颞下颌关节渗出液与内紊乱的关系

目的探讨渗出液与颞下颌关节内紊乱(TMJID)的关系,揭示渗出液的成因。方法用磁共振成像技术,对44例单侧关节疼痛、颞下颌关节紊乱病患者88侧关节完成开闭口T1、闭口T2加权成像,观察TMJID与关节腔渗出液的发生率。结果33个关节腔存在渗出液,占37.5%,其中21个(63.6%)表现为TMJID:9个(27.3%)为可复性关节盘前移位(ADDR),12个(36.3%)为不可复性关节盘前移位(ADDWR);而55个无渗出液的关节中,15个(27.3%)表现为TMJID,其中8个(14.5%)为ADDR,7个(12.8%)为ADDWR。经统计学分析,TMJID的发生在有渗出液关节与无渗出液关节差异具有统计学意义(P<0.05);去除少量渗出液的关节后,进一步分析发现两者差异仍有统计学意义(P<0.05)。结论渗出液可能反映了盘突关系异常所致的关节内炎症反应的存在。     

颞下颌关节骨关节病的病理改变特征

人颞下颌关节(TMJ)是具有特殊的功能、结构的滑液关节,它易于罹患骨关节病(OA)。本文对患TMJOA时TMJ关节软骨、软骨下骨组织、关节滑膜、关节盘及关节滑液的各种病理改变进行了系统的描述。TMJOA与颞下颌关节紊乱综合征(TMJDS)及颞下颌关节内紊乱症(TMJID)密切相关,但其因果关系尚不明确。对TMJOA病理改变特征的更深层次的研究对于揭示TMJ关节病的发病机理,准确、有效地进行该疾病诊治均具重要意义。     

髁突髓腔信号异常与颞下颌关节内紊乱关系的研究

目的探讨裸突髓腔信号异常与颗下领关节内紊乱(In印D)的关系。方法利用核磁共振成像(MRI ),对 44例颜下领关节紊乱病(TMD)患者88侧关节完成开闭口T1、闭口位T2加权成像,判定TMD患者的盘突关系及髓腔信号变化。结果TMD患者14.8%(13/88)表现髓腔信号异常,水肿型为II个关节,硬化型及混合型各1个关节,84.6%(11/13)存在TMJID;而75个髓腔信号正常关节中,33.3%(25/75)存在TMJID;髓腔信号异常与TMAD有显著相关性(P < 0.05)。结论关节盘移位是导致髓腔信号异常的原因之一。     

髁突矢状骨折继发颞下颌关节强直31例临床分析

目的:探讨髁突矢状骨折继发创伤性颞下颌关节强直的临床特点。方法:回顾性分析2001～2010年武汉大学口腔医院口腔颌面外科收治的31例、48侧继发于髁突矢状骨折的颞下颌关节强直患者的相关临床资料。结果:31例颞下颌关节强直患者平均外伤年龄15.6岁,其中23例(74.2%)外伤年龄小于16岁。病程3月~20年,平均病程6.5年。42侧强直关节的关节盘发生移位,6侧强直关节的关节盘完全破坏。强直关节标本镜下观察:内侧髁突骨折块发生废用萎缩性改变,外侧骨球区见软骨细胞呈灶性增生成骨,关节盘纤维结构紊乱、玻璃样变性。结论:青少年髁突矢状骨折易发生颞下颌关节强直,关节盘的移位损伤是颞下颌关节强直发生的重要条件。创伤性颞下颌关节强直首先发生在关节外侧,融合骨赘的组织病理学表现为软骨化生、成骨。     

颞下颌关节紊乱症薛氏位平片,上腔造影对比研究

本文通过55例颞下颌关节紊乱症99侧关节薛氏位平片和上腔造影X线影象对比分析,对平片所显示之髁状突位置,骨结构改变与造影片中所见之关节盘、关节囊等软组织病变的相互关系进行了研究。指出:颞下颌关节紊乱症患者平片所示髁状突位置不能提示关节盘移位方式和程度。髁突状骨结构改变多伴有关节盘破坏。关节盘移位多出现关节囊前份松弛。关节囊粘连关节骨结构吸收性改变和关节盘穿孔密切相关。关节囊粘连多见于关节囊内侧份。     

