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目的采用口腔颌面锥形束CT评价颞下颌关节重度骨关节病患者正颌术后髁突骨质影像学变化,探讨该类患者正颌术后髁突骨质稳定性。方法选取2013~2015年,诊断为颞下颌关节重度骨关节病伴牙颌面畸形并接受正颌手术,术前观察至少一年且髁突骨质稳定的患者48例,共计85侧髁突。采用CBCT评估术后3月、半年、一年的髁突骨质情况,比较术前髁突表面光整或不光整,以及术后即刻的髁突位置等因素对正颌术后髁突骨质情况的影响。结果术后3个月髁突骨质再吸收率16.67%,显著性低于术后半年(39.76%)、一年者(54.84%),虽然大多数患者术前均表现为髁突表面光整,但术后仍有较高的再吸收率(半年:42.03%;一年:56.86%)。正颌术后即刻髁突后移位或后下移位组,术后半年(60.61%)、一年再吸收率(76%)显著性高于髁突前移位或前下移位组(半年:22.22%;一年:23.08%)。结论 (1)颞下颌关节重度骨关节病患者正颌术后半年和一年髁突骨质再吸收率较术后3月显著增高;(2)即使术前髁突表面光整者(稳定期),正颌术后髁突骨质再吸收的风险并不会降低;(3)正颌术后即刻髁突位置可能与正颌术后髁突再吸收有关。一般来说,髁突向前、前下移位与髁突向后、后下移位相比,后者更容易出现骨质破坏。
OBJECTIVE: To evaluate the changes of mandibular condyle bone imaging in patients with severe osteoarthrosis of the temporomandibular joint by oral and maxillofacial cone beam computed tomography (CT). To study the stability of condylar bone after orthognathic surgery. Methods From 2013 to 2015, 48 cases of condyles with a total of 85 condyles were diagnosed as severe temporomandibular joint osteoarthrosis accompanied by maxillofacial deformity and undergoing orthognathic surgery. One hundred and eighty patients were observed for at least one year with stable condyle bone. The CBCT was used to evaluate the status of condylar bone after 3 months, 6 months and 1 year after operation. The condylar process was compared with the preoperative condyle surface smoothing or not, and the postoperative condylar position. Impact. Results The bone resorption rate of femoral condyle was 16.67% at 3 months postoperatively, which was significantly lower than that of postoperative six months (39.76%) and one year (54.84%). Although most of the patients showed condylar surface resurfacing before operation, However, postoperative high reabsorption rate (half year: 42.03%; one year: 56.86%). Immediately after orthognathic surgery, the posterior or posterior condylar displacement was significantly higher than that of the condylar anterior or posterior displacement group (60.61%) and one year reabsorption rate (76%) Six months: 22.22%; one year: 23.08%). CONCLUSIONS: (1) The patients with severe osteoarthrosis of temporomandibular joint had a significant increase in the bone resorption rate of condyle after six months and one year compared with March after surgery. (2) Even though the condylar surface integrator (stable phase) , The risk of condylar bone resorption after orthognathic surgery does not decrease; (3) The position of condyles immediately after orthognathic surgery may be related to the re-absorption of condyles after orthognathic surgery. In general, the condyle forward and anterior downward displacement and condyle back, after the next shift, the latter is more prone to bone destruction.