颞下颌关节的断层影像解剖学研究

目的：为颞下颌关节疾病的诊疗提供解剖学基础。方法：选用成人尸体头颈部标本15例，分别制成冠状、矢状、横断层标本。在经颞下颌关节层面上，观察颞下颌关节及其周围结构的解剖学关系，用游标卡尺测量关节盘的厚度。结果：冠状、矢状和横断层解剖可分别显示颞下颌关节的位置、毗邻关系及结构特点，冠状解剖可确定关节盘的位置，矢状解剖有利于关节脱位的诊断。关节盘最厚处4．02mm，最薄处1．32mm。结论：颞下颌关节的断层影像解剖对颞下颌关节疾病的影像诊断和内窥镜治疗具有重要的指导作用。     

不同牙 合 位时翼外肌对颞下颌关节盘的生物力学影响

目的　研究在牙尖交错位和最大张口位时可复性关节盘前移位中翼外肌对关节盘的生物力学影响及两牙合 位之间的差异。 方法　对已经建立的可复性关节盘前移位的颞下颌关节数字化仿真模型,在不同牙合 位时进行翼外肌加载,通过三维有限元的方法进行生物力学分析。 结果　最大张口位时,关节盘应力集中区较牙尖交错位时向前外侧移动,集中于关节盘中间带偏外侧区;关节盘中间带与关节盘后带之间存在明显位移差,形成位移撕裂带,而在牙尖交错位时则无类似位移差现象。 结论　在可复性关节盘前移位中,最大张口位时翼外肌可导致关节盘中间带偏外侧区的应力集中,在关节盘中间带形成位移撕裂带,导致此区域变薄、穿孔甚至撕裂。     

应力水平对猪颞下颌关节盘生物力学特性的影响

研究颞下颌关节盘对压缩载荷的反应性 ,了解关节盘的粘弹性和渗透性质 ,为分析关节盘的应力缓冲机制提供实验依据。采用围限压缩力学实验方法 ,对三种不同应力水平 (0 .0 7、0 .12、0 .30MPa)下 8个猪颞颌关节盘的蠕变效应进行研究。结果表明 :在 0 .0 7MPa应力水平 ,关节盘前、中、后带承受压缩载荷 2s时的压缩刚度分别为 4.48、3.93、6 .31MPa,盘后带压缩刚度最大 ;渗透系数K值分别为 0 .2 72× 10 12 、0 .30× 10 12 、0 .0 42× 10 12 m4 /NS ,后带值明显低于前带。在 0 .30MPa水平 ,前、中、后带刚度分别增至为 14.0 7、16 .6 8、14.0 0MPa,渗透系数分别减小为0 .0 17× 10 12 、0 .0 12× 10 12 、0 .0 0 5× 10 12 m4 /NS ,各带之间无明显差异。颞颌关节盘是具有粘弹性的生物二相体 ,有一定抗压强度和较低的渗透性 ,应力水平增加 ,整体压缩刚度增大而渗透系数减小。提示对压缩刚度和渗透性的调节可能是关节盘组织内部承受并缓冲应力的两种方式。     

狗颞颌关节盘的流变特性研究

本文把狗的颞颌关节盘分成前、中、后三个区域作单向拉伸、应力松弛及循环加载实验,得出了在不同区域,试件在不同阶跃应变作用下的瞬时弹性响应及平衡模量,应用拟线性粘弹性理论分析实验结果,得出该关节盘软骨不同区域的弹性响应及归一化松弛函数,从而得到它在不同区域一维拉伸时的本构方程。实验表明,理论分析与实验结果吻合较好。     

颞下颌关节的断面解剖学

头颈断层标本15例，其中冠状、矢状各6例。横断3例。在经颞下颌关节(TMJ)层面上，结合CT图像对照观察TMJ的位置、毗邻及关节结构，并测量关节盘的厚度。     

颞下颌关节的观测

本文在２０９具成年标本上对颞下颌关节的下颌窝、下颌头、关节盘及关节囊进行了观测;对颞下颌关节的运动及弹响机制进行了讨论。     

关节盘移位对颞下颌关节内应力分布的影响

目的 通过对不同关节盘移位的数值模拟,探究各种移位情况下颞下颌关节（temporomandibular joint,TMJ）内各结构的应力分布规律。方法 依据CT图像,建立包含下颌骨、全牙列、关节盘和关节软骨的正常TMJ三维有限元模型;参考关节盘前、后、外、内移位的临床特征,建立对应的4个模型。关节盘与关节软骨间考虑接触,用缆索元模拟下颌韧带和关节盘附着,施加正中咬合荷载。结果 前移位将导致关节盘中带产生过高的压应力,达到3.23 MPa;后、内、外移位时关节盘的整体应力水平比前移位和正常TMJ高;各种移位都使关节结节后斜面的应力值大幅度增加,但对髁突关节面的影响却不大。结论 各种移位都将导致关节盘和关节结节后斜面产生过高的应力,且后、内、外移位更为危险,更容易造成关节结构和功能的损伤。     

