Balkwill角和𬌗平面角与颞下颌关节形态的相关性

doi:10.13591/j.cnki.kqyx.2025.05.002

摘要/Abstract

摘要：

目的探讨骨性Ⅱ类2分类错𬌗患者Balkwill角和𬌗平面角与颞下颌关节形态之间的相关性。方法选取骨性Ⅱ类2分类(研究组)和骨性Ⅰ类均角患者(对照组)各35例。Invivo Dental 5软件测量Balkwill角、𬌗平面角(FH-OP)、后部𬌗平面角(FH-POP)、下颌𬌗平面角(FH-MOP)、DPO(从髁突中心到MOP的垂直距离)和颞下颌关节形态学指标。结果研究组中FH-OP、FH-POP和FH-MOP均值低于对照组,而Balkwill角、DPO均值大于对照组(P<0.05)。两组间髁突内外径、髁突头宽度、关节结节倾斜度和高度、关节上间隙的测量结果差异显著。研究组中DPO与髁突内外径、关节窝深度和关节结节高度呈中等相关性,FH-MOP与髁突内外径和关节结节高度呈中等相关性,Balkwill角与关节结节高度呈中等相关性,与髁突内外径、关节结节倾斜度、髁突长度和关节窝深度呈弱相关性。结论 DPO、FH-MOP、Balkwill角与颞下颌关节形态相关性依次降低。

关键词: Balkwill角, 𬌗平面角, 颞下颌关节, 骨性Ⅱ类2分类, CBCT

Abstract:

Objective To investigate the correlation between the Balkwill angle and occlusal plane angles and temporomandibular joint (TMJ) morphology in adults with skeletal Class Ⅱ division 2 malocclusion. Methods Thirty-five adult patients with skeletal Class Ⅱ division 2 low angle (study group) and 35 adult patients with skeletal Class Ⅰ average angle (control group) were included. The Invivo Dental 5 software was employed to acquire the data of Balkwill angle, occlusal plane angle (FH-OP), posterior occlusal plane angle (FH-POP), mandibular occlusal plane angle (FH-MOP), DPO (vertical distance from condylar center to the MOP) and the TMJ measurement items. Results The mean values of FH-OP, FH-POP and FH-MOP were lower in the study group than control group (P<0.05). The average value of Balkwill angle and DPO were higher in the study group than the control group (P<0.05). Significant differences were found in the measurement results of the mediolateral diameters of the condyle, width of condylar head, the articular eminence inclination and height, superior joint space between two groups. DPO had a medium correlation with mediolateral diameters of the condyle, glenoid fossa depth and articular eminence height. And FH-MOP angle had a medium correlation with mediolateral diameters of the condyle and articular eminence height. There was a medium correlation between the Balkwill angle and articular eminence height, a weak correlation with mediolateral diameters of the condyle, articular eminence inclination, condylar length and glenoid fossa depth. Conclusion The results indicated that the DPO had a significant impact on TMJ morphology, followed by FH-MOP, and finally Balkwill angle in skeletal Class Ⅱ division 2 low angle malocclusion.

Key words: Balkwill angle, occlusal plane angle, temporomandibular joint, skeletal Class Ⅱ division 2, cone-beam CT

中图分类号:

R782.6

单学龙, 李向鑫, 孟箭, 张静. Balkwill角和𬌗平面角与颞下颌关节形态的相关性[J]. 口腔医学, 2025, 45(5): 328-334.

SHAN Xuelong, LI Xiangxin, MENG Jian, ZHANG Jing. The correlation between Balkwill angle and occlusal plane angles and temporomandibular joint morphology[J]. Stomatology, 2025, 45(5): 328-334.

图/表 6

表1

三维重建后测量角度、距离和颞下颌关节解剖标志点的定义"

测量项目		定义
头影测量	ANB角	上牙槽座点、鼻根点与下牙槽座点构成的角
	下颌平面角	眶耳平面与下颌平面(通过Go和Gn的连线)之间的夹角
	𬌗平面角(FH-OP)	上下颌中切牙覆𬌗中点与上下颌第一磨牙覆𬌗中点连线与FH平面的夹角
	后部𬌗平面角(FH-POP)	后部𬌗平面(上颌第二前磨牙颊尖与上颌第二磨牙颊尖连线)与FH平面的夹角
	下颌𬌗平面角(FH-MOP)	下颌𬌗平面(下中切牙近中切点与下颌第二磨牙远颊尖连线)与FH平面的夹角
	切牙引导角(IGA)	上下中切牙切缘连线与FH平面相交的前下角
	Balkwill角	髁状突中心点到下切牙切缘的连线与下颌𬌗平面之间的夹角
	DPO	髁状突中心点到下颌𬌗平面的垂直距离
颞下颌关节	髁突内外径	髁突内外径的最大距离
	髁突前后径	髁突前后径的最大距离
	髁头高度	髁突头最上点到髁突头最前点与最后点间连线的垂直距离
	髁头宽度	髁突头最前点与最后点间的距离
	髁突长度	髁突最上点到过乙状切迹的最低点的切线间的垂直距离
	髁突倾斜角	髁突长轴与正中矢状面的夹角
	关节窝深度	关节结节最低点与关节凹后突点的连线,关节窝的最上点与该连线之间的垂直距离
	关节窝宽度	关节结节最低点与关节窝后突点间的距离
	关节结节高度	关节窝最上点到关节结节最下点的垂直距离
	关节结节倾斜度	从关节窝的最上点作关节结节后斜面的切线,该切线和FH平面形成的角度
	关节前间隙	髁突最上点与关节窝最上点之间的最短距离
	关节上间隙	从关节窝最上点作髁突前斜面的切线,该切线与关节窝前壁之间的最短距离
	关节后间隙	从关节窝最上点作髁突后斜面的切线,该切线与关节窝后壁之间的最短距离

