颞下颌关节紊乱病的MRI表现与疼痛关系的研究

[目的]研究颞下颌关节紊乱病(TMD)的MRI表现与颞下颌关节疼痛的关系,探讨MRI在TMD诊断和治疗中的价值.[方法]对30例具有疼痛主诉的TMD患者的60侧颞下颌关节(TMJ)行开、闭口冠状位和矢状位T1加权、T2加权和质子加权扫描.[结果]MRI观察到37个疼痛关节中,发现关节盘移位34个(91.9%),关节盘变形33个(89.2%),关节渗液31个(83.8%);23个非疼痛关节中,关节盘移位12个(52.2%),关节盘变形3个(13%),关节渗液1个(4.5%).经统计学分析,疼痛与关节盘移位、变形和关节渗液的出现有关系(P＜0.01).[结论]MRI能清楚显示TMJ关节盘及周围组织变化,能反映TMJ的变化与疼痛的关系,在TMD的诊断和治疗方面均具有重要价值.     

颞下颌关节紊乱病患者临床特征及MRI影像表现

  目的  探讨182例颞下颌关节紊乱病患者的临床特征及MRI影像表现。  方法  回顾性选取2018年9月~2021年6月于我院就诊的182例颞下颌关节紊乱病患者364只颞颌关节为研究对象,收集并分析其临床病例资料,包括一般资料、临床特征及MRI影像表现等。  结果  182例颞下颌关节紊乱病患者364只关节,关节盘可复性前移162只关节,不可复性前移114只关节,侧方移位27只关节,关节盘损伤变性60只,关节盘穿孔32只,髁状突变形、破坏47例,关节囊、韧带损伤31例。患者临床特征复杂多变,但多数患者普遍表现为关节疼痛、弹响、张口受限、下颌偏斜等症状。MRI图像可见清晰的关节盘位置、形态、厚度变化和关节积液。  结论  颞下颌关节紊乱病患者临床特征多样,可通过MRI精确反映颞下颌关节紊乱病进展中关节盘位置、形态及厚度变化情况,提高临床诊断准确性。      

关节镜治疗颞下颌关节紊乱病的临床研究

目的 评价应用颞下颌关节内镜上腔灌洗术治疗颞下颌关节紊乱病患者的临床疗效.方法 对保守治疗无效的26例临床表现为张口受限合并关节疼痛的颞下颌关节紊乱病患者行颞下颌关节镜上腔灌洗术,分析治疗前后不同时期患者的疼痛值(疼痛直观模拟标尺VAS)、张口度的变化,并通过MRI检测治疗前后关节盘位置的变化.结果 治疗后张口度≥35 mm的患者占88.5%(23/26),不同时期的张口度均较治疗前有显著差异(P<0.01),特别在治疗后1个月内增加明显,疼痛亦有显著缓解(P<0.01),所有病例均无并发症发生.MRI显示有4例患者的关节盘部分复位.结论 颞下颌关节内镜下的上腔灌洗术直视下操作准确,能有效治疗颞下颌关节紊乱病,明显改善张口度和缓解疼痛.颞下颌关节镜治疗技术安全有效,有临床推广应用价值.     

基于动能系统整体康复的手法治疗对改善颞下颌关节紊乱病的临床疗效

目的:探讨应用基于动能系统整体康复的手法治疗对颞下颌关节紊乱病(TMD)患者的临床疗效。方法:选取2017年7月—2019年3月我院康复医学科收治的颞下颌关节紊乱病患者60例,随机分为两组,常规理疗组(30例)采用常规理疗,手法治疗组(30例)采用基于动能系统整体康复的手法治疗。干预前后对两组采用目测类比法(VAS)疼痛评分、最大张口度(MMO)及颞下颌关节功能评价(Fricton指数法)评估颞下颌功能状况,并进行对比探讨。结果:经过4周治疗后,两组VAS疼痛评分,最大张口度(MMO),颞下颌关节功能(DI、MI、CMI)均较治疗前明显改善(P0.05),两组VAS疼痛评分及肌肉触压痛指数(PI)差异无显著性意义(P0.05)。手法治疗组患者的颞颌关节功能障碍指数(DI)及颞下颌关节紊乱指数(CMI)明显低于常规理疗组,差异具有显著性意义(P0.05)。结论:常规理疗(TENS和超短波治疗)与基于动能系统整体康复的手法治疗均可以改善颞下颌关节紊乱病患者的疼痛和张口受限,而手法治疗的疗效更加显著,尤其是在改善颞下颌关节功能方面,值得临床推广。     

