目的 通过影像学测量,探讨单纯双侧下颌升支矢装劈开术(Bilateral sagittal split ramus osteotomy,BSSRO)联合术后正畸,治疗下颌前突(Mandibularprognathism,MP)患者的TMJ变化情况。方法 2012年至2014年,24例(男性8例,女性16例)MP伴/不伴面部不对称患者入组,面部对称及不对称的患者各12例,均行BSSRO联合术后快速正畸。测量术前及术后1年TMJ间隙及髁突和升支的角度,并进行统计学分析。结果 术前偏颌侧面部对称组与面部不对称组相比,各参数统计学无显著性差异,非偏颌侧面部对称组冠状位升支角明显大于面部不对称组(P=0.016 1)。术后偏颌侧面部对称组水平位髁突角明显小于面部不对称组(P=0.017 9),非偏颌侧两组各参数无显著性差异。面部对称组中,偏颌侧术前术后各参数无显著性差异,非偏颌侧冠状位髁突角(P=0.035 5)及前间隙(P=0.041 2)术后明显大于术前。面部不对称组中,偏颌侧术前术后各参数无显著性差异,非偏颌侧冠状位升支角(P=0.017 5)及矢状位升支角(P=0.039 8)术后明显大于术前;上间隙术后明显小于术前(P=0.031 9)。结论 单纯BSSRO联合术后快速正畸,面部对称组的非偏颌侧术后冠状位髁突角及前间隙出现了扩张,面部不对称组的非偏颌侧术后冠状位升支角及矢状位升支角增加,上间隙缩小。

Objective To explore the change of the TMJ after bilateral sagittal split ramus osteotomy （BSSRO）- postoperative orthodontics therapy by radiographic measurement in mandibular prognathism （MP） patients. Methods From 2012 to 2014, 24 patients （8 male and 16 female） diagnosed with MP with and without asymmetry were included in this study. They were divided into 2 groups （12 symmetric patients and 12 asymmetric patients） and all received SSRO - postoperative orthodontics therapy. TMJ space, condylar and ramus angle were assessed by computed tomography （CT） pre- and post- operatively. Results There was no significant difference on the deviation side between the asymmetry and symmetry groups. Coronal ramus angle on the non - deviation side in the symmetry group was significantly larger than that in the asymmetry group （P=0.016 1）. Horizontal Condylar angle on the deviation side in the symmetry group was significantly smaller than that in the asymmetry group while no significant difference was found on the non - deviation side between the asymmetry and symmetry groups postoperatively （P=0.017 9）. The postoperative coronal condylar angle and anterior joint space were significantly larger than the preoperative value on non - deviation side in symmetry group （P=-0.035 5 and 0.041 2, respectively）. The oostoperative coronal ramus angle and saggital ramus angle were larger while the sunerior Joint soace was smaller than the preoperative value on non - deviation side in asymmetry group （P=0.017 5, 0.039 8 and 0.031 9, respectively）. The preoperative condylar position was not changed on deviation side in either group. Conclusion Significant expansion of coronal condylar angle and anterior joint space could occur on the non - deviation side in symmetry group. In asymmetry group, the coronal ramus angle and saggital ramus angle.can be enlarged and the superior joint space can be reduced.