颞下颌关节滑膜软骨瘤病的MRI表现

目的:探讨和描述颞下颌关节(TMJ)滑膜软骨瘤病的MRI表现特点。材料和方法:回顾性观察和分析13例经手术病理证实的TMJ区滑膜软骨瘤病的MRI表现。所有病例均在术前行闭口矢状面和冠状面PDWI、开口矢状面T_2WI检查。结果:所有滑膜软骨瘤病均发生于TMJ上腔。病变的MRI表现:关节上腔异常积液(13例,100%);关节囊明显扩张(11例,84.6%);关节腔内有多发软骨样小体的形成(11例,84.6%);关节囊或滑膜组织增厚(8例,61.5%)和颞骨关节面骨质破坏(4例,30.8%)。MRI未显示病变有下颌髁突侵蚀、关节囊外软组织侵犯、大脑颞叶脑膜和脑实质侵犯。结论:颞下颌关节滑膜软骨瘤病的MRI表现具有一定特点,主要表现为关节上腔异常积液,伴关节囊扩张、多发软骨样结节小体形成和滑膜组织增厚。     

MRI在颞下颌关节盘移位诊断中的应用

目的 :探讨MRI在颞下颌关节盘移位诊断中的应用价值。方法 :收集经临床确诊的52例颞下颌关节紊乱病(temporomandibular disorders,TMD)患者,观察颞下颌关节MRI斜矢状位及斜冠状位图像,分析张闭口位关节盘的位置及形态的改变。结果:52例中,关节盘前移位47例(可复性前移位20例,不可复性前移位27例),前内移位5例。结论:MRI可清晰显示颞下颌关节盘形态及盘-突位置关系改变,为临床治疗提供可靠的诊断依据。     

颞下颌关节盘移位的MRI表现及其临床诊断价值

目的:探讨颞下颌关节盘移位的MRI表现及其临床诊断价值。方法:23例共46侧关节盘行斜矢状面和冠状面T1WI、T2WI及T2*WI扫描,分析关节盘在开口位和闭口位上的位置变化和关节盘的形态等。结果:46侧关节盘中有17侧(17/46)正常;可复性关节盘前移位11侧(11/46),主要MRI表现为闭口位时关节盘在髁状突前方,关节结节前下方,开口位时,关节盘回到关节窝正常位置,关节盘可变形伸长,后带膨大,信号基本正常;不可复性关节盘前移位15侧(15/46),主要MRI表现为在闭口位和开口位时关节盘位置均位于髁突前方,关节结节前下方,不回到关节窝内,关节盘形态严重变形,出现圆形、折叠型、伸长型等,关节盘信号基本正常;关节盘内侧移位2侧(2/46),外侧移位1侧(1/46),这两种类型主要MRI表现为关节盘变形,呈低信号改变。结论:MRI可以清楚显示关节盘的位置、结构及盘突关系,对颞下颌关节盘移位有重要的临床诊断价值。     

颞下颌关节骨关节炎合并滑膜骨软骨瘤病一例

滑膜骨软骨瘤病为罕见疾病,现报道1例如下。     

颞下颌关节区滑膜软骨瘤病的CT诊断

目的探讨颞下颌关节区滑膜软骨瘤病在CT上的表现特点.资料与方法搜集9例主诉为单侧颞下颌关节区肿胀患者的CT轴位和冠状位扫描,并对其CT表现进行评价.所有病例均经关节镜或手术病理证实为滑膜软骨瘤病.结果颞下颌关节滑膜软骨瘤病的CT表现为:(1)关节区软组织肿大(n=8);(2)病变内有散在钙化小体(n=8);(3)关节间隙增宽(n=4);(4)下颌髁突骨质异常改变(n=3);(5)颞骨关节面骨质异常改变(n=6),其中CT表现为颞骨关节面骨质硬化者4例,颞骨关节面骨质吸收者3例,颞骨关节面骨质变薄者1例.1例CT检查显示滑膜软骨瘤病向上经颞骨关节面侵犯颅内(大脑颞叶脑膜).结论颞下颌关节滑膜软骨瘤病的CT表现以该区软组织肿胀伴散在的钙化小体和周围骨质受侵犯为特征.后者可以引起中颅窝底的破坏和颅内侵犯,进而影响病变的预后.     

