老年人穿孔的颞下颌关节盘解剖特点

目的：探讨老年人穿孔的颞颌关节盘特点和规律。方法：113具老年尸体标本266侧颞下颌关节，福尔马林液固定1年，常规解剖取出关节盘观察，取全部穿孔的关节盘，记录穿孔的部位、大小。结果：①样本平均年龄女性高于男性，穿孔者与非穿孔者无明显差别；②30例40侧颞下颌关节有关节盘穿孔；③矢状方向上关节盘中1／3及双板区的穿孔分别为25／69（36．2％）和24／69（34．8％），冠状方向上关节盘中1／3和外1／3的穿孔依次为33／69（47．8％）和30／69（43．5％）；④大于关节盘本体部表面积1／9的穿孔占80％。结论：老年人关节盘穿孔主要发生在关节盘中带的外、中份及双板区的外、中份。     

翼外肌对可复性颞下颌关节盘前移位的作用机制

目的 分析可复性关节盘移位中翼外肌作用下颞下颌关节的应力分布情况。方法 利用已建立的可复性关节盘前移位颞下颌关节数字化仿真模型,在单纯翼外肌加载下进行生物力学分析。结果 关节盘应力集中于关节盘中间带偏外侧区域;髁突及关节窝应力主要集中于与关节盘相接触的功能面。在颞下颌关节盘的位移分布中,从关节盘前带至关节盘中间带,位移趋势逐渐增大,关节盘中间带与关节盘后带之间出现位移撕裂带,从关节盘中间带至关节盘双板区位移逐渐递减;而颞下颌关节整体位移最大值出现在关节囊前份的翼外肌上头附着区。结论 在可复性关节盘前移位中翼外肌可导致关节盘中间带偏外侧区域的应力集中,可能导致此区域关节盘变薄、穿孔甚至撕裂。     

牙齿磨耗后颞下颌关节应力分布的三维有限元研究

目的：计算机模拟牙齿不同程度磨耗、颌垂直距离减小时，三维有限元分析颞下颌关节内的应力分布变化。方法：应用以往研究所建正常颞下颌关节三维有限元模型，分别将下牙列分层删除从上至下1／3、1／2及全部的单元，并改变咀嚼肌加力方向。应用ANSYS6．1分析颞下颌关节内的应力变化。结果：随着磨耗程度的加重，髁状突表面的应力增加较多。关节盘等效应力增加的速度较髁状突、关节窝要大；关节盘的后带后缘，还有关节盘中带、后带的中间、外侧区有应力集中表现；磨耗越重，变形越大，关节盘越薄。颞骨关节窝不但应力值增加，最大应力的位置也由关节结节后斜面向顶部移动。结论：牙齿磨耗可造成颞下颌关节应力的明显增加及特定的应力集中区。     

人颞下颌关节盘不同矢状层面前后向拉伸力学特性的比较研究

目的:探讨人颞下颌关节盘内、中、外不同部位拉伸力学特性的差异。材料和方法:Instron1122型拉伸实验机,自制夹头;人颞下颌关节盘3个,取外、外中、内中、内四个部位分别作拉伸实验,两部摄象机不同方向同步拍摄拉伸过程,计算机图象分析、计算各部弹性模量(E)和宽度泊松比(μ宽度)及厚度泊松比(μ厚度)。结果:关节盘的E为1.45±0.46兆帕～ 2.69±1.87兆帕,其中关节盘内中份者较小(1.45±0.46兆帕);μ宽度为0.31±0.13～0.44±0.04,μ厚度为0.18±0.0～ 40.44±0.05,关节盘内侧份和内中份的μ厚度均较小。结论:关节盘内、外侧份拉伸力学特性有明显差异,可能与其相应的功能需要有关。     

