关节腔注射治疗对不同年龄段颞下颌关节骨关节炎患者的疗效评价

目的:评价5周一个疗程的关节灌洗术联合透明质酸钠注射对不同年龄段颞下颌关节骨关节炎患者的疗效。方法:选取颞下颌关节骨关节炎患者47例,按年龄段不同分为青年组（<45岁）、中年组（45~65岁）和老年组（>65岁）3组。所有患者均接受5周一个疗程的关节灌洗联合透明质酸钠关节腔注射术。在试验基线和治疗后的第1、3、6个月,分别检测各试验组非辅助最大开口度、休息时及咀嚼时疼痛感以及关节运动功能障碍。在试验基线和治疗后第6个月使用OHIP-14量表测量患者的生存质量。使用SPSS18.0软件包对数据进行统计学处理。结果:各组患者治疗后生存质量均显著提高（P<0.05）;青年组（<45岁）患者休息时疼痛感在治疗后得到明显缓解（P<0.05）;中年组（45~65岁）患者治疗后最大开口度明显增加,下颌运动功能障碍明显改善（P<0.05）;老年组（>65岁）患者所有检测指标均显著优于治疗前（P<0.05）,临床症状的改善程度明显优于其他2组（P<0.05）。结论:颞下颌关节骨关节炎的临床疗效与年龄相关,老年患者能获得更好的整体疗效。     

颞下颌关节腔注射治疗的研究进展

颞下颌关节腔注射治疗已经有20多年的历史,是治疗颞下颌关节紊乱病的重要方法,但仍存在药物作用时间短,需要重复注射等问题。近年来,学者从不同角度进行了研究,力图提高颞下颌关节腔注射的治疗效果。本文就该方面的研究进展作一综述。     

软骨血管发生与颞下颌关节骨关节病间的关系

有关骨关节病的发病机制至今不明,近年来人们认识到发生于软骨组织的血管发生可能在其中扮演了重要的角色。本文就髁突软骨血管发生与骨关节病、软骨血管发生的分子机制等研究进展作一综述。     

Severe temporomandibular dysfunction and joint destruction after intra-articular injection of triamcinolone

BACKGROUND: Steroid injections into joints are frequently used to control symptomatic pain. Risks associated with intra-articular steroid injections are not well documented. METHODS: We report the case of a 29-year-old woman who was referred to a dental surgeon because of a suspected relationship between persisting chronic back pain and an arthrosis of the temporomandibular joint (TMJ). RESULTS: The dental surgeon diagnosed capsulitis of the right TMJ and injected 40 mg triamcinolone into the joint. Within 4 months the patient developed progressive pain and trismus of the right TMJ and the intra-articular injection was repeated. An occlusal splint slightly improved the patients' symptoms but induced crepitus. Magnetic resonance imaging revealed a disk dislocation in the right TMJ and severe necrosis of the condyle. The patient had persisting pain and ankylosis. Surgical restoration of the TMJ revealed a bony apposition in the fossa deformed with the socket of the joint, extensive medial erosion of the condyle and complete destruction of the disk. CONCLUSION: This case report supports earlier observations that intra-articular glucocorticoid injections, if used in a wrong way, may cause severe destruction of a joint.     

Collagen crimping in the intra-articular disc and articular surfaces of the human temporomandibular joint

The presence of crimping within soft fibrous connective tissues has a considerable role in determining the biomechanical properties of the tissue. However, there is little or no information on crimping of collagen in the human temporomandibular joint. To remedy this situation, the presence and nature of any crimping was studied in sections of human temporomandibular joints from individuals varying in age from between 4.5-63 years, using polarized light microscopy and differential interference contrast microscopy. The presence of crimping was looked for in collagen within the intra-articular disc and the articular surfaces of the mandibular fossa and mandibular condyle. By polarized light, crimping was seen throughout all three tissues at all ages studied. Quantification from micrographs enlarged to x250 showed that the periodicity of the banding (representing half a complete crimp wave) had a mean varying between about 15-20 microm. Crimping was also directly visualized by differential interference contrast microscopy. The presence of such a fundamental feature needs to be considered when explaining the normal function of the temporomandibular joint.     

白细胞介素-1受体拮抗剂抑制兔颞下颌关节骨关节炎软骨破坏的研究

目的:研究关节腔内注射白细胞介素-1受体拮抗剂对颞下颌关节骨关节炎关节软骨修复的影响。方法:取新西兰大白兔24只,用关节盘部分切除致使穿孔法建立双侧颞下颌关节骨关节炎模型。4周后,在每只动物右侧(实验侧)颞下颌关节腔内一次性注射重组人白细胞介素-1受体拮抗剂50μg,左侧(对照侧)关节腔内注射等量安慰剂。注射后12、24周分别处死12只动物,取双侧颞下颌关节标本进行组织学及RT-PCR检测。结果:双侧关节软骨均呈现出不同程度的骨关节炎病损,对照侧病损更严重。实验侧组织学分数明显高于对照侧(P<0.05)。注射后12和24周时实验侧II型胶原及聚集蛋白聚糖mRNA表达高于对照侧(P<0.05);12周时实验侧关节软骨聚集蛋白聚糖酶mRNA表达低于对照侧(P<0.05),24周时两侧无明显差异(P>0.05)。肿瘤坏死因子-αmRNA表达两侧无明显差异(P>0.05)。结论:颞下颌关节腔内注射IL-Ra能缓解骨关节炎导致的软骨病损,可望成为治疗颞下颌关节骨关节炎的一种新方法。     