探讨MRI对颞下颌关节紊乱病中关节盘穿孔的诊断标准

目的 探讨MRI对颞下颌关节紊乱病中关节盘穿孔的诊断价值及方法,以期提高关节盘穿孔的诊断准确率.方法 回顾性分析100例颞下颌关节紊乱病患者的临床资料和MRI图像.由两位放射科医师按照标准共同判定图像:(1)关节盘连续性中断,伴有或不伴有关节腔上下关节腔相通;(2)关节盘形态尚可,但关节盘信号增高、模糊;(3)关节盘扭...     

人颞下颌关节关节盘、软骨及下颌骨的纳米弹性性能

为探讨人颞下颌关节（TMJ）各结构及下颌骨骨组织在纳米量级的材料力学性能的分布特点，采用原子力显微镜及毫微压痕测量法，对3位正常成的男性6个TMJ的关节盘、髁突软骨、关节窝软骨和下颌骨皮质骨、松质骨不同部位的纳米弹性模量进行测量和分析。结果显示：人TMJ内关节盘、髁突软骨和关节窝软骨的不同部位具有不同的弹性模量，而各结构的弹性模量以前、内侧较高，中、后部及外侧较小。下颌骨皮质骨的弹性模量是松质骨的2倍多，而下颌骨颊侧骨组织的弹性模量则明显低于舌侧。提示在纳米范围测量，TMJ内各结构以及下颌骨骨组织为非均质性材料，其不同结构或同一结构不同区域在纳米量级所承受的局部力学载荷不同。     

正常青年人颞下颌关节盘位置的MRI斜冠状位研究

目的 分析正常青年人颞下颌关节张、闭口斜冠状位MR图像关节盘与髁突的位置关系.方法 对29例(58个颞下颌关节)正常青年人行MRI张、闭口斜冠状位PDWI扫描,选取闭口位通过髁突前斜面中心、张口位通过关节盘中带中心层面测量关节盘与髁突的位置.结果 58个关节中除去9个可复性关节盘前移位关节及1例有运动伪影影响的2个关节,47个关节斜冠状位观察结果如下:(1)闭口位有30个(63.83%)、张口位有45个(95.74%)关节盘内缘超出髁突内缘,关节盘内缘与髁突内缘间距于张口位大于闭口位(P =0.00);张、闭口位各有3个(6.38%)关节盘外缘超出髁突外缘,关节盘外缘与髁突外缘间距无统计学差异(P =0.70).(2)关节盘内外缘间距于张口位大于闭口位(P =0.00);髁突内外缘间距张闭口位比较无统计学差异(P=0.06).结论 正常青年人存在颞下颌关节盘内缘超出髁突内缘的现象,应避免误诊关节盘内侧移位.     

颞下颌关节的磁共振成像检查

颞下颌关节疾病是临床常见病,介绍了颞下颌关节的解剖及常用磁共振成像检查方法,主要对颞下颌关节的正常及常见病变的磁共振表现及一些新的成像方法进行了综述,并与其他常用检查方法进行了比较.     