改良Twin-block治疗颞下颌关节盘可复性前移位

目的 探讨改良Twin-block治疗颞下颌关节盘可复性前移位前后关节盘形态和位置的变化.方法 将2015年7月~2016年6月就诊于深圳市第二人民医院口腔科,经临床及MRI检查诊断为单侧或双侧颞下颌关节盘可复性前移位,并接受改良Twin-block矫治器进行治疗者19例,共28侧关节纳入研究,治疗前后均拍摄MRI,测量治疗前后关节盘前后径、盘髁距离、盘髁角度并进行配对t检验,对治疗前后的关节盘形态进行Wilcoxon符号秩和检验,P<0.01为差异具有统计学意义.结果 19例患者28侧关节盘均存在可复性前移位,经过改良Twin-block治疗后,24侧关节盘位置恢复正常,4侧关节盘在闭口时仍处于前移位状态.治疗后关节盘前后径增加,盘髁距离、盘髁角度减小,差异均具有统计学意义(P<0.01).关节盘形态治疗前以V形最多(16侧),其次为双面平滑形(9侧);治疗后以双凹形(16侧)和双面平滑形(10侧)为主;治疗后关节盘形变程度减小,且差异有统计学意义(P<0.01).4侧关节盘复位失败者,治疗前盘髁距离及盘髁角度相对较大,关节盘形变相对较重.结论 改良Twin-block是治疗颞下颌关节盘可复性前移位的一种有效手段,可以使发生移位的关节盘前后径及位置恢复,使关节盘形变减小.但对于关节盘移位及形变程度较重者,其治疗效果可能不理想,还需进一步扩大样本量进行分层研究,并延长随访时间.     

颞下颌关节盘及其附着的组织学观察

目的 :探讨关节盘及其附着的形态特点和生理病理意义。方法 :12具尸头的 2 3侧颞下颌关节 ,每关节四等分切片 ,共 92张 ,HE染色。结果 :①颞后附着和下颌前附着较疏松 ,下颌后附着和颞前附着较致密 ,其中的纤维以前后走行为主。②关节盘中带纤维以前后走行为主 ,前、后带纤维呈多向走行。③关节盘后区有 (6/ 12例、11/ 2 3 )侧 3 3 / 92张切片显示具有第四带结构 ,其特征是盘后区由类似于关节盘内的长而致密的胶原纤维结构构成 ;3 6/ 92张 (6/ 12例 10 / 2 3侧 )张具有转纤维 ,其特点为纤维从较厚的盘后带上端突然转向后下行 ,形成明显转折角。结论 :关节盘及其附着的纤维走行特征可有不同的表现 ,可能是其功能需要的形态学反映     

下颌前伸时颞下颌关节应力分布的三维有限元研究

目的探讨下颌前伸运动时颞下颌关节内的应力分布情况。方法利用可视化人体图像建立包括上下牙列、下颌骨、颞下颌关节在内的三维有限元模型,在Patran中采用位移加载的方法模拟下颌前伸运动至对刃位,在Marc中计算并分析接触情况和应力分布特性。结果关节盘随髁突向前、下运动,髁突的前斜面首先与关节盘中间带中央部发生接触,随后髁突的外斜面与关节盘的中间带外侧部、关节窝的顶部与关节盘的后带发生接触。关节盘的中间带外侧部(3.10 Mpa)和髁突的前斜面(5.05 Mpa)等部位的应力值较大。结论在前伸运动时,应力集中区位于关节盘的中间带外侧部和髁突的前斜面。     

Ⅲ类固定磁力功能矫治器对颞下颌关节影响的MRI研究

【摘要】目的：研究Ⅲ类固定磁力功能矫治器矫治后颞下颌关节的改建情况。方法：选择15例矫治前经X线头影测量分析,诊断为功能性和骨性Ⅲ类错畸形的患者为研究对象,采用Ⅲ类固定磁力功能矫治器进行治疗,在治疗前后使用MRI评估颞下颌关节的变化。结果：治疗后：1.关节前间隙增大,后间隙减小,关节间隙指数减小,髁突在关节窝内的位置发生向后移位;2.盘髁角、前带盘髁角增大,关节盘在生理范围内前移位,关节盘前带位置的变化与后带位置的变化一致;3.髁突头角增大,髁突前屈;4.节窝后斜面角和关节窝角,差异不显著。结论：固定磁力功能矫治器治疗后生长期Ⅲ类错畸形患者的TMJ发生了适应性改变,固定磁力功能矫治器矫治后髁突向后移位,关节盘前移位,双板区厚度减小,髁突头前屈。     

