中老年颞下颌关节紊乱病关节镜手术治疗

颞下颌关节紊乱病(temporomandibular disorders,TMD)是口腔科的常见病及多发病.部分病例病程迁延,经久不愈,严重影响口颌系统的功能.近年来,颞下颌关节镜手术治疗TMD已被普遍接受,作为介于保守治疗与开放性手术治疗之间的治疗方法,创伤小,并发症少,患者易于接受,在一定程度上可作为部分开放性手术的替代治疗手段.     

颞下颌关节紊乱病关节上腔灌洗术的压力研究

目的:观察关节灌洗术对不可复性盘前移位颞下颌关节内压力的影响,从生物力学角度初步探讨关节灌洗术的作用机理及不同操作手法对关节的影响。方法:颞下颌关节紊乱病患者8例10侧,在关节灌洗术时将8号针头插入关节上腔,进行颞下颌关节内压的测定。操作手法分两种:操作一、进水口进行间歇性加压的重复动作。操作二、封闭出水口,进水口加压达到患者所能忍受最大值并保持5秒钟后松开出水通道,使关节内液体间歇喷出。重复3次并记录关节内压变化曲线,计算平均值。结果:关节灌洗术手术操作一,平均加压27.575±5.657kPa,停止操作时为15.555±8.158kPa,灌洗压力落差平均12.020±4.342kPa;手术操作二,平均加压可达42.903±5.508kPa,停止时22.512±3.929kPa,压力落差为20.391±3.310kPa。结论:关节灌洗术可以通过不同操作手法,在颞下颌关节中形成不同的压力落差,从而达到治疗颞下颌关节紊乱病的目的。     

关节冲洗术治疗颞下颌关节紊乱病的临床研究

目的　观察和评价关节冲洗术治疗颞下颌关节紊乱病 (TMD)的临床效果。方法　对 86例出现急性疼痛、开口受限的TMD患者采用关节冲洗疗法进行治疗 ,比较治疗前后患者张口度和疼痛程度的变化 ,并对两种冲洗方法的效果进行了比较。结果　关节冲洗对恢复张口度和缓解疼痛有显著的疗效 ,两种冲洗方法的疗效无显著差异。结论　关节冲洗对出现关节绞锁症状的TMD患者是一种简便、微创、有效的治疗方法。     

三种方法治疗颞下颌关节紊乱病的疗效比较

目的　比较关节灌洗、关节镜和关节开放手术 3种方法治疗颞下颌关节紊乱病的临床效果。方法　应用 3种方法治疗颞下颌关节紊乱病 :关节灌洗术治疗 35例 (42侧关节 ) ,关节镜术治疗 4 2例 (5 0侧关节 ) ,关节开放手术治疗 2 8例 (2 9侧关节 ) ,并对 3种方法的疗效进行比较。结果　关节灌洗组随访 2 4～ 5 2个月 ,术后张口度平均增加 (8.1± 3.9)mm ,健侧侧向运动增加 (3.8± 1.4 )mm ,85 .7%患者疼痛缓解 ,72 .2 %杂音消失 ,总有效率为 82 .9%。关节镜组随访 2 4～ 5 6个月 ,张口度平均增加 (7.5± 3.8)mm ,健侧侧向运动增加 (4.1± 1.8)mm ,88.1%患者疼痛缓解 ,79.2 %杂音消失 ,总有效率为 85 .7%。关节开放手术组 ,随访 2 4～ 5 5个月 ,术后张口度平均增加 (8.0± 5 .1)mm ,健侧侧向运动增加 (3.7± 2 .3)mm ,92 .9%患者疼痛缓解 ,总有效率为 89 3%。 3组比较 ,张口度、侧向运动改善及疼痛缓解率均无显著差异。结论　关节灌洗术、关节镜术和关节开放手术治疗颞下颌关节紊乱病均有效 ,但关节灌洗术方法简单、损伤小 ,易于推广应用。首先应选择手术创伤小的治疗方法 ,最后才选择开放手术。     