颞下颌关节内紊乱与关节疼痛关系的研究

目的 :探讨TMJ疼痛与TMJID的关系。方法 :对 4 4例单侧关节疼痛TMD患者 88侧关节完成开闭口斜矢状位PDW成像 ,以非疼痛侧盘突关系做自身对照 ,评价关节疼痛与TMJID的关系。结果 :4 4个疼痛关节中 ,30个关节 (6 8.2 % )表现为TMJID ,其中ADDR为 11个关节 (2 5 % ) ,ADDWR为 19个关节 (4 3.2 % ) ;而 4 4个非疼痛关节中 6个关节 (13.6 % )表现为ADDR。经统计学分析 ,TMJ疼痛与TMJID及TMJID的类型有显著相关性 (P <0 .0 0 5 )。结论 :TMJID是颞下颌关节疼痛的原因之一     

髁突位置与颞下颌关节盘移位关系的研究

在颞下颌关节内紊乱（TMJID）的患者中髁突位置和关节盘移位之间的关系一直是研究者所关注的问题，许多学者从不同的角度进行了探索，但对TMJID患者髁突在关节窝中的位置及其临床意义存在争议。本文就TMJID概况、髁突位置与关节盘移位的关系及其在TMJID诊断中的意义作一综述。     

无牙牙合患者修复前后双侧颞下颌关节盘-髁关系的初步分析

目的:观察无颞下颌关节症状和体征的无牙颌患者修复前后双侧颞下颌关节(TMJ)盘-髁关系、关节腔积液及髁突骨质异常的变化。方法:通过8例无牙颌患者全口义齿修复前后双侧颞下颌关节的磁共振成像(MRI)检查,比较其修复前后双侧颞下颌关节MRI影像表现的差异。结果:修复前,8例无牙颌患者的16个关节中,10个关节盘移位(62.5%),包括7个关节盘内侧移位(43.8%),2个关节盘外侧移位(12.5%),1个关节盘前移位(6.25%);关节腔积液7个关节(43.8%);髁突骨质异常4个关节(25.0%)。修复后,8例无牙颌患者的16个关节中,10个关节盘移位(62.5%),包括7个关节盘内侧移位(43.8%)、2个关节盘外侧移位(其中1个关节盘外侧移位好转)和1个关节盘前移位(6.25%);关节腔积液7个关节(43.8%);髁突骨质异常4个关节(25.0%)。除1个关节的积液增加外,其余关节积液无变化。结论:长期缺牙可能引起无牙颌患者颞下颌关节的结构紊乱。无牙颌患者全口义齿修复后近期,关节盘移位、关节腔积液及髁突骨质异常无明显改变。     

青年的颞颌关节功能紊乱症

与咬(牙合)有关的颞颌关节功能紊乱的症状,主要表现为关节弹响,下颌运动受限或偏移、疼痛。 1.弹响:为卡嗒声或爆破响。卡嗒声是髁突的上面和关节盘下面产生不协调所致,也可能由翼外肌痉挛引起。爆破响多半与髁突上面的破坏和炎性改变有关。它使骨面粗     

颞下颌关节紊乱病磁共振诊断的研究

目的:研究MRI对颞下颌紊乱病诊断的准确性和可信性.方法:利用MRI对19例单侧关节疼痛颞下颌关节紊乱病(TMD)患者38侧关节完成开闭口斜矢状位T1和T2加权成像,观察盘突关系、盘形态改变及关节腔内积液情况.利用关节镜诊断为金标准判定MRI诊断的准确率.同期行灌洗术治疗,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)变化.结果:MRI检查结果显示在患侧89.47%(17/19)显示不可复性关节盘移位,10.53%(2/19)显示可复性关节盘移位,47.37%(9/19)关节上腔前隐窝出现积液.在健侧15.79%(3/19)显示可复性关节盘移位,无不可复性关节盘移位和腔内积液出现.通过关节镜手术对患侧进行检查,关节盘移位在MRI片上均得到证实,MRI检查的准确率为100%,灌洗术后疼痛100%有显著缓解(P<0.001).结论:颞下颌关节紊乱病与关节盘移位和腔内积液密切相关,通过MRI检查可以准确有效的对颞下颌紊乱病进行诊断,灌洗术对关节疼痛治疗效果显著.     