颞下颌关节滑膜软骨瘤病的影像诊断

目的：探讨颞下颌关节滑膜软骨瘤病的X线、C T、M RI征象,提高对本病的认识。方法回顾性分析经手术病理证实的8例颞下颌关节滑膜软骨瘤病的X线、CT、MRI表现,8例患者均行普通X线和CT平扫检查,6例同时行MRI平扫检查,2例加做M RI增强扫描。结果8例均单侧发病,右侧6例、左侧2例。X线示颞下颌关节间隙增宽,关节周围多发结节状钙化影。C T平扫示关节周围软组织密度肿块伴多发钙化游离体。MRI平扫示关节腔内多发结节状长 T1、短T2信号,滑膜增厚并呈等 T1、等及稍长T 2信号,关节腔内积液。M RI增强示滑膜组织明显均匀强化,游离体呈边缘强化。结论颞下颌关节滑膜软骨瘤病有典型的影像学表现,总结其X线、C T、M RI表现可以为临床诊断及治疗提供一定帮助。     

Clinical application of scaffolds for cartilage tissue engineering

The purpose of this paper is to review the basic science and clinical literature on scaffolds clinically available for the treatment of articular cartilage injuries. The use of tissue-engineered grafts based on scaffolds seems to be as effective as conventional ACI clinically. However, there is limited evidence that scaffold techniques result in homogeneous distribution of cells. Similarly, few studies exist on the maintenance of the chondrocyte phenotype in scaffolds. Both of which would be potential advantages over the first generation ACI. The mean clinical score in all of the clinical literature on scaffold techniques significantly improved compared with preoperative values. More than 80% of patients had an excellent or good outcome. None of the short- or mid-term clinical and histological results of these tissue-engineering techniques with scaffolds were reported to be better than conventional ACI. However, some studies suggest that these methods may reduce surgical time, morbidity, and risks of periosteal hypertrophy and post-operative adhesions. Based on the available literature, we were not able to rank the scaffolds available for clinical use. Firm recommendations on which cartilage repair procedure is to be preferred is currently not known on the basis of these studies. Randomized clinical trials and longer follow-up periods are needed for more widespread information regarding the clinical effectiveness of scaffold-based, tissue-engineered cartilage repair.     

持续性高正加速度下颞下颌关节软骨基质成分与相关炎性因子的mRNA变化

目的建立不同持续性高正加速度(+Gz)环境下的动物模型,研究颞颌关节紊乱病(temporomandibular joint di sorder,TMD)软骨关节基质成分Ⅱ型胶原、多糖聚糖体、胶原酶,以及IGF-1、TGF-β1、TNF-α、IL-2与IL-3的变化情况。方法分离并体外培养正常与+Gz下的颞下颌软骨细胞,提取总m RNA,荧光定量PCR检测。结果Ⅱ型胶原、多糖聚糖体、胶原酶,以及IGF-1、TGF-β1明显减少,TNF-α、IL-2与IL-3显著增高。结论在+Gz下,颞下颌关节软骨基质成分受到严重影响,修复能力下降,炎性反应增加。     

下颌髁突脱位骨折后颞下颌关节软组织改变的MRI表现

目的 分析下颌髁突脱位骨折后颞下颌关节(TMJ)软组织改变的MRI表现.方法 应用矢状面和冠状面质子密度加权成像(PDWI)和T2WI连续检查103侧(77例)患有下颌髁突脱位骨折的颞下颌关节(TMJ).结果 MRI上,103侧髁突脱位骨折后的TMJ异常表现有:(1)髁突骨折断片向前下(102侧,99.0%)和前(1侧,10%)脱位;(2)关节盘移位(100侧,97.1%),其中矢状面MRI显示关节盘随脱位的髁突向前下移位者99侧,向前移位者1侧;(3)关节腔积液(103侧,100%);(4)关节盘后区信号异常(91侧,88.3%);(5)关节盘下后附着异常(89侧,86.4%);(6)关节囊异常(89侧,86.4%);(7)关节盘上后附着异常(37侧,35.9%);(8)关节盘变形(8侧,7.8%);(9)关节盘撕裂(8侧,7.8%);(10)颞骨关节窝骨折(4侧,3.9%).结论矢状面MRI上,多数下颌髁突脱位骨折以TMJ关节盘随脱位的髁突向前下移位,并伴有关节腔积液为特点.     

