颞下颌关节盘前移位的研究进展

颞下颌关节盘前移位在关节结构紊乱中较常见。因为关节盘前移位后，颞下颌关节内结构发生明显改变，各种炎性因子增多，并可见退行性变化，从而产生或不产生临床症状。因此，颞下颌关节盘前移位的研究越来越被人们所关注。     

颞下颌关节盘和髁突组织工程研究现状

采用组织工程修复颞下颌关节缺损是一种新的治疗方法,但是颞下颌关节组织工程研究还处于起步阶段,并且集中在关节盘或髁突组织再生修复上。目前的研究主要包括这两种组织结构相关的种子细胞、支架和生长因子。本文分别对颞下颌关节盘和髁突组织工程研究现状做一论述。     

无症状人群颞下颌关节盘位置的核磁共振研究

目的 观察无症状志愿者颞下颌关节盘的位置,了解无症状人群中是否存在关节盘位置的异常,及其性别、左右侧分布特点.方法 无颞下颌关节病症状及病史的志愿者30名,共60例关节,其中男、女各15名,对其双侧颞下颌关节行开闭口轴位、斜矢状位和斜冠状位扫描,根据扫描结果对关节盘位置进行分类.结果 30名无症状志愿者中,正位关节盘45例,发生率为75%,其中女性20例,男性25例,右侧23例,左侧22例;前移位关节盘7例,发生率为11.67%,其中女性5例,男性2例,右侧5例,左侧2例;外侧移位关节盘6例,发生率为10%,其中女性3例,男性3例,右侧2例,左侧4例;内侧移位关节盘2例,发生率为3.33%,其中女性0例,男性2例,右侧0例,左侧2例;后移位关节盘0例,发生率为0.不同性别比较,差异无统计学意义(P>0.05),左右侧关节比较,差异无统计学意义(P>0.05).结论 无症状志愿者关节盘多为正位,但无症状人群的关节盘移位确实存在,且以前外侧旋转移位最为常见,关节盘移位类型与性别无关,左右侧分布无差异.     

颞下颌关节盘前移位的研究进展

颞下颌关节盘前移位在关节结构紊乱中较常见。因为关节盘前移位后,颞下颌关节内结构发生明显改变,各种炎性因子增多,并可见退行性变化,从而产生或不产生临床症状。因此,颞下颌关节盘前移位的研究越来越被人们所关注。     

髁突骨折伴关节盘移位的治疗

目的 探讨髁突骨折伴关节盘移位的临床特点及手术复位缝合的技巧。方法 32例关节盘移位均于髁突骨折手术复位过程中发现和证实，将其正确复位并缝合固定于关节囊。结果 25例术后未经任何颌间固定和牵引复位，7例术后1～2周颌间牵引复位；咬合关系除1例因髁突粉碎性骨折、下颌支高度降低使咬合向患侧偏斜外，其余均恢复良好；术后3个月复查开口度正常，无关节弹响及疼痛。结论 关节盘移位主要并发于髁突高位骨折，以前内向移位多见；手术正确恢复关节盘位置对颞下颌关节功能预后有重要意义。     

颞下颌关节盘移位患者髁突运动轨迹分析

目的:记录颞下颌关节盘移位患者和正常人下颌运动时髁突运动轨迹,分析关节盘移位对髁突运动的影响.方法:选取双侧不可复性关节盘移位(DDwoR)和可复性关节盘移位(DDwR)患者各18例,健康对照(HC)10例.电子髁突运动轨迹描记仪记录受试者下颌开闭口、前伸后退时髁突铰链轴运动轨迹,计算髁突最大位移(Smax)、髁突位移...     