颞下颌关节紊乱病磁共振诊断的研究

目的:研究MRI对颞下颌紊乱病诊断的准确性和可信性.方法:利用MRI对19例单侧关节疼痛颞下颌关节紊乱病(TMD)患者38侧关节完成开闭口斜矢状位T1和T2加权成像,观察盘突关系、盘形态改变及关节腔内积液情况.利用关节镜诊断为金标准判定MRI诊断的准确率.同期行灌洗术治疗,分析治疗前后不同时期患者的疼痛值(疼痛直观模拟标尺VAS)变化.结果:MRI检查结果显示在患侧89.47%(17/19)显示不可复性关节盘移位,10.53%(2/19)显示可复性关节盘移位,47.37%(9/19)关节上腔前隐窝出现积液.在健侧15.79%(3/19)显示可复性关节盘移位,无不可复性关节盘移位和腔内积液出现.通过关节镜手术对患侧进行检查,关节盘移位在MRI片上均得到证实,MRI检查的准确率为100%,灌洗术后疼痛100%有显著缓解(P<0.001).结论:颞下颌关节紊乱病与关节盘移位和腔内积液密切相关,通过MRI检查可以准确有效的对颞下颌紊乱病进行诊断,灌洗术对关节疼痛治疗效果显著.     

颞下颌关节紊乱病的治疗

关于因素是否颢下颌关节紊乱病(TMD)病因之一,以及TMD的治疗,现存在着各种争议.本文回顾了有关研究及观点.目前,无论是动物实验研究,还是临床实验研究,都不足以作出因素是TMD病因之一的结论.但是, 治疗在TMD临床治疗中占有重要地位,且发挥重要作用:调能有效地缓解慢性头痛,颈痛及肩部痛; 治疗对减轻TMD患者的肌肉疼痛也显示理想效果;调位咬合板能消除一部分关节弹响.进一步探索TMD的因素,正确掌握TMD 治疗的适应证及客观科学地评价治疗的临床效果是我们今后研究的课题.     

老年人颞下颌关节紊乱病的临床研究

目的 :研究老年人颞下颌关节紊乱病 (TMD)的临床表现、诊断和治疗的特点。方法 :对56例60岁以上的TMD患者进行治疗观察 ,对临床资料进行总结分析。结果 :老年人TMD占同期TMD患者总数的 9.9%。男女之比为 1∶1.7。经采用综合措施治疗 ,结果显效39.3%、有效53.6%、无效7.1%。结论 :老年人TMD器质变化型明显增多 ,牙齿缺失与磨损是老年人TMD的重要病因 ,治疗应采取综合措施 ,咬合板、封闭和义齿修复是主要的治疗方法。     

颞下颌关节上腔灌洗术应用研究现状

颞下颌关节紊乱病的治疗一直存在争议,对于治疗颞下颌关节紊乱病,颞下颌关节上腔灌洗术是一种介于手术治疗和非手术治疗之间的临床一线治疗方法,可松解关节腔内细小粘连,改善关节内环境,恢复正常的关节内压,减少关节液。自被提出以来,在临床上逐渐得到广泛应用,主要用于治疗闭口绞锁、关节盘不可复性前移位、关节炎等颞下颌相关疾病。目前各报道中具体操作方法不尽相同,本文主要对灌洗术的提出及应用研究现状作一综述。     

颞下颌关节上腔灌洗及药物注射治疗关节内紊乱的疗效评价

目的　评价上腔灌洗及药物注射对颞下颌关节内紊乱的疗效。方法　对 84例 (98侧 )不同分期的颞下颌关节内紊乱患者进行关节上腔灌洗 ,同时行药物注射治疗。结果　总有效率为 83.6 7% (81/ 98) ,有效率与临床分期有关。结论　上腔灌洗加药物注射对治疗颞下颌关节内紊乱是有效的 ,越早治疗效果越好。     

颞下颌关节紊乱病诊断标准的研究进展

颞下颌关节紊乱病(temporomandibular disorders,TMDs)是临床常见病但是病因复杂,相应的颞下颌关节紊乱病的诊断标准也在不停演变.本文围绕由RDC/TMD到DC/TMD的改进,DC/TMD的临床应用实施进行综述,并对未来可能的发展进行展望.     