超短波联合阻滞疗法治疗颞下颌关节紊乱综合症

颞下颌关节紊乱综合症(tempormandibular disorder,TMD)是咀嚼肌平衡失调,颞颌关节各组成结构之间运动失常而引起的疼痛、张口受限、弹响等综合征.2008年2月至2010年9月我科采用超短波联合阻滞疗法治疗颞下颌关节紊乱综合症44例,同时与神经阻滞加调制中频39例作对照,现报道如下:     

颞下颌关节镜治疗关节盘不可复性前移位的临床研究

目的 评价应用颞下颌关节内镜手术治疗关节盘不可复性前移位所致张口受限的临床疗效.方法 选取深圳大学第一附属医院口腔科2007 ～ 2009年保守治疗6个月以上无效,术前MRI检查发现关节盘出现不可复性前移位的关节内紊乱患者23名(28侧关节),局麻下进行行颞下颌关节镜手术治疗,采用关节上腔前后隐窝双通道手术(包括灌洗术、粘连松解术、关节盘盘前松解+盘复位术).主客观评价资料视觉模拟疼痛指数评估(visual analogue pain score,VAS),张口度及MRI检查在术前和术后7,30和60 d及以上收集分析,评价颞下颌关节镜手术的疗效.结果 术后各时间段开口度与术前相比差异有显著性(P＜0.01).治疗后6个月最大张口度平均值由(20.4±4.5)mm改善至(38.9±3.2)mm较治疗前差异有显著性(P＜0.01),视觉模拟疼痛指数评估(VAS),由术前的(56.4±9.9)改善至(9.2±2.7),差异有显著性(P=0.0023).术前MRI检查所有患者均可见关节盘不可复性前移位,其中18侧(18/28,64％)关节可见关节盘变形,5侧(5/28,18％)关节腔内可见积液.术后60 d复查MRI,发现14侧关节盘与术前相比位置明显改善,13侧关节盘与术前相比位置少许改善,1侧关节盘无改变.所有颞下颌关节镜手术过程顺利,术后无并发症的发生.结论 该颞下颌关节镜手术是一种安全性高,创伤小,并能有效改善关节区疼痛和下颌运动受限的治疗方法,并且关节盘位置明显改善.与开放手术相比较拥有风险性小,并发症少,恢复快等优势,成功率高能有效治疗颞下颌关节盘不可复性前移位,前景光明,值得在临床进一步推广.     

关节松动术配合理疗治疗颞下颌关节紊乱综合征的疗效评估

目的:观察关节松动术手法配合理疗治疗颞下颌关节紊乱综合征(TMD)的疗效。方法:筛选TMDⅡb类患者40例,随机分为关节松动术配合理疗组(A组,n=20)、针灸配合理疗组(B组,n=20)。治疗前及治疗4周后采用疼痛视觉模拟评分(Visual Analogue Scale,VAS)、最大张口度、下颌功能障碍问卷(Mandibular Function Impairment Questionnaire,MFIQ)、MRI评定患者的疼痛程度、最大张口度、下颌功能及盘髁活动度。结果:治疗后,两组疼痛(A组1.10±1.59,B组1.25±1.37)较治疗前差异均具有显著性意义(P0.001),两组组间比较差异无显著性意义(P0.05);A、B组最大张口度(A组36.50±4.68mm,B组26.15±4.49mm)、下颌功能障碍(A组0.50±0.76,B组0.75±0.55)、盘髁活动度(A组6.54±1.22mm,B组4.43±1.36mm)较治疗前差异均具有显著性意义(P0.001),两组组间比较差异有显著性意义(P0.05)。结论:关节松动术配合理疗的治疗方法可有效改善TMDⅡb类患者的关节疼痛。与针灸配合理疗治疗相比较,关节松动术配合理疗对张口受限、下颌功能障碍、盘髁活动度等症状的改善更加明显。     

物理疗法及手法治疗对颞下颌关节紊乱的疗效

目的观察物理疗法及手法治疗对颞下颌关节紊乱(TMD)的疗效。方法TMD患者90 例随机分为药物组(n=30)、理疗组(n=30)、理疗+手法组(n=30)。治疗前及治疗4 周后采用疼痛视觉模拟评分(VAS)、最大张口度、关节弹响程度进行评定。结果治疗后,各组疼痛均明显改善(P<0.01),理疗组还伴有最大张口度明显改善(P<0.01),理疗+手法组患者最大张口度、关节弹响程度显著改善(P<0.001)。治疗后三项评定从优到差顺序均为理疗+手法组、理疗组、药物组。结论理疗结合手法治疗可更有效改善TMD患者关节疼痛、张口受限及关节弹响。     