颞下颌关节盘前移位病因研究进展

颞下颌关节盘前移位(temporomandibular joint anterior disc displacement, TMJ ADD)是临床上常见的一种颞下颌关节紊乱病(temporomandibular disorder, TMD),主要表现为疼痛、关节弹响和下颌运动受限,严重者影响日常生活。但其病因复杂,至今尚无统一结论,对其发病机制也缺乏明确而全面的认识。本文将对ADD的病因以及发病机制作一综述。     

颞下颌关节紊乱综合征患者的髁突位置及对称性

目的:探讨伴有颞下颌关节紊乱综合征(temporomandibular disorders,TMD)的错(牙合)畸形患者的髁突位置及对称性.方法:在就诊的错(牙合)畸形患者中,选取有TMD症状的15例患者纳入实验组,并选取15例无症状患者作为对照组.分别对实验组和对照组行双侧颞下颌关节CT扫描,选取适当的断层并测量其关节间隙及对称性.采用SPSS17.0软件包对数据进行统计学处理.结果:实验组患者的髁突位置明显偏后位,而对照组患者的髁突位置稍前位.实验组患者患侧髁突水平倾斜角较健侧大(P＜0.05),而垂直倾斜角较健侧小(P＜0.05),两侧髁突内外径、前后径、髁突长轴、髁突中心至正中矢状面距离、两侧髁突前后距均无显著差异.结论:颞下颌关节紊乱综合征患者的髁突位置明显偏后位,且两侧髁突存在垂直向不对称.     

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。     

Temporomandibular Joint Arthrocentesis for Internal Derangement with Disc Displacement Without Reduction

Temporomandibular joint (TMJ) disc derangement is defined as a malpositioning of the articular disc relative to the condyle and eminence. Arthrocentesis of the TMJ is a minimally invasive chair side procedure for the patients with TMJ internal derangement. This case report presents convincing results to keep arthrocentesis as an imperative procedure to relieve such patients of their acute symptoms. TMJ dynamics has also been discussed for an in-depth understanding of the pathology in cases with internal derangement.     

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     

颞下颌关节盘前移后双板区改建的实验研究

目的:探讨关节盘前移后双板区的适应性改建。方法:日本大白兔30只,先制作成关节盘前移位动物模型,定期处死,取关节标本作HE染色、阿尔辛蓝、间苯二酚-品红染色、细胞凋亡检查和蛋白多糖含量测量。结果:在关节盘移位的初期,双板区即发生细胞凋亡,胶原纤维和弹力纤维排列紊乱、断裂;蛋白多糖先是急剧下降,然后缓慢上升。4周后,双板区内可出现软骨样细胞或典型的软骨组织。结论:双板区在关节盘移位后会进行重构,使之成为类似纤维软骨样组织。     

颞下颌关节盘前移位后关节的适应性改建

颞下颌关节盘前移位是最常见的关节紊乱病,它的发病机制仍然不清楚,近年来,许多研究表明关节盘移位后,关节会发生适应性改建。充分了解这一变化,对于临床上治疗颞下颌关节盘前移位患者时,判断其是否需要进行手术复位,具有重要的指导意义。本文就关节盘移位后关节盘、髁突软骨的适应性改建,及目前研究的局限和展望作一综述。     

兔关节盘、髁突及软骨下骨的年龄相关性改变组织学研究

目的:探究不同年龄段兔颞下颌关节(TMJ)关节盘、髁突和软骨下骨的生理特征的变化。方法 :选取1、4、12和32周龄健康雌性新西兰大白兔各3只,取材TMJ,经脱钙处理后进行5μm连续切片,苏木精-伊红染色。分别对关节盘大小、髁突前后径,以及关节盘所对应软骨下骨的形态结构和骨密度进行测量分析。采用SPSS19.0软件包对数据进行统计学分析。结果:关节盘大小比较,4周组明显大于1周组(P=0.039),12周组明显大于4周组(P=0.007);髁突前后径在4周和12周组间(P=0.003)显著增加;软骨下骨的形态结构和骨密度在4~32周内(P<0.05)显著改变。结论:兔颞下颌关节关节盘和髁突在青春期前生长发育明显;髁突软骨下骨的形态结构和骨密度在4周时开始出现明显改变。虽然青少年期和成年期兔髁突大小没有统计学差异,但是两者软骨下骨的骨质密度差异明显。     