表1

图1

图2

图3

表2

表3

两组角度、距离和颞下颌关节测量值之间的相关性分析"

测量项目	对照组						研究组
测量项目	FH-OP	FH-POP	FH-MOP	IGA	Balkwill角	DPO	FH-OP	FH-POP	FH-MOP	IGA	Balkwill角	DPO
FH-OP	1.000	0.346^**	0.652^**	0.154	-0.410^**	-0.461^**	1.000	0.495^**	0.552^**	0.289^*	-0.406^**	-0.524^**
FH-POP	0.346^**	1.000	0.405^**	-0.248^*	-0.153	-0.253^*	0.495^**	1.000	0.785^**	-0.010	-0.717^**	-0.795^**
FH-MOP	0.652^**	0.405^**	1.000	0.150	-0.665^**	-0.688^**	0.552^**	0.785^**	1.000	-0.177	-0.837^**	-0.815^**
IGA	0.154	-0.248^*	0.150	1.000	-0.075	-0.188	0.289^*	-0.010	-0.177	1.000	0.126	-0.134
Balkwill角	-0.410^**	-0.153	-0.665^**	-0.075	1.000	0.844^**	-0.406^**	-0.717^**	-0.837^**	0.126	1.000	0.875^**
DPO	-0.461^**	-0.253^*	-0.688^**	-0.188	0.844^**	1.000	-0.524^**	-0.795^**	-0.815^**	-0.134	0.875^**	1.000
髁突内外径	0.010	-0.131	-0.097	-0.197	0.145	0.292^*	-0.103	-0.521^**	-0.506^**	0.246^*	0.367^**	0.435^**
髁突前后径	-0.100	-0.208	-0.164	-0.048	0.059	0.199	-0.065	-0.357^**	-0.135	-0.039	0.149	0.277^*
髁突倾斜角	-0.028	-0.254^*	-0.035	0.236^*	-0.193	-0.013	-0.138	-0.128	-0.027	-0.124	0.065	0.072
髁突头宽度	-0.180	-0.187	-0.241^*	0.072	-0.027	0.143	0.049	-0.233	-0.046	0.006	0.139	0.242^*
髁突头高度	0.055	0.038	-0.160	-0.133	0.060	0.157	0.112	-0.012	0.150	-0.202	-0.177	-0.035
髁突长度	0.153	-0.293^*	0.016	0.171	-0.052	0.017	-0.079	-0.217	-0.168	0.222	0.290^*	0.261^*
关节窝深度	-0.234	-0.103	-0.165	-0.051	0.207	0.229	-0.359^**	-0.180	-0.341^**	-0.173	0.344^**	0.411^**
关节窝宽度	-0.409^**	-0.391^**	-0.361^**	-0.021	0.216	0.375^**	-0.224	-0.066	-0.047	-0.217	0.095	0.180
关节结节高度	-0.295^*	-0.009	-0.132	-0.153	0.101	0.215	-0.203	-0.385^**	-0.522^**	0.202	0.460^**	0.486^**
关节结节倾斜度	-0.121	0.044	-0.008	-0.239^*	-0.008	0.091	-0.035	-0.321^**	-0.397^**	0.354^**	0.317^**	0.245^*
关节前间隙	0.093	0.172	-0.007	-0.115	0.328^**	0.167	0.008	0.105	-0.021	0.292^*	-0.218	-0.182
关节上间隙	0.035	0.040	-0.192	-0.288^*	0.253^*	0.368^**	0.029	-0.301^*	-0.259^*	0.339^**	0.201	0.223
关节后间隙	-0.164	-0.276^*	-0.254^*	0.094	0.098	0.261^*	-0.112	-0.243^*	-0.120	-0.130	0.145	0.182

表3

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测量项目
头影测量	FH-OP/(°)	11.371±3.741	9.315±5.387	2.623	0.010^*
	FH-POP/(°)	17.051±4.317	15.249±5.196	2.233	0.027^*
	FH-MOP/(°)	10.401±3.286	5.456±4.828	7.085	0.000^**
	IGA/(°)	48.703±9.059	66.087±10.191	-10.667	0.000^**
	Balkwill角/(°)	21.252±2.430	23.080±2.883	-4.057	0.000^**
	DPO/mm	31.532±3.614	33.587±4.355	-3.038	0.003^**
颞下颌关节	髁突内外径/mm	18.148±1.920	20.041±2.512	-4.999	0.000^**
	髁突前后径/mm	8.576±0.863	8.730±0.979	-0.984	0.327
	髁突倾斜角/(°)	71.913±7.857	73.673±5.520	-1.534	0.128
	髁突头宽度/mm	8.076±1.029	8.493±0.917	-2.532	0.012^*
	髁突头高度/mm	3.869±0.633	3.891±0.541	-0.216	0.829
	髁突长度/mm	19.439±2.994	18.631±2.831	1.640	0.103
	关节窝深度/mm	9.130±1.173	9.377±1.218	-1.221	0.224
	关节窝宽度/mm	19.299±1.949	20.011±2.003	-2.130	0.035^*
	关节结节高度/mm	7.114±1.110	7.918±1.112	-4.286	0.000^**
	关节结节倾斜度/(°)	43.285±6.651	49.300±7.013	-5.207	0.000^**
	关节前间隙/mm	2.303±0.796	2.480±0.781	-1.328	0.186
	关节上间隙/mm	3.105±0.711	3.558±0.713	-3.765	0.000^**
	关节后间隙/mm	1.986±0.671	2.399±2.206	-1.496	0.137