下颌前伸后大鼠颞下颌关节盘的组织学和组织化学研究

应用组织学和组织化学的方法，对幼年ＳＤ雄性大鼠功能矫形前伸下颌后颞下颌关节盘的变化进行研究。结果显示；功能矫形前伸下颌后，关节盘胶原纤维束排列致密，前后向排列明显，纤维束粗大，关节盘后分软骨细胞增多，糖胺多糖及强硫酸化氨基己糖含量增加；未发现关节盘有病理性改变。提示关节盘随的翼外肌张胃衣髁突压     

颞下颌关节侧向咬合位与对刃位薄层塑化断面对照研究

目的:对比分析下颌对刃位、侧向咬合位颞下颌关节的运动解剖形态,为颞下颌关节病变提供解剖依据。方法:将8例新鲜尸头摆置成对刃位5例、下颌侧向咬合位3例,以颞下颌关节为中心,切割成8cm×8cm×10cm的标本块,利用生物塑化技术,制成斜矢状位、斜冠状位、轴位塑化断层标本共16套。下颌侧向咬合位工作侧、非工作侧关节形态改变与对刃位相对照。结果:下颌侧向咬合位工作侧,髁突在关节窝内向后、向上、向外移位,关节盘位置无变化,关节盘双板及后带受压;非工作侧,髁突向下、向前、向内侧移位,关节盘后带位置向下移位,无前移位,关节盘中带外侧位居上下关节面之间,明显受压变薄。结论:关节盘并非随髁突作同步同向运动。关节盘在髁突作滑动运动时发生移位;当转动运动、滑动运动复合出现时,关节盘发生移位;而在关节窝内发生的转动运动,关节盘不发生移位。     

颞颌关系X线影像特征及其解剖学测量结果相关性分析

目的：探讨颞颌关关节X线影像特征与解剖结构的相关关系。方法：对18具具有稳定咬合关系的36侧颞颌关节颅骨标本分别拍摄TMJ的内,中外1／3的正矢状位片和正后前位片,采用电子测量尺分别测量其显示的髁突内外径,前后径及关节前,上,后间隙值,用游标卡尺测量颅骨标本的髁突内外径和内,中外,1／3的前后径;用印模料取得牙尖交错位时关节间隙厚度,测量内,中,外1／3的层面的前,中,后1／3处印模厚度（关节间隙值）,将X线测量值与解剖测量值进行相关性分析。结果：颞颌关节髁突内外径,中,外1／3的前后径及中,外1／3上间隙值均有显著相关（P＜0．01）,而其它值则无明显相关（P＞0．05）。结论 ：颞颌关节后前位和中1／3正矢状位X线片有实际诊断意义。     

正常颞下颌关节应力分布的三维有限元研究

目的:探讨正常人牙尖交错位紧咬牙时颞下颌关节内的应力分布情况,了解生理状况下TMJ生物力学特点。方法:应用ANSYS 6.1对以往研究所建正常颞下颌关节三维有限元模型进行分析。加载情况接近正常生理。由ANSYS 6.1进行求解。在后处理器中研究分析应力分布与形变。结果:正常人牙尖交错位紧咬牙时颞下颌关节内拉压应力并存,存在剪切应力,分布较均匀,无特别明显应力集中表现。髁突前斜面等效应力值高于后斜面,而前斜面外侧区的应力值又明显高于内侧、中间区。关节盘腹面平均应力值大于背面,且背面应力分布较腹面均匀。腹面应力分布,外侧区最高,最大应力值0.244位于后带与双板区交界处;后带与中间带差别不大,但都明显大于前带。关节盘的变形量明显大于髁突及颞骨关节窝。颞骨关节窝前部即关节结节后斜面等效应力较大。结论:正常牙尖交错位紧咬牙时颞下颌关节内的应力分布,与髁突、关节盘、颞骨关节窝的解剖生理之间,具有良好的功能适应性。     