工程化颞下颌关节盘组织的细胞源问题:现状与展望

目的是为学者探索适当的颞下颌关节盘组织工程种子细胞提供参考。目前颞下颌关节盘组织工程正处于起步阶段,而细胞来源是制约关节盘组织工程发展的主要因素之一,本文概述了关节盘细胞、软骨细胞、皮肤成纤维细胞、骨髓基质干细胞、脂肪干细胞和胚胎干细胞等6种细胞作为关节盘组织工程细胞源的可行性,以便寻找一种合适的细胞源。     

颞下颌负荷与颞下颌关节病

颞下颌关节负荷与其正常生理功能和某些疾病的形成关系密切。本文就负荷与颞下颌关节改建、生长发育、致病机制及临床治疗方法之间的相互作用进行了比较全面的论述，旨在深入认识颞下颌关节负荷临床意义。     

Functional anatomy of the temporomandibular joint

Summary A study of 72 temporomandibular joints of adults without any gross signs of degenerative changes was made, in order to analyse the stress on individual regions of the joint, and to determine the path of the split line pattern in the articular cartilage. The cancellous architecture and the material distribution in the juxta-articular bone were also investigated. Zones of high-density compact substance in the lateral region of the joint, and the presence of attractive singular points in the split line orientation in this localization, suggest great stress on the lateral part of the temporomandibular joint. This increased stress in the lateral region is confirmed by the fact that arthrotic changes in the temporomandibular joint first almost always appear laterally. Degenerative changes usually originate at the articular disc, affect the articular tubercle after a delay, and finally spread to the condyle. Besides the greater physiological, mechanical stress on the lateral region of the joint, the force acting on every individual temporomandibular joint is influenced by the dental condition. The molars and bicuspids serving as a support zone play a decisive role in this context.Dedicated to Professor Dr. H. Haug on the occasion of his 70th birthday     

The temporomandibular joint in video motion--noninvasive image techniques to present the functional anatomy.

The presentation of the functional anatomy of the temporomandibular joint (TMJ) is involved with difficulties if dynamic aspects are to be of prime interest, and it should be demonstrated with the highest resolution. Usually noninvasive techniques like MRI and sonography are available for presenting functionality of the temporomandibular joint in video motion. Such images reflect the functional anatomy much better than single pictures of figures could do. In combination with computer aided records of the condyle movements the video motion of MR and sonographical images represent tools for better understanding the relationships between functional or dysfunctional patterns and the morphological or dysmorphological shape and structure of the temporomandibular joint. The possibilities of such tools will be explained and discussed in detail relating, in addition, to loading effects caused by transmitted occlusal pressure onto the joint compartments. If pressure occurs the condyle slides mainly more or less retrocranially whereas the articular disc takes up a more displaced position and a deformed shape. In a few extreme cases the disc prolapses out of the joint space. These video pictures offer new aspects for the diagnosis of the disc-condyle stability and can also be used for explicit educational programs on the complex dysfunction-dysmorphology-relationship of temporomandibular diseases.     

颞下颌关节镜穿刺与有关神经血管的位置关系

目的：为颞下颌关节内窥镜在临床上使用提供解剖学基础。方法：在３０侧成人头颈部标本上解剖观察了颞下颌关节内窥镜穿刺进路的三种常用方法的穿刺通道与面神经和颞浅血管的位置关系。结果：前外侧穿刺径路距面神经颧支最近，为１．５±１．４ｍｍ，下外侧穿刺径路距面神经颞支及颞浅血管最近，分别为８．６±３．３ｍｍ和２．４±１．４ｍｍ。结论：只要避免粗暴操作，三种常用穿刺法的穿刺径路损伤面神经、颞浅血管的危险性是很小的。     

距下关节韧带的解剖学和生物力学特性研究进展

距下关节是保持足部稳定的枢轴，承受并传导人体体重，转换下肢的旋转应力，协同和辅助踝关节运动，支配跗中关节和前足活动，因此它是后足的力学中心。功能上主要发挥稳定作用，活动度小，属微动关节。距下关节的关节囊菲薄，主要依靠韧带的力量来维持关节稳定，韧带损伤常导致距下关节不稳定，影响足部的功能。因此研究距下关节韧带的解剖和生物力学特性，具有重要临床意义。现将近年来距下关节相关韧带的研究进展综述如下。     

Skeletal pattern in subjects with temporomandibular joint disorders

Introduction

To establish the skeletal pattern in subjects with malocclusions and temporomandibular disorders (TMD); to assess the relationship between craniofacial skeletal structures and TMD in subjects with malocclusions.