Temporomandibular joint internal derangement: detection with 12.5 MHz ultrasonography

The purpose of this study was to determine whether 12.5 MHz ultrasonography (US) could be used to assess the presence or absence of temporomandibular joint (TMJ) internal derangement (ID). In 48 consecutive patients with TMJ disorders 192 TMJ positions were investigated by US to analyse the functional disc-condyle relationship (DCR). In order to compare the respective findings with those of a diagnostic method offering a high accuracy, coronal and sagittal magnetic resonance imaging was carried out immediately afterwards. With US showing a sensitivity of 0.58 and 0.75, and a specificity of 0.92 and 0.84 for disc displacement with and without reduction, the data revealed US to be marginal in detecting the presence, but sensitive in detecting the absence of the respective types of a TMJ ID. In addition, with a positive predictive value of 0.83 and 0.71, and a negative predictive value of 0.81 and 0.87 for disc displacement with and without reduction, the results indicate that US may be insufficient in establishing a correct diagnosis for the presence or absence of the respective types of TMJ ID. Regarding the diagnosis of absence or presence of TMJ ID, the results demonstrate high-resolution (HR)-US to be sensitive in detecting the absence, and reliable in predicting the presence of TMJ ID. In view of the fact that the 12.5 MHz US technique proved to be a reliable diagnostic aid for the detection of normal, and the prediction of abnormal DCR, the results of this study should be of further interest and encourage research in its potential uses and diagnostic capabilities.     

人体颞下颌关节关节盘及关节软骨渗透性的研究

目的 测量人体颞下颌关节（TMJ）关节盘及关节软骨的渗透性,为口腔生物力学和口腔组织工程提供基本参数,并从生物力学角度探讨其抗力及分散载荷的机制。方法 4具新鲜人尸体TMJ标本按照关节盘、髁突及关节窝取材共制成不同直径（2 mm,3 mm,4 mm）试件128个,使用与试件直径相同的压缩头,以围限压缩方法测量TMJ渗透性。结果 关节各区中关节盘渗透性最大,关节窝渗透性最小。小直径试件比大直径试件渗透性低,随着试件直径的增加,关节盘、髁突和关节窝的渗透性均增加。结论 在正常生理范围内,关节软组织可以通过降低渗透性保护关节组织;关节盘由于具有较大渗透性,是TMJ的薄弱易损区域,关节盘破坏是TMJ损伤的始动因素。     

Histopathological changes in rabbit craniomandibular joint associated with experimentally induced anterior disk displacement (ADD)

Several studies have shown that anterior disk displacement (ADD) of human temporomandibular joint (TMJ) can lead to cellular and extracellular alterations in the disk proper, bilaminar zone (BZ), condyle, articular eminence and synovial membrane. Due to lack of an animal model for this disease, it is not known whether the mechanical displacement of the disk could lead to the observed histopathological changes. The purpose of this experiment was to investigate the histopathological changes that occur in the rabbit craniomandibular joint (CMJ) following surgical induction of ADD. The right CMJ was exposed surgically and the discal attachments were severed except for the BZ attachments. Then the disk was displaced anteriorly and sutured to the zygomatic arch. The left joint served as surgical control. The CMJs were removed after 24 h, 1 week, 2 weeks or 6 weeks and stained with H&E or modified Masson stain. The results showed neovascularization, cell clustering and fibrillation of the displaced disk. The BZ showed marked fibrosis. The condyle showed subchondral hemorrhage and fibrosis followed by osteoarthritic changes in the articular cartilage. The articular eminence showed chondrocytic clustering and an increase in the amount of chon-droid bone. Synovial membrane exhibited marked hyperplasia. We concluded that surgical induction of ADD in the rabbit CMJ leads to cellular and extracellular alterations in the disk proper, BZ, condyle, articular eminence and synovial membrane similar to those described previously in human ADD. It appears that the mechanical trauma resulting from ADD could lead to a cascade of reparative and degenerative changes of the affected joints similar to those described for osteoarthritis.