不良修复体与颞下颌关节紊乱病的相关性研究

目的研究不良修复体导致颞下颌关节紊乱病(TMD)的因素。方法选择199例佩戴不良修复体并导致TMD的患者,根据不良修复体引起的症状分为3组:咬合垂直距离改变组、咬合紊乱组、基牙损伤组。治疗后随访12个月,通过分析TMD治疗的有效性,探讨不良修复体引起TMD的因素。结果咬合垂直距离改变、咬合紊乱、基牙损伤3组治疗有效率分别为89.55%、89.06%、32.35%,基牙损伤组治疗有效率与其他2组比较,差异均有统计学意义(P0.05),提示咬合垂直距离改变和咬合紊乱更容易导致TMD。结论不良修复体所导致的上下颌垂直距离改变、咬合关系紊乱与基牙损伤与颞下颌关节滑膜炎、关节盘移位及骨关节病存在相关性。     

枢轴合板配合直丝弓矫治器治疗青少年AngleⅡ~2错颌畸形伴颞下颌关节紊乱的临床疗效观察

目的探讨枢轴合板配合直丝弓矫治器治疗青少年AngleII2错颌畸形伴颞下颌关节紊乱病(TMD)的临床疗效。方法选择临床检查AngleⅡ2错颌畸形伴TMD患者15例,年龄12～21岁,均采用直丝弓托槽,上颌牙固定矫治开始的同时,佩戴枢轴合板进行关节调整,治疗1～3月后脱离枢轴合板,评价合板脱离时及正畸治疗完成时的疗效,对部分患者治疗前后的许勒位片进行评价。结果 15例患者疗程治疗结束时总治愈率80%(12/15),各症状如弹响、疼痛、张口受限、绞锁的治愈率分别:86.67%,100%,80.0%和87.5%。对其中5例患者进行了X射线片复查,3例患者恢复了正常的盘突关系,2例患者关节盘较治疗前位置回复明显。结论 枢轴合板配合直丝弓矫治器是治疗青少年AngleⅡ2错颌畸形伴TMD的一种可行方法。     

与关节置换相关的国人髋关节结构测量

背景:髋关节置换作为治疗严重髋关节疾病的重要手段已在临床广泛应用,如何更加合理地设计以及置入假体,预防术后并发症的发生,延长假体使用寿命得到越来越多的重视.目的:测量与关节置换相关的陶人髋关节假体相关数据.设计、时间及地点:前瞻性实验,于2008-03/06在青岛大学医学院人体形态学实验中心完成.材料:抽取青岛大学医学院人类学研究室专供科研用的长春、通辽出土的137副完整成人骨盆及股骨,其中男66副,女71副.方法:测量全部标本的髋臼外展角、髋臼前倾角、股骨颈扭转角、股骨颈干角和股骨偏心距5项指标.所得数据输入SPSS11.0软件行统计学分析,并与国内外同类文献资料比较.结果:测耸数据完整,无缺失值.髋臼外展角[男:(42.83±3.75)°,女:(42.07±4.12)°],髋臼前倾角[男:(15.31±6.95)°,女:(14.97±6.44)°],股骨颈扭转角[男:(6.76±9.39)°,女:(7.66±10.30)°]和股骨颈干角[男:(131.81±5.05)°,女:(132.82±5.83)°]的性别差异较小,无显著性意义(P>0.05).男性股骨偏心距大于女性[(44.12±5.14),(41.07±7.25)mm,P<0.05].实验结果与国内文献报道相似,但异于国外数据.结论:髋关节解剖数值的国内地区间差异较小,但与其他国家人种存在差别.适宜的假体设计有助于髋关节置换的开展和减少并发症的风险.     

人工关节置换与关节的运动性损伤

高校体育学院和体育系从事专业运动训练的学生比社会体育和体育教育专业学生的运动性损伤率要高得多。随着比赛对抗程度的明显增强,导致运动性关节损伤有上升趋势。四川省运动训练专业学生运动损伤发病率为75.75%,在运动性损伤中,关节损伤时有发生,严重的关节损伤后可能要通过人工关节置换才可以达到修复。人工关节置换可以基本符合运动损伤后关节功能恢复的生理要求,保持原关节的大部分活动度,恢复后大部分功能良好,而且假体来源不受限,无排斥反应。     

Sacroiliac joint and lumbar zygapophysial joint corticosteroid injections

The sacroiliac joint and the lumbar zygapophysial joints are both known pain generators with demonstrated pain-referral patterns. They are both amenable to image-guided intraarticular injection of corticosteroids, a procedure that is commonly performed for pain. The literature on the efficacy of intraarticular corticosteroid injections for these joints is currently limited. This article covers the diagnostic dilemmas associated with these joints, the utility of anesthetic blocks, and the literature on the efficacy of intraarticular corticosteroid injections.     