Chondrotoxic effects of intra-articular injection of local anaesthetics in the rabbit temporomandibular joint

The aim of this study was to investigate the chondrotoxic effects of a single-dose intra-articular injection of articaine, lidocaine, and bupivacaine on the rabbit temporomandibular joint (TMJ). Twenty-four rabbits were divided into four groups: control (group 1), articaine (group 2), lidocaine (group 3), and bupivacaine (group 4). Synovial fluid samples and venous blood were taken to evaluate matrix metalloproteinase 3 (MMP-3) levels. One millilitre of local anaesthetic solution was injected in the study groups and saline solution in the control group. The rabbits were euthanized after 4 weeks and the mandibular condyles and articular discs were evaluated. On histological examination, the study group samples had irregular joint surfaces, decreased collagen, and a thinner cartilage layer. Apoptotic cells were evaluated with the TUNEL method. TUNEL-positive apoptotic cell counts were higher in all study groups compared to the control group, and the difference was significant (P < 0.001). The mean preoperative serum MMP-3 level for all groups was 5.71 ± 3.33 ng/mL, while the mean postoperative level was 22.61 ± 6.36 ng/mL; this difference was significant (P < 0.001). A single-dose intra-articular injection of local anaesthetic had apoptotic effects on chondrocytes, leading to degenerative changes in the TMJ articular structures. Articaine was found to have less harmful effects than lidocaine and bupivacaine. Intra-articular injection of local anaesthetics should be limited in the TMJ because of the potential toxic effects.     

关节腔注射TGF-1治疗兔颞下颌关节骨关节炎的实验研究

目的：探讨关节腔注射TGF-1治疗兔颞下颌关节骨关节炎（TMJOA）的效果。方法：24只新西兰大白兔采用双侧关节盘部分切除方法建立TMJOA动物模型,于建模后4周于右侧（实验侧）TMJ关节腔一次性注射TGF-150μl,左侧（对照侧）注射等量生理盐水。关节腔注射后12周、24周分别处死12只动物,解剖颞下颌关节,进行组织学及RT-PCR检测。结果：所有关节均表现出骨关节炎病理改变,术后12周、24周实验组病损较对照组轻,RT-PCR检测结果提示术后12周,实验组Ⅱ型胶原及蛋白聚糖表达升高,且较对照组强（P〈0.05）,IL-1及蛋白聚糖酶表达与对照组无明显差异（P〉0.05）;术后24周实验组所有检测指标与对照组无明显差异（P〉0.05）。结论：重组TGF-1因子关节腔注射能阻止TMJOA关节软骨的破坏,对TMJOA产生治疗作用。     

Arthrocentesis followed by intra-articular autologous blood injection for the treatment of recurrent temporomandibular joint dislocation

Temporomandibular joint (TMJ) dislocation is an excessive forward movement of the condyle beyond the articular eminence with complete separation of the articular surfaces and fixation in that position. This study was conducted to assess autologous blood injection to the TMJ for the treatment of chronic recurrent TMJ dislocation. Fifteen patients with bilateral chronic recurrent condylar dislocation were included in the study. Bilateral TMJ arthrocentesis was performed on each patient, followed by the injection of 2 ml of autologous blood into the superior joint compartment and 1 ml onto the outer surface of the joint capsule. Preoperative and postoperative assessment included a thorough history and physical examination to determine the maximal mouth opening, presence of pain and sounds, frequency of luxation, recurrence rate, and presence of facial nerve paralysis. Eighty percent of the subjects (12 patients) had a successful outcome with no further episodes of dislocation and required no further treatment at their 1-year follow-up, whereas three patients had recurrent dislocation as early as 2 weeks after treatment. Autologous blood injection is a safe, simple, and cost-effective treatment for chronic recurrent TMJ dislocation.     

Interrelationship between temporomandibular joint osteoarthritis (OA) and cervical spine pain: Effects of intra-articular injection with hyaluronic acid

Objective: The aim of this study was to evaluate cervical spine pain and function after five sessions of viscosupplementation with hyaluronic acid (HA) in patients with temporomandibular joint (TMJ) osteoarthritis.

Methods: Forty-nine patients, (79% females, aged between 43–81 years), affected by TMJ osteoarthritis and concurrent cervical spine pain and limited function were recruited. All patients underwent a cycle of five weekly arthrocenteses and viscosupplementation with 1 ml of medium molecular weight HA according to the single-needle arthrocentesis technique. Outcome variables were TMJ pain (VAS), cervical active ranges of motion, cervical disability (NPDS), and presence of painful palpation sites. Assessments were carried out at baseline and at one, three and six months after the end of treatment protocol.