颞下颌关节弹响的临床体征与关节造影诊断的对比研究

目的：探讨依据颞下颌关节(TMJ)弹响的临床体征判断TMJ结构紊乱(TMJID)的发生与病程阶段的可靠性。方法：依据美国第三届TMJ研讨会提出的关节盘移位的特征性临床表现,对128例具有TMJ弹响或病史共140侧TMJs(116例单侧,12例双侧)TMJID的存在与病程阶段进行判断,并与TMD上腔造影及X线摄片检查形成对照。结果：临床特征符合可复性盘前移位(ADDR)与不可复性盘前移位(ADDWR)分别为79侧与61侧;上腔造影证实79侧ADDR中21侧为正常盘突关系(NA),61侧ADDWR中12侧为ADDR,临床诊断的误诊率分别为26％与19％。ADDWR组骨关节炎(OA)发病率(36％)显高于ADDR组(2％),但ADDWR组与NA组OA发病率无明显差异。结论：依据TMJ弹响的临床体征判断TMJID的存在与病程阶段易误诊,仅供临床参考。TMJID与OA密切相关,本研究认为OA是与TMJID有关的另一种疾病较为合适,而不是TMJID不可避免的最后阶段。     

Validation of the clinical diagnostic criteria for temporomandibular disorders for the diagnostic subgroup of degenerative joint disease

Research is needed to assess the validity of the Clinical Diagnostic Criteria for Temporomandibular Disorders (CDC/TMD). The purpose of this study was to test the reliability of the clinical diagnosis of temporomandibular joint (TMJ) degenerative joint disease (DJD) as compared with the magnetic resonance imaging (MRI) 'gold standard'. The TMJ DJD group comprised 48 joints in 24 consecutive patients who were assigned a clinical bilateral diagnosis of TMJ DJD. The TMJ non-DJD group consisted of 82 joints in 41 consecutive patients without a TMJ-related diagnosis of TMD. Bilateral sagittal and coronal MR images were obtained subsequently to establish the corresponding diagnosis of degenerative joint changes. An MRI diagnosis of osteoarthrosis (OA) was defined by the presence of flattening, subchondral sclerosis, surface irregularities, and erosion of the condyle or presence of condylar deformities associated with flattening, subchondral sclerosis, surface irregularities, erosion and osteophyte. For the CDC/TMD interpretations, the positive predictive of DJD for OA was 67%, and for the presence of degenerative joint changes 88%. The overall diagnostic agreement for DJD was 44.6% with a corresponding K-value of 0.01. Most of the disagreement was due to false-negative interpretations of asymptomatic joints. The results suggest CDC/TMD to be predictive for degenerative joint changes but insufficient for determination of OA. Patients assigned a clinical TMJ-related diagnosis of DJD may need to be supplemented by evidence from MRI to determine the presence or absence of OA.     

颞颌关节盘前移与颞颌关节骨关节病相互关系初探

本研究对２５例经临床检查及ＴＭＪ关节造影检查诊断为关节盘前移的患者（其中可复性１１例，不可复性１４例）进行了关节内窥镜检观察。结果发现，２５例患者均见有ＴＭＪ骨关节病（０Ａ）改变，其中以不可复性盘前移患者关节腔中ＯＡ改变较为严重。作者对关节盘前移与ＴＭＪＯＡ的相互关系进行了初步讨论。     

The relationship between bone marrow edema and bone changes in the mandibular condyle: A longitudinal study with MR imaging