The agreement between magnetic resonance imaging and arthroscopic findings in temporomandibular joint disorders

The aim of this retrospective observational study was to assess the potential agreement between independent magnetic resonance imaging (MRI) and arthroscopic findings and their respective contributions to a final diagnosis in patients with refractory temporomandibular joint disorders. Two dentomaxillofacial radiologists and two oral and maxillofacial surgeons scored 50 joints. All observers, who were blinded to additional clinical information, used a specific scoring form and selected one or more diagnostic labels. Agreement between MRI and arthroscopy and their contributions to the final diagnosis were assessed as primary outcomes using Fleiss’ kappa. Intra-modality agreement and the correlation between signal intensity ratio (SIR) measurements on MRI and synovitis grading on arthroscopy were assessed as secondary outcomes. Agreement between MRI and arthroscopy was poor. A fair level of agreement was only reached for reduction capacity of the disc and disc perforation. Arthroscopic diagnostic labels matched better with the final diagnosis, suggesting a bigger contribution to that diagnosis. Higher SIR measurements correlated with higher synovitis grading scores for the retrodiscal tissue and the posterior band of the disc. Intra-modality agreement was better in arthroscopy. When blinded to clinical information, arthroscopy and MRI observations can lead to different conclusions. The diagnostic outcomes of both examinations should be considered and integrated into a final diagnosis.     

The evaluation of temporomandibular joint disc position in TMJ disorders using MRI

The purpose of this study was to correlate disc position and the type of disc displacement, intra-capsular effusion and degenerative changes of the condyle as demonstrated in MRI studies. In this study, 126 temporomandibular joints (TMJs) of 63 patients with TMJ disorders were investigated using clinical examination and MRI. One hundred and twelve TMJs were found to have internal derangement as disc displacement. The angle between the posterior margin of the disc and the vertical line drawn through the centre of the condyle was measured on MRI for each TMJ. The positions of the discs were normal, 0 degrees-10 degrees, in 11.11%; slightly displaced, 11 degrees-30 degrees, in 37.30%; mildly displaced 31 degrees-50 degrees, in 15.08%; moderately displaced, 51 degrees-80 degrees, in 7.14% of the TMJs with anterior displacement with reduction (ADDR). The disc position was severely displaced anteriorly, as over 80 degrees, in all TMJs with anterior disc displacement without reduction (ADD), constituting 27.78% of all cases. We found that the smaller the degree of disc displacement the milder the internal derangement and that the intra-capsular effusion was more frequently associated with TMJ with ADDR. The degenerative condylar changes were more severe with an increased degree of anterior disc displacement.     

Validation of the clinical diagnostic criteria for temporomandibular disorders for the diagnostic subgroup - disc derangement with reduction

Research is needed to assess the validity of the clinical diagnostic criteria for temporomandibular disorders (CDC/TMD). The purpose of this study was to test the reliability of the clinical diagnosis of temporomandibular joint (TMJ) internal derangement type (ID)-I as compared with the magnetic resonance imaging (MRI) 'gold standard'. The study comprised 168 TMJs in 84 patients, who were assigned a clinical TMJ-related diagnosis of ID-I (disc displacement with reduction) in at least one TMJ. Bilateral sagittal and coronal MR images were obtained subsequently to establish the corresponding diagnosis of the disc-condyle relationship. For the CDC/TMD interpretations, the positive predictive value (PPV) of ID-I for disc displacement with reduction (DDR) was 44%, and for the presence of an ID 69%. The overall diagnostic agreement for ID-I was 47.6% with a corresponding K-value of 0.05. Most of the disagreement was the result of the false-positive interpretations of ID-I, and false-negative interpretations of an 'absence of ID'. The results suggest CDC/TMD for ID-I to be insufficient reliable for determination of ID and/or DDR. Patients assigned a clinical TMJ-related diagnosis of ID-I may need to be supplemented by evidence from MRI to determine the functional 'disc-condyle relationship'.     

