【作者】 董研；

【导师】 郭天文；

【作者基本信息】 第四军医大学 ， 口腔科学（口腔修复学）， 2001， 博士

【摘要】 发育性下颌偏颌畸形是临床常见的颌骨畸形。偏颌不仅使患者颜面形态异常、口腔功能障碍，近年来的临床观察还发现该类患者常伴有颈椎生理弯曲度的改变及头、颈、肩、背部肌酸痛甚至肌强直等头颈功能紊乱的症状。头颈功能紊乱是否与下颌偏颌有因果关系、偏颌畸形通过何种途径诱发头颈功能紊乱等问题尚无明确的结论。本研究以发育性下颌偏颌畸形患者28例为患者组，同龄咬合正常者39例做对照组，进行以下三方面的研究：一．采用头颅定位后前位X线片、自然头位侧位X线片、颏顶位X线片、颞下 颌关节体层X线片及颈椎正侧位片对两组受试者做颌面与颈椎骨质结构的观 察、对颜面形态与颈椎曲度进行测量分析，寻找颌面形态与颈椎姿势之间的 相关性。二．采集受试者咀嚼肌、颈肩背部肌自主运动时的表面肌电信号，采用功率谱与 联合时频分析法提取时域、频域特征矢量；采集受试者下颌运动轨迹信号， 分析其特点及与肌电特征的对应关系，以明确下颌运动中咀嚼肌运动系统与 颈椎周围肌运动系统的相互作用关系，并探讨偏颌畸形致头颈功能紊乱的生 理病理机制。三．采用正畸与正颌外科联合治疗的方法，通过畸形矫治前后形态学及运动功能 变化的比较，探讨偏颌畸形合并头颈功能紊乱的有效治疗方法。结果显示一 颜面形态与颈椎姿势的相关性1．咬合正常者、下颌偏颌者的齿突倾斜度、齿突平面倾斜度与眶耳平面、腭平 面、咬合平面、下颌平面的倾斜度之间均呈正相关，齿突前倾时，各平面倾 斜度增大；2．咬合正常者、偏颌畸形者第2颈椎到第4颈椎的弯曲度与齿突平面倾斜度呈 负相关，齿突前倾时，上位颈椎弯曲度小，齿突后倾时，上位颈椎弯曲度增 加；3．头颅定位后前位X线片显示患者组下颌左右侧磨牙点、下颌角、髁状突的位 置及左右下颌升支高度明显不对称（P＜0.05），而面中部骨性结构的形态、对 称性无明显差异（P＞0.05）；4．颏顶位X线片示偏颌者下颌骨对称结构的水平非对称率及前后向位置差异明 显高于正常咬合组（P＜0.05）；5．偏颌畸形者下颌中切牙点、颏点及第4至第6颈椎在冠状面内走向明显偏离 第四军医大学博士学位论文 颅骨中线（P＜0刀5）；颈椎正、侧位片未发现明显骨质异常； 6．偏颌畸形患者咬合平面、下颌平面的倾斜度大于正常咬合者（r＜0刀5），而颈 椎曲度、倾斜度小于对照组，患者头呈前倾位。 二偏颌畸形者头颈功能紊乱的生理病理研究 128例发育性偏颌畸形患者中，有头颈功能紊乱者！9例（67．8％）；39例同龄咬巴 合正常者中仅有一例受试者的颈椎在冠状面内曲度异常，头颈功能紊乱患病率 为2．56叽，明显低于偏颌畸形患者（r＜0刀5）； Z下颌开闭口、咀嚼运动时颈背部肌出现明确的协同肌电活动；头颈、肩背运动 时咀嚼肌也有相应的肌电活性增强； 3偏颌患者下颌功能性运动及颈肩部运动时，患侧与对侧咀嚼肌、胸锁乳突肌、 斜方肌肌电的时域、频域参数有明显差异（卜＜0刀5）；咀嚼运动时患者斜力－肌肌 电幅度比开闭口运动时增强。无论患侧或对侧咀嚼，患侧二腹肌动作电位幅度 均强于对侧； 4两组受试者频率参数对称性差异显著（P＜0刀5），时域参数对称性差异不显著 （卜＞o刀5）； 5偏颌者下颌开闭口运动在左右、前后、垂直方向的位移、速度均大于对照组 （P＜0．05）；患者开闭口运动、咀嚼运动时下颌运动轨迹环在冠状面内主要分布 在患侧。 三 偏颌畸形矫治后颌面、颈椎形态、功能的变化 偏颌畸形经矫治一年后，患者颈椎曲度有改善，但与治疗前的差异不显著； 左右侧咀嚼肌、颈椎周围肌肌电时域、频域特征参数的对称性有显著提高 （P＜0．05）；下颌运动在前后、垂直方向的位移、速度均较治疗前减小。 结论＿发育性下颌偏颌者不仅颌面形态不对称、肤状突位置与下颌运动型异常，而 且其颈椎姿势也明显异常，表现为颈椎曲度、倾斜度的异常，两侧咀嚼肌、颈、 肩背部肌功能不协调，其头颈功能紊乱的患病率高于正常咬合者。发育性下颌偏 颌与头颈功能紊乱有明显相关关系。咀嚼肌、颈、肩背部肌功能不快调是偏颌寻 致头颈功能紊乱的重要病理机制。更多还原

