伴颞下颌关节紊乱病患者不同颌位髁突位置的差异

doi:10.13591/j.cnki.kqyx.2025.06.005

摘要/Abstract

摘要：

目的研究伴颞下颌关节紊乱病(temporomandibular disorders,TMD)的错牙合患者不同颌位髁突位置的差异,进一步探讨髁突偏移和错牙合因素对TMD的影响。方法按照试验纳入标准分别收集无TMD个别正常牙合组(A组,n=10)、伴TMD个别正常牙合组(B组,n=8)、无TMD错牙合组(C组,n=9)和伴TMD错牙合组(D组,n=20),采用CadiaxⅣ和CPM(condylar position measurement)分别记录4组试验对象牙尖交错位(intercuspal position,ICP)和参考位置(reference position,RP)髁突的位置,游标卡尺测量下颌从RP位到ICP位髁突位置的偏移量和偏移方向,采用 SPSS 26.0软件包对所得结果进行统计学分析。结果矢状向,A组与B组、C组与D组、A组与D组髁突偏移量均差异有统计学意义(P<0.01),垂直向D组右侧髁突的位移量大于A组,差异有统计学意义(P<0.05),其余各组间差异无统计学意义。髁突横向的偏移量在4组组间均不具有统计学差异。A组和D组髁突偏移方向占比最大的为前上,B组和C组中髁突偏移占比最大的为后上。结论伴TMD人群常伴有RP-ICP髁突矢状向偏移。无TMD的错牙合患者RP-ICP的髁突位移与无TMD正常牙合人群无显著差异。有TMD错牙合患者较无TMD正常牙合在矢状向和垂直向均易发生髁突的偏移。

关键词: 颞下颌关节紊乱病, 颌位, 髁突位置

Abstract:

Objective To investigate the differences of condylar position in patients with temporomandibular disorders(TMD), and to further explore the effects of condylar position displacement and malocclusion factors on TMD. Methods According to the inclusion criteria, normal occlusion subjects without TMD(group A, n=10), normal occlusion subjects with TMD(group B, n=8), malocclusion subjects without TMD(group C, n=9) and malocclusion subjects with TMD(group D, n=20) were collected. Condylar position measurement(CPM) and Cadiax Ⅳ were used to locate the position of condyle in RP and ICP, and the displacement and direction of condyle in three-dimensional direction from RP to ICP were measured by vernier caliper. All the data were averaged three times and analyzed by SPSS26.0 statistical software. Results In the sagittal direction, the condylar displacement of group A and group B, group C and group D, and group A and group D had statistical differences(P<0.01). The displacement of the right condyle in the vertical direction of group D was greater than that of group A, and the difference was statistically significant(P<0.05). The difference among other groups was not statistically significant. There was no significant difference in the lateral displacement of condyle between the four groups. In group A and group D, the largest proportion of condyle deviation was anterior up, while in group B and group C, the largest proportion of condyle deviation was posterior up. Conclusion RP-ICP condylar sagittal displacement is common in people with TMD. The condyle displacement of RP-ICP in malocclusion patients without TMD is not significantly different from that in normal occlusion patients without TMD. Patients with TMD malocclusion are more likely to have condylar displacement in sagittal direction and vertical direction than normal occlusion without TMD.

Key words: temporomandibular disorders, jaw position, condylar position displacement

中图分类号:

R782.63

王静, 张淋坤, 张春香, 林晨, 金晶, 王天齐, 刘冬巧. 伴颞下颌关节紊乱病患者不同颌位髁突位置的差异[J]. 口腔医学, 2025, 45(6): 424-429.

WANG Jing, ZHANG Linkun, ZHANG Chunxiang, LIN Chen, JIN Jing, WANG Tianqi, LIU Dongqiao. The difference of condyle position in patients with temporomandibular disorders[J]. Stomatology, 2025, 45(6): 424-429.

