颞下颌关节紊乱病疼痛的分子机制

颞下颌关节紊乱病是一种多因素疾病,在临床上以疼痛为主要症状。关于颞下颌关节紊乱病的疼痛机制迄今仍未完全明了,因而其治疗也没有取得突破性进展。近年来,颞下颌关节紊乱病疼痛的分子机制已成为国内外研究的热点,本文就此作一综述。     

Correlation between bony changes measured with cone beam computed tomography and clinical dysfunction index in patients with temporomandibular joint osteoarthritis

ObjectivesTo investigate the correlation between clinical dysfunction index (Di) and condylar bony changes, glenoid fossa bony changes and joint space changes.MethodsClinical data and cone beam computed tomography (CBCT) images of 240 patients with temporomandibular joint osteoarthritis (TMJ OA) were analyzed. The patients were assigned a score of Helkimo's clinical Di ranging from 1 to 25 and thereafter divided into 3 groups by the degree of Helkimo's Di. The condylar bony changes observed with CBCT were graded by the classification method of Koyama et al. Glenoid fossa bony changes and joint space changes were both classified as “positive” or “negative”. Spearman's rank correlation test was used to correlate the score or degree of Helkimo's Di with the maximum condylar bony changes, glenoid fossa bony changes, and joint space changes.ResultsThere was a significant correlation between the Helkimo's Di score and the maximum condylar bony changes (P ≤ 0.0001) and glenoid fossa bony changes (P ≤ 0.0001), and there was a poor correlation between the Helkimo's Di score and joint space changes (P = 0.184). Furthermore, there was a significant correlation between the degree of Helkimo's Di and the maximum condylar bony changes (P ≤ 0.0001) and glenoid fossa bony changes (P ≤ 0.0001), but there was a poor correlation between the degree of Helkimo's Di and joint space changes (P = 0.346).ConclusionsBoth the score and degree of Helkimo's Di were highly correlated with maximum condylar changes and glenoid fossa bony changes, but not with joint space changes.     

应用锥形束CT诊断颞下颌关节骨关节病的探讨

目的探讨锥形束CT（cone beam CT，CBCT）在颞下颌关节骨关节病诊断中的应用前景。方法临床诊断为颞下颌关节骨关节病（炎）、不可复（可复）性盘前移位伴骨关节病患者共48例（96侧关节）。48例同时拍摄经咽侧位x线平片和CBCT，比较两种x线检查方法的病变检出率、医师判断的重复性和一致性。结果颞下颌关节骨关节病x线表现分为6型：髁突表面皮质骨模糊消失型（I型）、表面缺损破坏型（Ⅱ型）、髁突磨平型（Ⅲ型）、骨质硬化型（IV型）、骨质增生型（V型）、囊样变型（Ⅵ型）。CBCT的检出率分别为65．63％、37．50％、27．08％、31．25％、28．13％、1．04％；经咽侧位x线平片的检出率分别为52．08％、19．79％、32．29％、23．96％、12．50％、2．08％。对每一型病变的程度和范围，同一医师两次判断或不同医师之间，对I、Ⅱ型病变的评判，经咽侧位x线平片和CBCT均有高度的一致性，Kappa值大于0．60。结论除Ⅲ型外，CBCT对每一类型的病变均有很高的检出率，所显示的病变及其部位清晰、明确。CBCT清晰的病变影像、明确的病变部位和显示多层面病变的优势，使其有望成为颞下颌关节骨关节病判定病变程度、预后以及药物治疗后效果的定量评价手段。     

颞下颌关节紊乱病患者口腔不良习惯与髁突骨质改变相关性的影像学研究

目的研究颞下颌关节病患者口腔不良习惯与颞下颌关节髁突骨质改变之间的关系。方法选取诊断为颞下颌关节紊乱病的患者106例,问卷调查患者的口腔不良习惯,并行双侧颞下颌关节锥形束CT成像,分析患者口腔不良习惯与颞下颌关节髁突骨质影像学改变的相关性。结果 106例患者中,口腔不良习惯以偏侧咀嚼、紧咬牙、夜磨牙和喜食硬物较常见。经统计学分析,喜食硬物是出现髁突骨皮质模糊消失型改变的危险因素(P=0.019,OR=2.570)。喜食硬物是髁突前外侧(P=0.025,OR=2.298)、髁突后外侧(P=0.023,OR=2.692)及关节结节(P=0.020,OR=3.067)易出现骨质改变的危险因素。偏侧咀嚼习惯则是关节窝前内侧(P=0.013,OR=0.311)易出现骨质改变的危险因素。结论口腔的不良习惯与颞下颌关节骨质改变的类型及部位有一定相关性。     

Can modifying shielding,field of view,and exposure settings make the effective dose of a cone-beam computed tomography comparable to traditional radiographs used for orthodontic diagnosis?

ObjectivesTo analyze the effect of changes in exposure settings, field of view (FOV), and shielding on radiation to an adult and child phantom from cone-beam computed tomography (CBCT) imaging compared to panoramic and lateral cephalometric radiographs.Materials and MethodsThe effective dose to an adult and child anthropomorphic phantom by the CS 9300 using various scan protocols was recorded. Absorbed radiation was measured with optically stimulated luminescence dosimeters and effective dose calculated using 2007 International Commission on Radiological Protection tissue weighting factors. Scan protocols included different FOVs, voxel sizes, and standard versus low-dose protocols. Radiation shielding was used when it did not interfere with FOV. Panoramic and lateral cephalometric radiographs were taken with the Orthophos SL.ResultsEven with shielding, smaller FOVs, and increased voxel sizes, the effective dose of standard CBCT scans was higher than panoramic and lateral cephalometric radiographs. A shielded limited FOV standard scan combined with a lateral cephalometric radiograph resulted in a lower dose (P < .001) than a full FOV standard scan. Low-dose shielded scans resulted in significant dose reductions to the adult (P < .05) and child (P < .001) phantoms compared to the respective panoramic and lateral cephalometric radiographs combined. Image quality analysis was not possible with radiation equivalent phantoms.ConclusionsUnlike standard CBCTs, shielded low-dose CBCT protocols in the CS 9300 have lower effective doses than conventional radiographs for adult and child phantoms. If high resolution and cranial base visualization are necessary, combining a shielded LFOV standard exposure with a cephalometric radiograph is recommended.