关节置换术后假体周围感染的实验室诊断

关节假体周围感染(PJI)是关节置换术后发生的严重并发症,需尽快明确诊断、积极治疗,以避免产生严重的不良后果。由于实验室传统检查方法敏感性和特异性的限制,PJI的诊断至今仍面临巨大挑战。近年来,一些兼具高敏感性和高特异性的检测方法,包括生物标志物检测和病原学检测方法在PJI诊断方面具有良好的应用前景。文章对关节置换术后PJI早期诊断的研究进展作一综述,以便为临床诊治提供参考。     

Trapeziometacarpal joint arthritis

Trapeziometacarpal (TM) joint arthritis is a common cause of radial-sided wrist pain that preferentially affects women. It is diagnosed by a thorough history, physical examination, and radiographic evaluation. While radiographs are used to determine the stage of disease, treatment is dependent on symptom severity. Nonoperative treatment frequently consists of activity modification, non-steroidal anti-inflammatory drugs (NSAIDs), splinting, and corticosteroid injections. After failure of conservative treatment, various surgical options exist depending on the stage of disease. This article reviews the literature supporting the various surgical treatment options. Special consideration is given to the comparison of trapeziectomy with and without tendon interposition and ligament reconstruction.     

Temporomandibular joint disease

The best therapy for painful temporomandibular joint problems in most cases appears to be the least. Recommendations are made on the basis of a study of 90 patients.     

Acromioclavicular joint separations

Acromioclavicular (AC) joint separations are common injuries of the shoulder girdle, especially in the young and active population. Typically the mechanism of this injury is a direct force against the lateral aspect of the adducted shoulder, the magnitude of which affects injury severity. While low-grade injuries are frequently managed successfully using non-surgical measures, high-grade injuries frequently warrant surgical intervention to minimize pain and maximize shoulder function. Factors such as duration of injury and activity level should also be taken into account in an effort to individualize each patient’s treatment. A number of surgical techniques have been introduced to manage symptomatic, high-grade injuries. The purpose of this article is to review the important anatomy, biomechanical background, and clinical management of this entity.     

Acromioclavicular joint dislocations

Acromioclavicular (AC) dislocation is a common injury especially among sportsmen. There is still a lack of consensus on whether to conserve or operate type III AC joint dislocations. Even among surgeons inclined to operate AC joint dislocations there is no unanimity on which surgical technique. There are a plethora of choices between mechanical fixation or synthetic materials or biologic anatomic reconstructions. Even among surgeons, there is a choice between open repairs and the latest—arthroscopic reconstructions. This review of AC joint dislocations intends to analyze the available surgical options, a critical analysis of existing literature, actual technique of anatomic repair, and also accompanying complications.     

Prosthetic joint infection

Infection is the second most common cause of prosthetic joint failure. Signs and symptoms associated with prosthetic joint infection may develop weeks or even years following arthroplasty. While some patients with prosthetic joint infection present with findings consistent with acute septic arthritis, many present with pain alone. Morbidity and cost associated with repeat surgery, prolonged medical treatment and joint immobilization render importance to the accurate and timely diagnosis, and appropriate treatment of prosthetic joint infection. No consensus exists, however, in terms of the most cost–effective diagnostic methods or the ideal medical and/or surgical interventions. This review describes diagnostic tests and available treatment for prosthetic joint infection and gives a practical approach to this challenging clinical entity.     

Fluoroscopically guided therapeutic sacroiliac joint injections for sacroiliac joint syndrome

OBJECTIVE: To investigate the outcomes resulting from the use of fluoroscopically guided therapeutic sacroiliac joint injections in patients with sacroiliac joint syndrome. DESIGN: A retrospective study design with independent clinical review was utilized. Thirty-one patients were included; each patient met specific physical examination criteria and failed to improve clinically after at least 4 wk of physical therapy. Each patient demonstrated a positive response to a fluoroscopically guided diagnostic sacroiliac joint injection. Therapeutic sacroiliac joint injections were administered in conjunction with physical therapy. Outcome measures included Oswestry scores, Visual Analog Scale pain scores, work status, and medication usage. RESULTS: Patients' symptom duration before diagnostic injection averaged 20.6 mo. An average of 2.1 therapeutic injections was administered. Follow-up data collection was obtained at an average of 94.4 wk. A significant reduction (P = 0.0014) in Oswestry disability score was observed at the time of follow-up. Visual Analog Scale pain scores were reduced (P < 0.0001) at the time of discharge and at follow-up. Work status was also significantly improved at the time of discharge (P = 0.0313) and at follow-up (P = 0.0010). A trend (P = 0.0645) toward less drug usage was observed. CONCLUSIONS: These initial findings suggest that fluoroscopically guided therapeutic sacroiliac joint injections are a clinically effective intervention in the treatment of patients with sacroiliac joint syndrome. Controlled, prospective studies are necessary to further clarify the role of therapeutic injections in this patient population.