图/表 5

图1

图2

表1

表2

表3

参考文献 27

[1]	Jiménez-Silva A, Tobar-Reyes J, Vivanco-Coke S, et al. Centric relation-intercuspal position discrepancy and its relationship with temporomandibular disorders. A systematic review[J]. Acta Odontol Scand, 2017, 75(7): 463-474. doi: 10.1080/00016357.2017.1340667 pmid: 28641068
[2]	Dzingutè A, Pileičikienè G, Baltrušaitytè A, et al. Evaluation of the relationship between the occlusion parameters and symptoms of the temporomandibular joint disorder[J]. Acta Med Litu, 2017, 24(3): 167-175. doi: 10.6001/actamedica.v24i3.3551 pmid: 29217971
[3]	Battistuzzi PGFCM, Truin GJ. Temporomandibular disorders:“occlusion”matters![J]. Pain Res Manag, 2018, 2018: 8746858.
[4]	Myllymäki E, Heikinheimo K, Suominen A, et al. Longitudinal trends in temporomandibular joint disorder symptoms, the impact of malocclusion and orthodontic treatment: A 20-year prospective study[J]. J Oral Rehabil, 2023, 50(9): 739-745.
[5]	曾祥龙. 现代口腔正畸学诊疗手册[M]. 北京: 北京医科大学出版社, 2000.
[6]	Crawford SD. Condylar axis position, and signs and symptoms of temporomandibular dysfunction[J]. Angle Orthodontist, 1999, 69(2):103-15. pmid: 10227550
[7]	Alexander SR, Moore RN, DuBois LM. Mandibular condyle position: Comparison of articulator mountings and magnetic resonance imaging[J]. Am J Orthod Dentofacial Orthop, 1993, 104(3): 230-239.
[8]	Manfredini D, Perinetti G, Guarda-Nardini L. Dental malocclusion is not related to temporomandibular joint clicking: A logistic regression analysis in a patient population[J]. Angle Orthod, 2014, 84(2): 310-315. doi: 10.2319/041613-295.1 pmid: 23957663
[9]	Slavicek R. The masticatory organ function and dysfunction[M]. Klosterneuburg: Gamma-MedizinischwissenschaftlicheFortbidungs-GmbH, 2002.
[10]	Padala S, Padmanabhan S, Chithranjan AB. Comparative evaluation of condylar position in symptomatic(TMJ dysfunction)and asymptomatic individuals[J]. Indian J Dent Res, 2012, 23(1): 122.
[11]	Piehslinger E, Celar RM, Horejs T, et al. Recording orthopedic jaw movements. Part Ⅳ: The rotational component during mastication[J]. Cranio, 1994, 12(3): 156-160. pmid: 7813026
[12]	Weffort SYK, de Fantini SM. Condylar displacement between centric relation and maximum intercuspation in symptomatic and asymptomatic individuals[J]. Angle Orthod, 2010, 80(5): 835-842. doi: 10.2319/090909-510.1 pmid: 20578853
[13]	He SS, Deng X, Wamalwa P, et al. Correlation between centric relation-maximum intercuspation discrepancy and temporomandibular joint dysfunction[J]. Acta Odontol Scand, 2010, 68(6): 368-376.
[14]	王云霁, 陈嵩, 石安田, 等. 安氏Ⅱ类错牙合正中关系位-最大牙尖交错位位移与颞下颌关节紊乱症的相关性研究[J]. 四川大学学报(医学版), 2013, 44(2): 231-236.
[15]	Zhu JY, Gong YJ, Zheng FJ, et al. Relationships between functional temporomandibular joint space and disc morphology, position, and condylar osseous condition in patients with temporomandibular disorder[J]. Clin Oral Investig, 2024, 28(3): 193.
[16]	商永慧, 李帅, 刘义琮, 等. 正畸减数患者后牙前移对颞下颌关节应力影响的三维有限元分析[J]. 中国组织工程研究, 2024, 10(34): 5516-5520.
[17]	Aboalnaga AA, Amer NM, Elnahas MO, et al. Malocclusion and temporomandibular disorders: Verification of the controversy[J]. J Oral Facial Pain Headache, 2019, 33(4): 440-450.
[18]	Utt TW, Meyers CE Jr, Wierzba TF, et al. A three-dimensional comparison of condylar position changes between centric relation and centric occlusion using the mandibular position indicator[J]. Am J Orthod Dentofac Orthop, 1995, 107(3): 298-308.
[19]	何红, 傅民魁. 安氏Ⅰ类和Ⅱ类1分类错牙合患者下颌位置的研究[J]. 中华口腔医学杂志, 2001, 36(5): 367-370.
[20]	郁馨, 左志刚, 杨子靓, 等. 青少年低角不同矢状骨面型颞下颌关节形态及位置的CBCT分析[J]. 口腔医学研究, 2024, 40(1): 66-72. doi: 10.13701/j.cnki.kqyxyj.2024.01.013
[21]	Ponces MJ, Tavares JP, Lopes JD, et al. Comparison of condylar displacement between three biotypologicalfacial groups by using mounted models and a mandibular position indicator[J]. Korean J Orthod, 2014, 44(6): 312-319. doi: 10.4041/kjod.2014.44.6.312 pmid: 25473647
[22]	Khojastepour L, Paknahad M, Rastegarian N, et al. Correlation of horizontal condylar angle measured with CBCT and clinical dysfunction index in patients with temporomandibular disorders[J]. Oral Surg, 2023, 16(3): 272-278.
[23]	鄢梨, 周茂强, 邱嘉旋. 颞下颌关节盘前移位患者关节骨形态与矢状向关节盘位置的关系[J]. 华西口腔医学杂志, 2022, 40(4): 414-421.
[24]	Joy TE, Kiran MS, Rahul R, et al. Evaluation of vertical facial height reduction and severity of temporomandibular joint disorders using Shimbashi number and cephalometric analysis[J]. Cranio, 2021, 39(4): 287-293.
[25]	Bell DE, Harris EF. Disclusion in mandibular protrusion[J]. Angle Orthod, 1983, 53(2): 146-156. pmid: 6576654
[26]	Nokar S, Sadighpour L, Shirzad H, et al. Evaluation of signs, symptoms, and occlusal factors among patients with temporomandibular disorders according to Helkimo index[J]. Cranio, 2019, 37(6): 383-388. doi: 10.1080/08869634.2018.1449781 pmid: 29602287
[27]	朱锦怡, 龚衍吉, 郑芳杰, 等. 咬合异常与颞下颌关节紊乱症的关系再思考[J]. 口腔医学, 2024, 44(1): 24-30.