Validation of the clinical diagnostic criteria for temporomandibular disorders for the diagnostic subgroup of degenerative joint disease

Research is needed to assess the validity of the Clinical Diagnostic Criteria for Temporomandibular Disorders (CDC/TMD). The purpose of this study was to test the reliability of the clinical diagnosis of temporomandibular joint (TMJ) degenerative joint disease (DJD) as compared with the magnetic resonance imaging (MRI) 'gold standard'. The TMJ DJD group comprised 48 joints in 24 consecutive patients who were assigned a clinical bilateral diagnosis of TMJ DJD. The TMJ non-DJD group consisted of 82 joints in 41 consecutive patients without a TMJ-related diagnosis of TMD. Bilateral sagittal and coronal MR images were obtained subsequently to establish the corresponding diagnosis of degenerative joint changes. An MRI diagnosis of osteoarthrosis (OA) was defined by the presence of flattening, subchondral sclerosis, surface irregularities, and erosion of the condyle or presence of condylar deformities associated with flattening, subchondral sclerosis, surface irregularities, erosion and osteophyte. For the CDC/TMD interpretations, the positive predictive of DJD for OA was 67%, and for the presence of degenerative joint changes 88%. The overall diagnostic agreement for DJD was 44.6% with a corresponding K-value of 0.01. Most of the disagreement was due to false-negative interpretations of asymptomatic joints. The results suggest CDC/TMD to be predictive for degenerative joint changes but insufficient for determination of OA. Patients assigned a clinical TMJ-related diagnosis of DJD may need to be supplemented by evidence from MRI to determine the presence or absence of OA.     

利用咬合力计指导调治疗颞下颌关节紊乱病

目的：用咬合力计指导调[牙合]并评价调[牙合]对治疗TMD的疗效。方法：随机选取10例因TMD来我院就诊的患者,取观测模型,分析其咬合,并进行调[牙合]。根据调[牙合]治疗前后其临床症状改善情况,进行疗效分析。结果：3个月后多数患者的颌面部肌肉酸痛、无力、关节弹响、开口型异常等症状缓解或消失。结论：（1）调[牙合]是治疗TMD的一种有效的治疗方法。（2）咬合力计能够客观、真实、准确地反应出咬合接触点的详细情况。     

Attitude of Chinese orthodontists towards the relationship between orthodontic treatment and temporomandibular disorders

OBJECTIVE: To determine the attitude of some Chinese orthodontists towards the relationship between orthodontic treatment and temporomandibular disorders (TMDs). SUBJECTS AND METHODS: 25 orthodontists, in six public hospitals (Xi'an, the capital of Shaanxi Province, China), were asked to complete a 10-item questionnaire concerning orthodontics/TMD. RESULTS: 84% of orthodontists often asked their patients about the signs and symptoms of TMD before orthodontic treatment and 92% reported examining the TMJ region. 76% of orthodontists thought orthodontic treatment may possibly lead to a greater incidence of TMD, while 84 per cent claimed that orthodontic treatment might prevent TMD. Methods of orthodontic treatment, patient's age, and occlusal interference were regarded as risk factors leading to increased incidence of TMD. CONCLUSIONS: Some Chinese orthodontists realise the importance of the relationship between orthodontic treatment and TMD. Most thought that unsuitable orthodontic treatment might increase the development of TMD and that orthodontic treatment could prevent TMD.     

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提要：颞下颌关节紊乱病（TMD）是口腔临床常见病之一,其治疗方法众多。咬合板作为一种保守、可逆的治疗方法被广泛应用在TMD的治疗上。然而,各类咬合板治疗TMD的疗效尚不完全明确,本文结合近年来国内外文献对其进行综述。     

What you can and cannot see in TMJ imaging – an overview related to the RDC/TMD diagnostic system

