本文選題：青少年 + 顳下頜關節(jié)　； 參考：《上海交通大學》2014年碩士論文

【摘要】：目的：基于顳下頜關節(jié)磁共振表現，觀察青少年單側顳下頜關節(jié)盤不可復性前移位患者髁突吸收情況，并隨訪觀察其自然轉歸對髁突高度的影響，以期為制定治療方案及探究其與牙頜面畸形的關系提供參考。 病例和方法：收集于2010年1月至2013年6月于我院關節(jié)專科就診的單側顳下頜關節(jié)盤不可復性前移位的青少年患者，以健側髁突為對照，在磁共振影像上觀察患側髁突骨質的吸收程度；進行至少6月的隨訪，觀察髁突吸收的進展情況，并對患者隨訪前后的關節(jié)盤移位程度和髁突高度進行定量測量；按初診年齡分組，測量分析年齡對盤移位程度和髁突高度改變的影響。對隨訪前后數據采用SAS9.13軟件包進行統(tǒng)計分析。 結果:共納入124例患者，，平均初診年齡16.4歲。初診時患側髁突無、輕、中和重度骨質吸收者分別為49例（39.52%）、47例（37.90%）、23例（18.55%）、和5例（4.03%）。平均隨訪時間13.6月。隨訪后患側髁突無、輕、中和重度骨質吸收者分別為38例（30.65%）、44例（35.48%）、34例（27.42%）、和8例（6.45%），髁突骨質吸收程度較初診時加重(P0.05)。初診時,健側平均髁突高度和關節(jié)盤長度分別26.07mm和12.48mm；患側平均髁突高度、關節(jié)盤長度和盤前移距離分別為24.22mm、9.06mm和5.44mm。隨訪后,健側平均髁突高度、關節(jié)盤長度分別為26.82mm和12.98mm；患側平均髁突高度、盤長度和盤前移距離分別是23.81mm、8.12mm和6.83mm。初診時,健患側髁突高度差為1.85mm，隨訪后,健患側髁突高度差為3.00mm。以上測量指標健患側之間的差異、患側隨訪前后之間的差異均有統(tǒng)計學意義（P0.05）。按初診年齡分組，3組平均年齡分別為12.97歲、16.02歲和18.98歲:3組隨訪前后患側關節(jié)盤前移距離分別增加1.19mm、1.81mm、1.01mm，3組間無統(tǒng)計差異（P0.05）。3組患側隨訪前后關節(jié)盤縮短分別為0.85mm、1.26mm、0.65mm，3組間無統(tǒng)計差異（P0.05）；3組隨訪前后健患側髁突高度差分別增加1.71mm、0.99mm、0.98mm，3組間無統(tǒng)計學差異（P0.05）。 結論:在青少年單側顳下頜關節(jié)盤不可復性前移位患者中，約60%會發(fā)生不同程度的髁突骨吸收。隨病情的延續(xù)，盤移位逐漸加重，髁突吸收會進一步加劇，而健側髁突繼續(xù)生長，健患側的髁突高度差增大。這可能是顳下頜關節(jié)盤移位患者發(fā)生牙頜面畸形的重要原因之一。故對于青少年顳下頜關節(jié)盤不可復性前移位，建議盡早治療，糾正關節(jié)盤的位置，以減少髁突骨質吸收的發(fā)生和繼發(fā)牙頜面畸形。
[Abstract]:Objective: to observe the condylar process absorption in unreducible anterior temporomandibular joint (TMJ) patients based on temporomandibular joint (TMJ) magnetic resonance imaging (TMJ), and to observe the effect of natural outcome on condylar height. In order to provide a reference for the establishment of treatment plan and explore its relationship with maxillofacial malformation. Cases and methods: patients with unilateral temporomandibular joint disc irreducible anterior displacement were collected from January 2010 to June 2013 in our hospital. The healthy condyle process was used as control. The degree of condylar bone resorption was observed on magnetic resonance imaging, the progress of condylar resorption was observed after at least 6 months follow-up, and the degree of displacement of articular disc and the height of condyle were measured quantitatively before and after follow-up. The effect of age on the degree of disc displacement and the change of condylar height was measured and analyzed according to the age at first visit. The data before and after follow-up were analyzed by SAS9.13 software package. Results: 124 patients with an average age of 16.4 years were enrolled. In the first diagnosis, 49 cases (39.52%) had no, mild, moderate or severe bone resorption on the affected side, and 47 cases (37.90%) were involved with 18.555.55 and 5 cases with 4.03g bone resorption. The mean follow-up time was 13.6 months. After follow-up, 38 cases with mild, moderate and severe bone resorption were found in 38 cases (30.65%), 44 cases (35.48%) and 34 cases (27.42%), and 8 cases (6.45%). The degree of bone resorption of condylar process was more severe than that of the first diagnosis (P 0.05). At first visit, the average condylar height and disc length were 26.07mm and 12.48 mm, respectively, and the average condylar height, disc length and disc forward distance were 24.22 mm, 9.06 mm and 5.44 mm, respectively. The average condylar height and disc length of the healthy side were 26.82mm and 12.98 mm, respectively, and the average condylar height, disc length and the distance of disc anterior movement were 23.81 mm and 6.83 mm respectively. The difference of condylar height was 1.85 mm in the first visit and 3.00 mm in the healthy side after follow-up. The difference between the health side and the affected side was statistically significant before and after follow-up (P 0.05). The average age of the 3 groups was 12.97 years old, 16.02 years old and 18.98 years old respectively. The distance of anterior displacement of articular disc was increased by 1.19 mm and 1.81 mm and 1.01mm respectively before and after follow up. There was no statistical difference among the three groups. The reduction of articular disc was 0.85 mm 1.26 mm and 0.65 mm before and after follow-up in P0.05.3 group. The difference of condylar height was increased by 1.71 mm to 0.99 mm and 0.98 mm respectively before and after follow up in the three groups. There was no statistical difference among the three groups (P 0.05). Conclusion: about 60% of the patients with unilateral temporomandibular joint disc irreducible anterior displacement have different degree of condylar bone resorption. With the extension of the disease, the disc displacement gradually aggravated, the condylar process absorption would be further aggravated, while the condylar process of the healthy side would continue to grow, and the condylar height difference of the healthy side would increase. This may be one of the important causes of maxillofacial malformation in patients with temporomandibular joint disc displacement. Therefore, the irreducible anterior displacement of temporomandibular joint disc in adolescents should be treated as early as possible to correct the position of articular disc so as to reduce the occurrence of condylar bone resorption and secondary maxillofacial malformation.
【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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