方向	A组	B组	C组	D组
后下	3(15.00)	3(18.75)	0(0)	4(10.00)
后上	4(20.00)	8(50.00)^*	6(33.33)^*	14(35.00)
前下	0(0)	0(0)	3(16.67)	3(7.50)
前上	7(35.00)^*	4(25.00)	5(27.78)	17(42.50)^*
后	0(0)	0(0)	1(5.56)	0(0)
前	0(0)	0(0)	1(5.56)	0(0)
上	3(15.00)	0(0)	1(5.56)	2(5.00)
重合	3(15.00)	1(6.25)	1(5.56)	0(0)
合计	20(100)	16(100)	18(100)	40(100)

测量项目		A组	B组	C组	D组
矢状向/mm	左侧	0.32(0.09,0.65)	1.02±0.84	0.10(0.05,0.62)	1.08±0.79
	右侧	0.17(0.00,0.44)	0.81±0.50	0.51(0.08,0.98)	1.16±0.90
垂直向/mm	左侧	0.55±0.52	0.54(0.33,1.35)	0.10(0.00,0.72)	0.73(0.31,0.98)^a
	右侧	0.60±0.52	0.63(0.27,1.49)	0.40(0.05,1.41)	1.14(0.54,1.93)^a

测量项目		A组	B组	C组	D组
矢状向/mm		0.20(0.00,0.52)^*b	0.95(0.41,1.27)^*	0.16(0.06,0.96)^#	1.05(0.41,1.68)^#b
垂直向/mm	左侧	0.39(0.17,0.82)^a	0.54(0.32,1.40)	0.25(0.00,1.00)	0.73(0.31,0.98) 1.14(0.54,1.93)^a
横向/mm	右侧	0.31(0.00,0.50)	0.19(0.04,0.97)	0.11(0.03,0.57)	0.34(0.06,0.72)