Unilateral medial dislocation of the temporomandibular joint

We present our experience of the rare condition of unilateral medial dislocation of the temporomandibular joint (TMJ) in 11 patients with head trauma who had received a direct lateral blow on the chin. The diagnosis was made by direct coronal CT of the TMJ performed from 6h to 7 days following the injury. In 6 patients, subcondylar fracture of the ipsilateral mandibular ramus was also demonstrated. A second CT performed 11–16 months following the first one demonstrated pseudoarthrosis of the fractured ramus in these 6 patients. The second CT was identical to the first in the remaining 5 patients with pure dislocation of the condyle. All patients suffered from severe disability of the TMJ. The maximal vertical distance between the upper and lower incisors in patients with uncomplicated dislocation ranged between 8 and 12 mm. In cases with complicated medial condylar dislocation with fracture and pseudoarthrosis of the mandibular ramus, this distance ranged between 16 and 25 mm, probably because of additional movement in the area of the pseudoarthrosis. The maximal vertical distance between the incisors was compared with a control group of 20 normal adults who had values from 40 to 52 mm. Medial unilateral dislocation of the TMJ can appear in two forms: uncomplicated or complicated, with pseudoarthrosis of the ipsilateral mandibular ramus. Received: 8 July 1996 Accepted: 22 July 1996     

颞颌关节磁共振成像技术探讨

目的通过选择合理的扫描层面、脉冲序列及参数诊断颞颌关节紊乱综合征。方法对１１例病人行双侧ＭＲＩ检查，斜矢位自旋回波（ＳＥ）Ｔ１ＷＩ，９例用５１２×２５６矩阵，２例单侧用２５６×２５６矩阵，矢状位的快速多相位梯度回波（ｍｕｌｔｉｐｈａｓｅＦＳＰＧＲ），９例用３０°翻转角，２例分别用１０°、３０°及５０°翻转角。结果ＳＥ序列中，用５１２×２５６矩阵能清晰显示颞颌关节半月板的纤维软骨结构，ｍｕｌｔｉｐｈａｓｅＦＳＰＧＲ序列的翻转角选择３０°图像对比度信噪比最佳。结论ＭＲＩ确为诊断颞颌关节紊乱综合征的无创伤性检查方法，对口腔科矫形病人手术前后对照有一定帮助。     

Pathologic-sonographic correlation in temporomandibular joint pathology

The accuracy of high-resolution ultrasonography (HR-US) in detecting disk displacement and condylar erosion of the temporomandibular joint (TMJ) was evaluated, using corresponding cryosections as a “gold standard”. HR-US of the TMJ was performed with a high frequency 12 MHz transducer on 30 preserved autopsy specimens. Succeeding sonography, the autopsy specimens were deep-frozen and cut in paracoronal planes corresponding to the sonographic images. HR-US diagnoses were compared with cryosectional findings in a blinded fashion. HR-US detected 19 (95%) of 20 instances of condylar erosion and 16 (73%) of 22 instances of disk displacement. There were one false-positive finding for condylar erosion and two false-positive findings for disk displacement. The accuracy of HR-US evaluating condylar erosion and disk displacement rated 93% and 73%, respectively. In conclusion, condylar erosion was reliably assessed by HR-US, but the evaluation of disk position was less accurate.     