Histopathological study of human TMJ perforated discs with emphasis on synovial membrane response

Fifteen perforated TMJ discs from human cadavers were studied histologically to examine the synovial membranes and to compare the findings with previous experimental results in monkeys. There were four with perforations in the bilaminar zone (these four discs were displaced anteriorly), three in the medial third of the disc, and eight in the lateral third of the disc. Histopathologically, there was an increase in vascularity and strong methyl pyronine-positive cellularity around the margins of the perforations. A young, loose, collagenous tissue lined the lateral margins of the perforated discs. Increased fibrous tissue content of the synovial subintimal territorial matrix and osteochondroid metaplasia were also seen. Severe synovial hyperplasia was visible in all joint recesses, but was greatest within those associated with displaced discs. There was patchy distribution of acidic glycoproteins, especially in the lateral parts of the perforated discs. As in the animal studies, human TMJ disc perforation was associated with a vigorous synovial reaction that was seen to form lateral bridges along the margins.     

Discal attachments of the human temporomandibular joint

BACKGROUND: Despite its clinical significance, the anatomy of the human temporomandibular joint (TMJ) and its relationship to the lateral pterygoid muscle remains poorly described and often misrepresented in standard texts. The aim of this study was to describe how the anterior and posterior attachments of the TMJ disc vary between lateral, central and medial regions of the joint. METHODS: Ten left TMJs were removed en bloc from cadavers and serial sections were made at 3-4mm intervals. Observations were made to ascertain the anterior and posterior attachments of the disc and the joint structures were traced from standardized photographs. RESULTS: Laterally, the capsule and lateral discal ligament merged prior to their attachment at the condylar pole. Medially, muscle fibres, capsule and the disc converged on the medial pole of the condyle. There was no evidence that fibres of the upper head of the lateral pterygoid muscle inserted directly into the disc. The upper head inserted into the condyle either directly at the pterygoid fovea or via a central tendon or indirectly via the capsule. Posteriorly, the superior part of the posterior attachment of the disc attached to the cartilaginous meatus and tympanic part of the temporal bone. The inferior part of the posterior attachment of the disc attached to the posterior surface of the condyle. In four joints, this attachment was folded beneath the posterior band of the disc, creating a wedge-shaped flap that ran medio-laterally. CONCLUSION: This study is in broad agreement with other anatomical TMJ studies but there are two main points of difference. Firstly, a true muscle insertion of the superior head of the lateral pterygoid muscle to the disc was not observed. Secondly, a wedge-shaped flap of retrodiscal tissue was identified between the condyle and the disc.     

Insertions of the lateral pterygoid muscle: an anatomic study of the human temporomandibular joint

The objective of this investigation was to evaluate the anatomic relationships of the lateral pterygoid muscle with the disc-condyle complex using an acrylic embedding technique to obtain anatomic serial cuts of a solid block containing the temporomandibular joint (TMJ) and the neighboring structures. The fibers of the upper and lower heads were found to be fused in front of the TMJ and to constitute medially a strong muscular wall. The lateral third of the anterior band of the disc was free of any muscle insertions and related anteriorly with loose connective tissue; the middle third showed fibers that run under the anterior band of the disc and attached in the upper part of the condylar fovea. Only the medial portion demonstrated both fibers running into the disc and fibers inserting into the bone. The fibers inserted into the bone run under those attached into the disc and terminated below the medial pole of the condyle binding the disc tightly over the medial pole. This study demonstrates that the main insertions of the superior head are not into the disc but into the condyle. Considering the anatomic organization of the upper head, the explanation of anterior displacement of the disc due to a spastic activity of this muscle alone is not probable. Hypotonicity, not hyperactivity, of the upper head may contribute to an anterior and medial disc displacement.     

