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目的 研究成人骨性安氏Ⅲ类错(殆)正畸-正颌联合治疗前后颞下颌关节(TMJ)变化.方法 选择2002-2010年在中国医科大学口腔医院正畸科就诊的成人骨性安氏Ⅲ类错(殆)患者30例,采用正畸治疗加双侧下颌升支矢状劈开后退术(BSSRO)的正畸-正颌联合治疗方案,分别在BSSRO术前、术后1个月、矫治结束时拍摄标准薛氏位片,采用Cohlmia测量法对关节片进行关节间隙及关节窝形态测量,观察髁突位置及关节形态的变化.结果 (1)关节间隙变化:与术前比较,术后1个月双侧关节各间隙均明显变大(P＜0.05)；矫治结束后关节间隙测量值与术前比较,差异无统计学意义(P＞0.05).(2)髁突位置和关节窝形态变化:术后1个月髁突位置与术前比较,矢状向髁突位置后移,垂直向髁突位置下移.矫治结束后与术前比较,髁突位置各项指标差异无统计学意义(P＞005).反映关节窝形态的指标在术前、术后1个月和矫治结束后三者间比较差异均无统计学意义(P＞0.05).(3)30例患者中治疗前9例有关节弹响,治疗后5例弹响消失,术前无关节弹响者术后均未出现弹响,所有患者治疗前后均未出现关节疼痛及开口受限.结论 (1)BSSRO术后1个月关节间隙增大,髁突位置稍偏后,矫治结束后恢复正常.正畸-正颌联合治疗未引起关节窝形态的改变.(2)所有患者均未引起颞下颌关节紊乱病(TMD),且部分患者治疗后关节弹响消失,提示正畸-正颌联合治疗可能对TMD有一定的治疗作用.

Changes of the temporomandibular joint following combination of orthognathic surgery and orthodontics of skeletal Class HI malocclusion on radiography

Objective To investigate the effects of combination of orthognathic surgery and orthodontics for skeletal Ⅲ malocclusion on the position and configuration of temporomandibular joint （TMJ） with radiography. Methods Thirty patients with skeletal Angle Class Ⅲ malocclusion were studied. The patients treated with pre-operative orthodontics, bilateral sagittal split ramous osteotomy （BSSRO） and post-operative orthodontics were studied clinically and radio- graphically in three different phases in order to locate the position of the temporomandibular joint in relation to the gle- noid fossa. Results ① Changes of temporomandibular joint space ： the joint space changed one month after operation （P 〈 0.05）, and returned to the original position 6-12 months after operation（P 〉 0.05）.②Changes of condylar position and glenoid fossa configuration： the condylar positions changed one month after operation（P 〈 0.05）. The condylar posi- tions shifted backward in sagittal and moved down in vertical, and returned to the original position 6-12 months after op- eration（P 〉 0.05）. The glenoid fossa configuration was not changed （P 〉 0.05）. ③Abnormal joint sound disappeared in five of nine patients with abnormal joint sound before surgery, and there was not any new case of abnormal joint sound af-ter the sugery. There were no temporomandibular disor- ders （TMD） in all of the 30 patients preoperatively and postoperatively. Conclusion ①The effects of combina- tion of orthognathic surgery and orthodontics on TMJ space is obviously changed, and most of the changes are within the normal adaptability of TMJ. The joint spaceand condylar position have been changed one month after BSSRO, and returned to original position 6-12months after BSSRO. The glenoid fossa configuration is not changed. ②None of the patients leads to TMD, and abnormal joint sound disappears in some of nine patients with joint sound before surgery. Therefore it suggests that orthodontic-orthognathic therapy has a certain efficacy in the treatment of TMD.