采用温敏性壳聚糖水凝胶体外构建组织工程化软骨的实验研究

目的 验证自行制备的温敏性壳聚糖水凝胶作为软骨细胞支架材料构建组织工程化软骨的可行性.方法 以壳聚糖、β-甘油磷酸钠和羟乙基纤维素为原料,制备温敏性壳聚糖水凝胶,通过SD大鼠肌内注射植入,进行组织相容性检测.在此基础上,将其与软骨细胞复合构建组织工程化软骨,观察软骨细胞在壳聚糖水凝胶中的存活情况,并于体外培养3周后,作相关组织形态学检测.结果 制备的壳聚糖水凝胶具有温度敏感性,即室温时为液态,37℃时10～15min可发生交联反应成为固态凝胶.SD大鼠肌内注射不同时间点组织相容性检测表明,该材料具有良好的组织相容性,植入体内2、4周时有少量炎性细胞浸润,6周时材料降解明显,8周时已经基本降解.采用该材料构建的组织工程化软骨体外培养3周后取材,通过组织学检查,HE染色可观察到软骨陷窝样结构,甲苯胺蓝染色、番红O染色及免疫组化染色结果显示软骨细胞具有分泌细胞外基质的功能.结论 本研究自行制备的温敏性壳聚糖水凝胶材料具有良好的组织相容性,将其与软骨细胞复合后,可以在体外再造组织工程化软骨,是一种有广泛应用前景的软骨组织工程支架材料.     

Loose bodies of the temporomandibular joint: Arthrographic diagnosis

We report a series of four patients presenting with symptoms of temporomandibular joint pain and dysfunction, and manifesting calcified loose bodies within the temporomandibular joint. Tomographic and arthrotomographic findings are described. Surgical confirmation was obtained in two patients and the histopathology in one demonstrated that the loose body was calcified cartilage surrounded by synovial tissue. The synovial tissue of the joint space was normal in all four cases by arthrotomography and at surgery in two patients. The findings suggest that these cases may be examples of osteochondrosis dissecans.     

Real-time assessment of temporomandibular joint using HASTE sequences: feasibility and comparison with standard static sequences

Objective:To test real-time MRI (rtMRI) using HASTE sequences in patients with suspected internal disk derangement (IDD) of temporomandibular joint (TMJ) and to compare these sequences with standard static sequences.Methods and materials:99 TMJ were studied with both standard sequences (fat-saturated proton density) and HASTE sequences with high temporal resolution. Image quality was assessed using a 4-point Likert scale. Two radiologists analysed both standard and rtMRI sequences separately, randomly and blinded (by a third operator) to patients’ names in order to assess inter-observer repeatability. One of the radiologists performed the analysis twice for assessing intra-observer repeatability. The same radiologists evaluated randomly and blinded to the previous assessment both the sequences and decided in consensus which was the most credible. Qualitative scores were compared using Friedman’s test while concordance between radiologists and sequences was evaluated using the concordance correlation coefficient.Results:At image quality analysis, mean score was 3.41 for static MRI and 3.82 for rtMRI, with a statistically significant difference in favour of rtMRI (p < 0.0001). Inter-rater concordance between operator 1 (Op1) and operator 2 (Op2) with regard to the same sequence was high for both static and rtMRI sequences (0.824 and 0.888, respectively). Inter-rater variability of Op1 and Op2 between static and rtMRI sequences was lower (0.647 for Op1 and 0.633 for Op2). Among 71 discordances between sequences, 60 were judged in favour of rtMRI, while 11 were in favour of static MRI.Conclusion:rtMRI with HASTE sequences is a robust technique and provide additional information in assessing IDD compared to static sequences.     

羊间接性颞下颌关节损伤后髁突软骨中基质金属蛋白酶-3表达及其意义

目的 探讨基质金属蛋白酶-3(matrix metalloproteinase-3，MMP-3)在羊颞下颌关节((temporomandibular joint，TMJ))间接创伤后骨关节病发生中的作用。方法 用自制撞击装置造成山羊双侧颞下颌关节间接性创伤，分别于伤后1周、1，3，6个月取TMJ髁突软骨，并以正常TMJ作为对照，用免疫荧光组织化学方法观察MMP-3的表达。结果 TMJ髁突软骨中MMP-3伤后1个月表达开始增强，后期进一步增强；荧光着色于软骨破坏区及增生的滑膜样组织、软骨肥大带及骨髓内较强，正常对照组基本呈阴性反应。结论 MMP-3参与了TMJ创伤所致TMJ骨关节病过程，并起了重要作用。