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目的:应用MRI定量分析功能矫治器在颞下颌关节(temporomandibularjoint,TMJ)可复性盘移位(discdisplacementwithreduction,DDWR)治疗中对关节间隙的影响,初步探讨间隙改变的实质及意义。方法:选择42例应用功能矫治器复位单侧DDWR的Ⅱ类错畸形,以正常侧作为对照,在斜矢状MRI图像上,计算治疗前、后关节间隙指数(jointspaceindex,JSI)的改变。定量测量功能矫治器治疗前(T1)、戴用功能矫治器初期(T2)和治疗结束(T3)后关节间隙的变化。采用SPSS16.0软件包对数据进行t检验。结果:T2与T1的平均间隔时间为3周(2周~1个月),T3与T1的平均间隔时间为9个月(6~14个月)。年龄小者治疗周期短。对DDWR患者,治疗前患侧JSI显著大于对照侧;治疗结束,患侧JSI与对照侧相似。表明在T1阶段患侧关节前间隙明显大于后间隙。在T2阶段,患侧前间隙减小,后上间隙明显增加。与T2比较,T3阶段关节前间隙变大,后上间隙明显变小。与T1相比,患侧治疗后前间隙变小,无显著差异;后上间隙变大,有显著差异。结论:DDWR患者通过矫形治疗前移下颌骨,复位关节盘,关节间隙分布更趋均匀。矫形治疗主要改变后上间隙,对前间隙影响较小。
OBJECTIVE: To quantitatively analyze the effect of functional appliance on the joint space in the treatment of temporomandibular joint (TMJ) discordance disc displacement (DDWR), and to explore the essence and significance of the gap change. Methods: Twenty - two patients with type Ⅱ malocclusion were treated with functional appliance to reset the unilateral DDWR. The normal side was used as control. The changes of joint space index (JSI) before and after treatment were calculated on the sagittal MRI images. The changes of joint space after functional appliance (T1), functional appliance (T2) and end of treatment (T3) were quantitatively measured. SPSS16.0 software package for t-test data. Results: The average interval between T2 and T1 was 3 weeks (2 weeks to 1 month), and the average interval between T3 and T1 was 9 months (6 to 14 months). Small age treatment period is short. For DDWR patients, the JSI before treatment was significantly greater than that on the control side; at the end of treatment, the JSI at the affected side was similar to the control side. Showed in the T1 stage ipsilateral anterior gap was significantly larger than the posterior gap. In stage T2, the ipsilateral anterior gap was reduced and the posterior upper gap was significantly increased. Compared with T2, T3 anterior gap becomes larger, after the gap was significantly smaller. Compared with T1, ipsilateral after treatment ipsilateral clearance smaller, no significant difference; after the gap becomes larger, there are significant differences. Conclusion: The DDWR patients are treated by orthopedic treatment to move the mandible forward and reset the joint disc. The joint space distribution is more uniform. Orthopedic treatment of the main change after the gap, the front gap less affected.