次為張口偏斜,咀嚼肌疼痛和張口受限。(3)對比臨床癥狀及JVA關節(jié)記錄情況,可見出現(xiàn)異常關節(jié)振動者35人中有21人出現(xiàn)了明顯的TMD臨床癥狀,14人僅見關節(jié)異常改變未表現(xiàn)出明顯臨床癥狀,確定分組情況:A組21人,B組14人,C組35人,D組2人。(4)ICP最大緊咬MIP幀咬合接觸結果顯示各組受試者COF位置有差別(P0.05),關節(jié)異常振動者的早接觸情況高于對照組,AOF、OT、DT具有統(tǒng)計學差異(P0.05);肌電情況顯示LTA、RTA、LMM、RMM、LDA、RDA的平均表面肌電幅值具有統(tǒng)計學差異(P0.05),左右側TA、MM、DA的對稱性各不相同(P0.05),而同側TA和MM的協(xié)同性無統(tǒng)計學差異(P0.05)。(5)下頜前伸運動時關節(jié)異常振動者的前伸牙合干擾情況高于對照組,四組受試者前伸牙合分離時間、LTA、RTA、LMM、RMM、LDA、RDA的平均表面肌電幅值均具有統(tǒng)計學差異(P0.05)。(6)下頜左側運動時關節(jié)異常振動者的側方牙合干擾情況高于對照組,四組受試者左側牙合分離時間、LTA、RTA、LMM、RMM、LDA、RDA的平均表面肌電幅值均具有統(tǒng)計學差異(P0.05)。(7)下頜右側運動時關節(jié)異常振動者的側方牙合干擾情況高于對照組,四組受試者右側牙合分離時間、LTA、RTA、LMM、RMM、LDA、RDA的平均表面肌電幅值均具有統(tǒng)計學差異(P0.05)。結論:(1)關節(jié)異常振動者的咬合穩(wěn)定性差,牙合干擾、早接觸率高;肌電顯示ICP緊咬時咀嚼肌功能下降,邊緣運動時更易發(fā)生異常咀嚼肌收縮。(2)咬合的失調可能造成咀嚼肌和顳下頜關節(jié)的紊亂,即使對于沒有明顯臨床癥狀的“正�！比巳�,也要提高重視,時刻警惕TMD的發(fā)生。(3)咬合失調是否是引起關節(jié)異常改變的原因以及與肌功能紊亂的關系,需要咬合干預實驗進一步驗證。
[Abstract]:Objective: to analyze the relationship between temporomandibular joint vibration and the related factors of mandibular movement by observing the vibration of temporomandibular joint, clinical symptoms, occlusal and masticatory muscle electromyography, and to provide an experimental basis for further exploring the relationship between occlusion and masticatory muscles and temporomandibular joint. Methods: (1) screening subjects: using systematic sampling method 120 students from the 2013~2016 class of stomatology in Wangnan Medical College were selected to check out the abnormal malocclusion and the remaining 72 people (34 men, 38 women, 19.47 + 1.83 years old). (2) the BioJVA temporomandibular joint vibration analyzer was used to detect the joint vibration of the subjects, the abnormality was recorded as JVA (+), and the normal person was recorded as JVA (3) (3) the subjects were investigated with a questionnaire, and the same examiner performed the TMJ (temporomandibular joint, TMJ) palpation before the TMJ (TMJ), and the subjects were divided into clinical (+) and clinical ((-)) according to the symptoms of joint projectile response, opening restriction, mouth opening deviation and masticatory muscle pain. (4) according to clinical symptoms and joints The vibration situation was divided into 4 groups: group A. Clinical (+) JVA (+), group B. Clinical (-) JVA (+), group C. Clinical (-) JVA (-), D group. Clinical (+) JVA (-). The A group can be diagnosed as TMD patients initially, B group is only abnormal vibration of the joint, not showing clinical symptoms, C group is normal group, but there is no joint clinical symptoms but no joints in the group. Abnormal vibration. (5) the T-Scan III occlusion analysis system and the BioEMG III electromyography system were used to synchronize the dislocation of the teeth (intercuspal position, ICP), the mandibular protrusion movement, the occlusal contact characteristics and EMG of the left and right lateral movements, and the analysis of the electromyography. All the subjects knew the content of the experiment and signed the information. Results: (1) the test results of the JVA joint vibration analyzer showed that there were 35 persons with abnormal joint vibration, and there was no difference between the left and right vibration parameters and no sex (P0.05). The joint vibration occurred in the stage of mandibular movement generally at the end of the opening and the early stage of the closure, and the abnormal joint vibration was more than normal. The vibration distribution of the joint was more scattered. (2) combined with the patient's main complaint and the same examiner to examine the TMJ, 23 people (11 men and 12 women) with TMD clinical symptoms, the positive rate of TMD 31.9%., the highest frequency of the joint elastic response, the downward deviation of the mouth, the pain of masticatory muscles and the limited opening of the mouth. (3) comparison of clinical symptoms 21 of the 35 people with abnormal joint vibration showed obvious TMD clinical symptoms in 35 people with abnormal joint vibration. 14 people only found abnormal changes in the joint. The group situation was 21 in A group, 14 in group B, 35 in group C and 2 in group D. (4) the result of ICP maximum clenched MIP frame occlusal contact showed COF position in each group. P0.05 was higher than the control group, AOF, OT, and DT had statistical difference (P0.05), and the electromyography showed that LTA, RTA, LMM, RMM, LDA, RDA were statistically different (P0.05). The difference (P0.05). (5) the interference of joint abnormal vibration was higher than that of the control group. The average surface electromyography amplitude of LTA, RTA, LMM, RMM, LDA, RDA had statistical difference (P0.05). (6) the lateral occlusion of abnormal vibrators in the left side of the mandible was higher than that in the left movement of the mandible (6). In the control group, the average surface electromyography amplitude of LTA, RTA, LMM, RMM, LDA, RDA were all statistically different (P0.05). (7) the interference of lateral occlusion of the abnormal vibration in the right side of the mandible was higher than that of the control group. The time of the right occlusal separation of the four subjects, LTA, RTA, LMM, RMM, LDA, and the average table The electrical amplitude of the facial muscle had statistical difference (P0.05). Conclusion: (1) the occlusion stability of the patients with abnormal vibration of the joints was poor, the occlusion and early contact rate were high; the EMG showed that the masticatory muscle function decreased while the ICP was clenched, and the abnormal masticatory muscle contraction during the edge movement. (2) the disorder of the masticatory muscles and the temporomandibular joint may be caused by the maladjustment of the occlusion, even if the maladjustment of the occlusion may cause the disorder of the masticatory muscles and the temporomandibular joint. For the "normal" people who have no obvious clinical symptoms, we should pay more attention to the occurrence of TMD. (3) whether the maladjustment of occlusion is the cause of abnormal changes of joints and the relationship with the disorder of muscle function.

【學位授予單位】：皖南醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R782.6

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