【Abstract】 Developmental lateral jaw deformity(DLJD) is a common kind of jaw deformity in clinic. Patients suffer from not only craniofacial paramorphia but also oral ~lysfunction. Additionally, recent studies have found that DUD was often accompanied by abnormal cervical curve and pain in head-neck, shoulder and back muscles, which are similar to cervical spine disorder(CSD).Up to now, it is not clear that whether DUD could lead to CSD and by what way it does. Therefore, studies of facial morphology, cervical spine curve and also oral clinical examination were preformed to research the relationship between these two kinds of disease. Furthermore, electromyography and mandibular movement as well as head and shoulders movement were also recorded to research the etiology from craniofacial to cervical diseases. 39 young healthy adults with normal occlusion severed as control group and 28 developmental mandibular lateral deviation persons as patient group. The following studies have been carried out: i.The relationship between developmental lateral jaw deformity and cervical spine disorders. Cephalometric and cervical spine roentgenograms of posterior-anterior, lateral projection in nature head position and radiographs of mental-vertical, lateral temporomandibular joint tomogram were taken for both two groups to exam bone structures and morphology both in craniofacial and cervical vertebrae in order to research the relationship between this two kinds of diseases. 2.The pathogenesis from jaw deformity to cervical spine disorders. Surface electromyographic signals from left and right sides of masseter, anterior digastricus, sternocleidomastoid,upper-trapezius muscles and mandibular movement were detected during self-paced continuous maximum jaw opening-closing, gum chewing, shoulders elevation-lowering, protraction-retraction and head flexion? extension movement. Basing on frequency domain, time domain and Joint Time Frequency, muscular function was analyzed to compare the difference of the four paired muscles and the symmetry in the two groups so as to clarify the etiology from jaw deformity to cervical spine disorders. -4- 3.Treatment methods for patients who suffer from both jaw deformity and cervical spine disorders. Morphological and kinetic changes in patients were compared to find if cervical spine disorders could be relieved by orthodontic correction and (or)orthognathic surgery treatment. The main findings were: The relationship between cranofacial morphology and cervical spine posture. 1.The inclination of the dens and the cervical vertebrae plane showed positive correlation to Frankfort Horizontal, Palatal, Occlusal and Mandibular Plane. Each plane inclination was high in case of forward flexion dens in both control and patient group; 2.The curve from the second cervical vertebrae to the fourth cervical vertebrae had a negative correlation to the cervical vertebrae plane inclination .The curve was small with forward flexion dens but large with backward flexion dens in both two groups. 3.The position of the left and right side molar, mandibular angle and condylar as well as mandible height had significant difference in two groups (P<O.05).However, middle partial of facial bone had no difference both in morphology and structure. 4.Both horizontal更多还原