MRI study of stable splint in the treatment of unilateral anterior disc displacement without reduction with chewing side preference
徐鑫宇 1黄东宗 1王岩 2刘刚 2胡一帆 1胡敏 3刘洪臣 4姜华1
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作者信息
1. 100853 北京,解放军总医院第一医学中心口腔修复科
2. 100853 北京,解放军总医院第一医学中心放射诊断科
3. 100853 北京,解放军总医院第一医学中心口腔颌面外科
4. 解放军总医院口腔医学研究所,口腔颌面战创伤军队重点实验室,口腔颌面修复军队医学重点实验室
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摘要
目的 通过MRI评估稳定型咬合板治疗伴偏侧咀嚼单侧不可复性盘前移位患者的疗效.方法 选取在解放军总医院第一医学中心口腔科就诊,经过临床检查及影像学检查诊断为单侧不可复性颞下颌关节盘前移位患者34例,根据其是否存在偏侧咀嚼习惯,将其分为伴偏侧咀嚼组(17例)和无偏侧咀嚼组(17例),分析患者最大开口度、疼痛指数、关节盘长度、盘分界角、关节盘位置以及翼外肌特点.采用SPSS25.0软件对结果进行统计分析.结果 稳定型咬合板治疗前,伴偏侧咀嚼(chewing side preference,CSP)组患者同侧关节盘-髁突角度(61.13±10.54°)大于无CSP组(51.12±17.27°);伴CSP组同侧、对侧关节盘-髁突角度差值(52.52±10.91°)大于无CSP组差值(41.26±17.78°);伴CSP组同侧、对侧翼外肌下头面积差值(-0.43±3.66mm2)小于无CSP组同侧、对侧翼外肌下头面积差值(0.288±4.57mm2),差异均有统计学意义(P＜0.05).经稳定型咬合板治疗后两组患者疼痛及最大开口度均有改善,差异有统计学意义(P＜0.05),组间比较两组治疗后疼痛及最大开口度无明显统计学差异(P＞0.05);稳定型咬合板治疗后两组患者关节盘-髁突角度、关节盘长度减小,差异均有统计学意义(P＜0.05),组间比较无明显统计学差异(P＞0.05).两组稳定型咬合板治疗后翼外肌上、下头长度、厚度和面积的平均值接近,差异无统计学意义(P＞0.05).Logistic回归分析显示,MMO(OR=0.743)与偏侧咀嚼存在相关性(P＜0.05).结论 MRI能无创诊断ADDWoR,伴CSP的单侧ADDWoR患者患侧关节移位更加显著,且单侧ADDWoR患者MMO与CSP存在相关性,通过稳定型咬合板治疗能显著改善ADDWoR患者开口度及疼痛症状,缓解关节盘受压及关节盘移位程度.
Abstract
Objective The objective of this study was to assess the effectiveness of stable occlusal splint treatment in patients with unilateral anterior disc displacement without reduction(ADDWoR)and associated unilateral mastication habits using MRI.Methods Thirty-four patients diagnosed with unilateral ADDWoR underwent clinical and imaging examinations at the Stomatology Department of the First Medical Center of the Chinese PLA General Hospital.Based on their mastication habits,patients were categorized into two groups:those with unilateral mastication(n=17)and those without(n=17).Parameters including MMO,pain index,length of the articular disc,demarcation angle,position of the articular disc,and characteristics of the lateral pterygoid muscle were analyzed.Statistical analysis was performed using SPSS 25.0 software.Results Before the treatment of stable splint,the ipsilateral disc-condylar angle of patients with CSP was higher than that of patients without CSP(51.12±17.27°),and the difference of ipsilateral and contralateral disc-condylar angle of patients with CSP was higher than that of patients without CSP(41.26±17.78°).The difference of inferior head area of ipsilateral and contralateral lateral pterygoid muscle in the group with CSP(-0.43±3.66mm2)was smaller than that in the group without CSP(0.288±4.57mm2).After treatment with stable occlusal plate,the pain and MMO were improved in both groups,and there was significant difference between the two groups(P＜0.05).There was no significant difference in pain and MMO between the two groups(P＞0.05).After the treatment of stable splint,the length of articular disc and the angle of articular disc condyle decreased between the two groups,and there was significant difference between the two groups(P＜0.05),but there was no significant difference between the two groups(P＞0.05).The average length,thickness and area of the superior and inferior pterygoid muscle were similar between the two groups after stable splint treatment,but there was no statistical difference(P＞0.05).Logistic regression analysis showed that there was a correlation between MMO(OR=0.743)and unilateral mastication.Conclusion MRI is effective for non-invasive diagnosis of ADDWoR,particularly in cases with unilateral mastication habits.Stable occlusal splint treatment significantly improves mouth opening and pain symptoms in ADDWoR patients,alleviating articular disc compression and displacement.
关键词
稳定型咬合板/不可复性颞下颌关节盘前移位/偏侧咀嚼/MRI
Key words
Stable splint/Anterior disc displacement without reduction/Chewing side preference/MRI
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