Results: A significant reduction over time was shown both in TMJ pain levels and in NPDS values with respect to baseline (p < 0.001). Most parameters of active cervical range of motion showed an improvement with time. Benefits remained stable throughout six months after the viscosupplementation protocol.

Conclusions: A protocol of TMJ intra articular arthrocentesis and viscosupplementation improved cervical function and reduced disability in patients with concurrent cervical spine pain. These findings add to the complex amount of literature on the relationship between temporomandibular disorders and cervical spine disorders.     

颞下颌关节内压的研究进展

颞下颌关节是口腔颌面部仅有的活动关节,颞下颌关节紊乱病是颌面部最常见的疾病之一。关节内压随着关节内结构的变化和功能运动而改变,关节内压的改变是引起颞下颌关节紊乱的重要因素。对关节内压的研究和测量对疾病的发展及治疗具有一定的指导意义。该文对近年来颞下颌关节内压的研究进行了总结,重点在于关节内压产生的机制、影响因素、关节内压的测定及其对于临床治疗的意义。     

Insulin-like growth factor-1 suspended in hyaluronan improves cartilage and subchondral cancellous bone repair in osteoarthritis of temporomandibular joint

This study sought to evaluate the effects of intra-articular injection of insulin-like growth factor-1 (IGF-1) suspended in hyaluronan (HA) on the cartilage and subchondral cancellous bone repair in osteoarthritis (OA) of the temporomandibular joint (TMJ). Disc perforation was performed bilaterally in rabbit TMJs to induce OA. Four groups of animals (n = 12) received OA induction only, and either intra-articular HA injection alone, intra-articular IGF-1 injection alone, or a combination of HA and IGF-1 injection. All therapy was begun 4 weeks after OA induction. The animals were killed 12 or 24 weeks after the first injection, for histology and micro-CT examinations. Two additional animals were used as normal controls. Typical cartilage and subchondral cancellous bone lesions were observed in the OA group. No protective effect on cartilage and subchondral cancellous bone was found in the HA or IGF-1 alone groups. Better histological repair and nearly normal micro-architectural properties of the subchondral cancellous bone were observed in the HA + IGF-1 group compared with the HA or IGF-1 alone groups. HA may be used as an effective carrier for intra-articular injection of IGF-1 and the combination of HA/IGF-1 shows promise as a new rational approach to therapy of TMJ OA.     

ADAMTs-5在颞下颌关节骨关节病大鼠髁突软骨中的表达和意义

目的本实验拟通过检测新型金属蛋白酶ADAMTs-5在颞下颌关节骨关节病大鼠髁突软骨中的表达,探讨其在髁突软骨降解中的作用。方法 32只大鼠随机分为4组(对照组1,2周组,对照组2和4周组),每组8只。通过胶原酶注射法建立大鼠颞下颌关节骨关节病动物模型,采用免疫印迹和RT-PCR法从蛋白和核酸水平检测ADAMTs-5的表达。结果对照组和2周组ADAMTs-5蛋白水平变化不明显,4周组ADAMTs-5蛋白表达量明显增高;与对照组相比,2周组和4周组ADAMTs-5 mRNA表达均有不同程度升高,这与蛋白表达趋势不完全一致。结论 ADAMTs-5在颞下颌关节骨关节病早期阶段有较显著表达,表明其在髁突软骨降解的始动环节中可能发挥着重要作用。     

rhIL-1Ra抑制大鼠颞下颌关节骨关节炎软骨破坏的研究

目的:探讨关节腔内注射重组人IL-1Ra对实验性大鼠颞下颌关节炎软骨关节修复的影响.方法:取SD大鼠24只,用关节腔内注射Ⅱ型胶原酶法建立双侧颞下颌关节骨关节炎模型,1周后,右侧(实验侧)关节腔内一次性注射重组人IL-1Ra5 μg(稀释于0.05 ml生理盐水),左侧(对照侧)注射等量生理盐水.建模后2周、4周各处死12只动物,取颞下颌关节标本进行HE染色、免疫组化染色及RT-PCR检测,用Mankin评分方法评估TMJ组织病理变化程度.另取1只SD大鼠用作空白对照,2周后处死.结果:2周时双侧颞下颌关节软骨均呈现不同程度的关节病损,实验侧和对照侧Mankin计分分别为1.33±0.52和2.00±6.63(P ＞0.05).4周时,实验侧改良和对照侧Mankin评分分别为3.00±0.63和6.50 ±0.84(P＜0.05).AD-AMTS-4、5的蛋白及mRNA表达也低于对照侧(P＜0.05).结论:颞下颌关节腔内注射重组人IL-1Ra能缓解骨关节炎导致的软骨病损,其治疗机制可能是通过抑制ADAMTS-4、5的表达来实现的.