Summary In the current version (I) of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), imaging of the temporomandibular joint (TMJ) is not required for a diagnosis. Research has shown that radiological findings of the TMJ do not always support the clinical findings of the RDC/TMD diagnosis. But imaging should only be performed when it is known that it could contribute to (i) a proper diagnosis and (ii) treatment with a better prognosis. Several techniques are used to image the TMJ: panoramic radiography, plain radiography, conventional and computed tomography (CT), digital volume tomography or cone‐beam computed tomography (CBCT), arthrography and magnetic resonance imaging (MRI). Osseous changes are best visualized in tomography, and the newly developed CBCT is a promising method but must be evaluated in a comparative analysis with other tomographic techniques. And although MRI is the method of choice for imaging the disc, a systematic review found the evidence grade for the diagnostic efficacy of MRI to be insufficient. Today, there is no clear evidence for when TMD patients should be examined with imaging methods. Future research designs should be randomized controlled trials where various radiological examination findings are analysed in relation to therapeutic outcome. In future versions of the RDC/TMD diagnostic system, recommended radiographic techniques must be evaluated and defined, diagnostic criteria well defined and observers calibrated.     

Magnetic resonance imaging findings of internal derangement in temporomandibular joints without a clinical diagnosis of temporomandibular disorder

The purpose of this study was to assess the prevalences of magnetic resonance (MR) imaging findings of internal derangement (ID) in temporomandibular joints (TMJs) without a specific clinical diagnosis of temporomandibular disorder (TMD), and to investigate whether in this TMJ group the variable of pain may be linked to MR imaging findings of ID. The study comprised 109 patients, who were assigned a clinical uni- or bilateral TMJ-related diagnosis of 'absence of TMD'. Bilateral sagittal and coronal MR images were obtained subsequently to establish the prevalence of TMJ ID. An MR imaging diagnosis of ID was found in 99 (55.9%) of the 177 TMJs investigated. About 30.3% of the closed mouth-related TMJ positions characterized by disc displacement presented with anterior disc displacement, while 27.3% had anterolateral and 25.3% anteromedial disc displacement. Analysis of the data revealed the presence of TMJ pain to be associated with significantly more MR imaging diagnoses of disc displacement without reduction than disc displacement with reduction (P < 0.05), while there was no significant difference in the prevalences of ID and those of absence of ID (P > 0.05). Using chi-square analysis, no significant relationship was found between the presence of TMJ pain and the MR imaging diagnosis of TMJ ID (P=0.93). Use of the kappa statistical test indicated poor diagnostic agreement between the presence of TMJ pain and the MR imaging diagnosis of ID (kappa=0.01). The results suggest TMJs with a clinical diagnosis of 'absence of TMD' to be associated with a high rate of IDs, while in these instances the clinical variable of TMJ pain may have no effect on prevalences of MR imaging diagnoses TMJ ID. The data confirm the aspect of clinical diagnostic criteria as an unreliable instrument in predicting MR imaging diagnoses of TMJ ID.     

Prevalence of temporomandibular disorders (TMD) among Finnish prisoners: cross-sectional clinical study

Objective: The aim of the present study was to evaluate the prevalence of self-reported temporomandibular disorders (TMD) symptoms and clinically diagnosed TMD among Finnish prisoners.

Material and methods: Altogether 100 prisoners from the Pelso Prison, Vaala, Finland, underwent dental and TMD clinical examinations performed by a calibrated and well-trained dentist. Symptom Questionnaire and clinical examination according to a Finnish pre-final version of the DC/TMD (Diagnostic Criteria for Temporomandibular Disorders) Axis I protocol were used to evaluate the prevalence of TMD sub-diagnoses.

Results: The most common TMD symptoms were facial pain (54.0%), temporomandibular joint noises (43.0%) and headache (37.0%). The prevalence of joint-related TMD diagnoses was four and a half times higher than diagnoses attributed with pain (76.0% vs. 17.0%). The most common TMD diagnoses were degenerative joint disease (33.0%) and disc displacement with reduction (33.0%).

Conclusions: The prevalence of self-reported TMD symptoms and clinical assessed TMD, especially join-related TMD diagnoses, is high among Finnish prisoners. Examination and treatment of TMD should become a common practice also in prison dental care.