Material and methods

Sixty-four subjects with malocclusions, over 18 years of age, were included in the study. Temporomandibular disorders were clinically assessed according to the Helkimo Anamnestic Index. Subjects underwent a lateral cephalogram. Subjects were grouped according to the sagittal skeletal pattern (ANB angle) into class I, II and III. Parametric Student tests with equal or unequal variations were used (variations were previously tested with Levene test).

Results

Twenty-four patients with TMD (experimental sample); 40 patients without TMD (control group); interincisal angle was higher in class I and II (p < 0.05) experimental subjects; overjet was larger in experimental subjects; midline shift and Wits appraisal were broader in the experimental group in all three classes. In class III subjects, the SNB angle was higher in the experimental group (p = 0.01). Joint noises followed by reduced mandible mobility, muscular pain and temporomandibular joint (TMJ) pain were the most frequent symptoms in subjects with TMD and malocclusions.

Conclusions

Temporomandibular joint status is an important factor to consider when planning orthodontic treatment in patients with severe malocclusions; midline shift, large overjet and deep overbite have been associated with signs and symptoms of TMD.     

In vivo prediction of temporomandibular joint disc thickness and position changes for different jaw positions

Temporomandibular joint disorders (TMD) are common dysfunctions of the masticatory region and are often linked to dislocation or changes of the temporomandibular joint (TMJ) disc. Magnetic resonance imaging (MRI) is the gold standard for TMJ imaging but standard clinical sequences do not deliver a sufficient resolution and contrast for the creation of detailed meshes of the TMJ disc. Additionally, bony structures cannot be captured appropriately using standard MRI sequences due to their low signal intensity. The objective of this study was to enable researchers to create high resolution representations of all structures of the TMJ and consequently investigate morphological as well as positional changes of the masticatory system. To create meshes of the bony structures, a single computed tomography (CT) scan was acquired. In addition, a high‐resolution MRI sequence was produced, which is used to collect the thickness and position change of the disc for various static postures using bite blocks. Changes in thickness of the TMJ disc as well as disc translation were measured. The newly developed workflow successfully allows researchers to create high resolution models of all structures of the TMJ for various static positions, enabling the investigation of TMJ disc translation and deformation. Discs were thinnest in the lateral part and moved mainly anteriorly and slightly medially. The procedure offers the most comprehensive picture of disc positioning and thickness changes reported to date. The presented data can be used for the development of a biomechanical computer model of TMJ anatomy and to investigate dynamic and static loads on the components of the system, which could be useful for the prediction of TMD onset.     

与关节置换有关的股骨近端髓腔解剖学研究进展

阐述与髋关节置换有关的股骨近端髓腔的解剖学研究的现状和进展。通过对中国人近端股骨髓腔解剖学参数的测量和研究,发现中国人股骨近端髓腔形态与西方人存在差异,并且股骨近端的各截面髓腔横径大小、峡部的高度及股骨前弓的弧度半径,中国人均小于西方人种,因此容易导致假体松动甚至髋关节脱位,并且股骨的髓腔开放指数及峡部的位置个体间的差异也较大。因此提出可以根据中国人解剖学特点,设计个体化的假体,使其与股骨近端髓腔匹配良好,延长假体使用寿命,减少术后并发症。     

Cytopathologic diagnosis on joint lavage fluid for patients with temporomandibular joint disorders

Temporomandibular joint (TMJ) disorders (TMD) are usually diagnosed based on the patient's clinical findings and the results of image investigations; however, understanding of the inflammatory process in TMJ is difficult. In addition, many of the TMJ disease types share common principal symptoms. Therefore, TMJ diseases in the early stage can be misdiagnosed with TMD. It is hypothesized that cytopathologic examination of the joint lavage fluids is useful in interpreting the TMD‐associated inflammatory process from a cellular aspect. The aim of this study was to assess the TMJ lavage fluid cytopathologically in TMD patients. Thirty‐nine patients, clinically diagnosed as TMD, were included in the present study. Clinical symptoms of the patients were recorded. Forty‐four samples of TMJ lavage fluid were collected and paraffin‐embedded cell sections were made by cell block tissue array method. Cytologic conditions in upper articular cavity of TMJ were cytopathologically diagnosed and were compared with the clinical symptoms of each patient. Cell components were detected in 22 of the 44 analyzed joint lavage fluids. There was a correlation between cytopathologic findings and clinical symptoms. Variety of cytopathology and inflammatory conditions in patients with similar clinical symptoms were also found. The results suggested that cytopathologic examination of the joint lavage fluids from TMD patients is helpful for gaining an understanding of the inner local conditions of TMJ at the cellular level. Diagn. Cytopathol. 2014;42:30–36. © 2013 Wiley Periodicals, Inc.