Magnetic resonance imaging evaluation of temporomandibular joint disc deformities in relation to type of disc displacement.

PURPOSE: This study was undertaken to assess the relationship between the temporomandibular joint (TMJ) disc deformity and the type of internal derangement. PATIENTS AND METHODS: One hundred thirty-three TMJs of 72 patients (53 female and 19 male) with intracapsular dysfunction were studied using clinical and magnetic resonance imaging examinations. RESULTS: Of the 133 TMJ discs, 41.35% had no deformity, whereas 18% of the discs were folded, 19.55% were lengthened, 9.77% were round, 7.51% were biconvex, and 3.75% had thick posterior bands. The frequency of disc deformity was greater with anterior disc displacement without reduction than in cases of anterior disc displacement with reduction (P <.001). Folded and round discs were most common in cases with TMJ anterior disc displacement without reduction (P <.0001). An increase in length was seen in 56.75% of the cases with anterior disc displacement with reduction, whereas 100% of nonreducing discs were mainly folded or rounded. Crepitation was correlated with folded and round disc deformities, whereas lengthening was the feature of reducing discs associated with early and intermediate clicking. CONCLUSIONS: The results show that the degenerative changes in the TMJ disc are influenced by the degree and the type of disc displacement. The more advanced the internal derangement, the more deteriorated the disc configuration.     

The elastic modulus of the temporomandibular joint disc from adult dogs.

The present study was designed to measure the elastic properties of temporomandibular joint (TMJ) discs from six adult dogs. Each disc was divided mediolaterally into medial, middle, and lateral parts. Under tension, the articular disc exhibited a non-linear stress-strain relationship, which could be represented as two lines (two moduli of elasticity) connected at a point of stress around 1.5 MPa. These two elastic moduli of the disc were approximately 44 MPa and 92 MPa in the lower- and higher-stress regions, respectively. Elastic moduli of the articular disc in the middle area were significantly different from that in the lateral area of the disc. The reaction to external force appeared to be different in the medial, middle, and lateral regions of the disc.     

暂时性绞锁颞下颌关节的运动特征研究

目的：本研究观察分析了暂时性绞锁颞下颌关节髁状突的运动轨迹特征。方法：对9名可复性盘前移位伴暂时性绞锁患以MT－1602下颌三维运动轨迹描记仪记录髁状突的运动数据,动态观察锁结和非锁结时的髁状突运动扫描轨迹。结果：发现锁结和非锁结时髁状突循两条不同路径滑动。结论：前移位关节盘后带在不同位置对髁状突阻力不一样,神经肌肉的功能状态在前移位关节盘的发展中不可忽视。     

Stress distribution in the temporomandibular joint affected by anterior disc displacement: a three-dimensional analytic approach with the finite-element method

The purpose of this study was to investigate the influences of anterior disc displacement on TMJ loading during maximum clenching by use of finite-element analysis. Based on a young human dry skull, an analytic model of the mandible including the TMJ was developed. In addition to the standard model with normal disc-condyle relation, two models were designed to simulate various degrees of anterior disc displacement. In the standard model, compressive stresses were induced in the anterior, middle and lateral areas on the condyle and glenoid fossa, whereas tensile stresses were observed in the posterior and medial regions. In the models with anterior disc displacement, compressive stresses were recognized in all the areas of TMJ components excluding the bilaminar zone. Shear stresses in the articular disc and bilaminar zone significantly increased in most areas. In conclusion, stress distributions in the TMJ with a normal disc position was substantially different from those with anterior disc displacement, suggesting that the progress in disc displacement may have some association with the nature of stress distributions in the TMJ, in the articular disc in particular.