PurposeDecreased signal intensity on T1- or proton-density weighted magnetic resonance imaging (MRI) and increased signal intensity on T2-weighted MRI in the bone marrow space are thought to reflect bone marrow edema (BME). The purpose of this study was to determine whether condyle BME is associated with condyle bone changes.MethodsThe subjects were 57 patients [65 temporomandibular joints (TMJs)] with TMJ disorders showing condyle BME on initial MRI. Condyle bone changes were compared between TMJs that showed a persistent BME pattern (group P, 43 TMJs in 40 patients) and those that showed normal bone marrow signals, indicating disappearance of BME (group D, 21 TMJs in 22 patients) on follow-up MRI.Results(1) In TMJs with a condyle with a normal shape on initial MRI, condyle bone changes were present in 53.9% of TMJs in group P in follow-up MRI, whereas the normally shaped condyle remained in all TMJs in group D. (2) In TMJs with condyle erosion on initial MRI, condyle erosion was also present in 35.7% of TMJs in group P in follow-up MRI, but had disappeared in all TMJs in group D. (3) In TMJs with condyle osteophytes on initial MRI, erosion was present in 22.2% of TMJs in group P, whereas osteophytes remained in all TMJs in group D.ConclusionsThe longitudinal study showed that condyle BME is associated with condyle bone changes and may cause condyle erosion.     

关节盘无移位的症状性颞下颌关节的核磁共振研究

目的：本研究的目的是应用核磁共振成像（MRI）诊断颞下颌关节紊乱病（TMD），讨论在关节盘位置正常的TMD关节中的核磁共振影像发现，并探讨这些影像发现与临床症状间的关系。方法：本研究对2000－2002年期间在芬兰欧鲁大学牙学院颌面外科就诊的78名TMD患中，经MRI发现为关节盘位置正常的68侧关节作了影像及临床症状的对比分析。结果：在此68侧关节MRI中，发现了髁突运动异常：过度运动（61.8%）及运动受限（2.9%）；发现了怀疑为翼外肌上头和／或下头的肥大、萎缩及挛缩等病理改变（58.9%）。在关节盘形态方面，未发现明显的关节盘畸形，但发现了关节盘整体变厚的病理影像表现（22.1%），还到涉及关节囊上腔、下腔和／或双板区的炎性渗出（35.3%）。髁突过度运动及翼外肌病理改变与症状组有显性关系。结论：本研究的结果提示，髁突过度运动及可能发生的翼外肌病理改变，在引起关节盘位置正常的颞下颌关节的临床TMD症状中，扮有十分重要的角色。     

MR evidence of characteristics in symptomatic osteoarthritis of the temporomandibular joint: increased signal intensity ratio on proton density-weighted images of bone marrow in the mandibular condyle

The purpose of this study was to clarify the presence of pain and a correlation between pain and characteristics of signal intensity of mandibular bone marrow in temporomandibular joints (TMJ) with osteoarthritis (OA). A total of 196 joints in 98 patients with TMJ disorders were examined using magnetic resonance imaging (MRI). A pain score and signal intensity on mandibular bone marrow were analyzed in the TMJ with OA. TMJ with OA showed a higher degree of pain compared to those without (p < 0.05). During opening, the joints in the higher signal intensity group showed a significantly higher degree of pain compared to the joints in the lower signal intensity group in those with OA on proton density weighted images (p < 0.05). It was concluded that TMJ with osteoarthritis is related to pain and that a symptomatic osteoarthritic TMJ can accompany bone marrow changes in the condyle, showing an increased signal on proton density weighted images.     

MR Evidence of Characteristics in Symptomatic Osteoarthritis of the Temporomandibular Joint: Increased Signal Intensity Ratio on Proton Density-Weighted Images of Bone Marrow in the Mandibular Condyle

Abstract

The purpose of this study was to clarify the presence of pain and a correlation between pain and characteristics of signal intensity of mandibular bone marrow in temporomandibular joints (TMJ) with osteoarthritis (OA). A total of 196 joints in 98 patients with TMJ disorders were examined using magnetic resonance imaging (MRI). A pain score and signal intensity on mandibular bone marrow were analyzed in the TMJ with OA. TMJ with OA showed a higher degree of pain compared to those without (p<0.05). During opening, the joints in the higher signal intensity group showed a significantly higher degree of pain compared to the joints in the lower signal intensity group in those with OA on proton density weighted images (p<0.05). It was concluded that TMJ with osteoarthritis is related to pain and that a symptomatic osteoarthritic TMJ can accompany bone marrow changes in the condyle, showing an increased signal on proton density weighted images.