颞下颌关节的3T磁共振高分辨扫描方法研究

目的：探索3T磁共振对颞下颌关节（TMJ）的成像方法与序列特点,并优化扫描参数。方法：采用Siemens3.0TTrio磁共振扫描机,8通道相控阵头线圈,对25例双侧TMJ分别行张口位、闭口位扫描。其中正常志愿者15例,TMD10例。结果：所有被检查者均一次扫描成功,分别取T1WI,T2WI,PWI以及T2WI,T1WI 3D容积成像,扫描方位以髁突为中心,分别做平行于髁突长轴的斜冠状位,垂直于髁突长轴的斜矢状位扫描,正常志愿者的双侧TMJ在优化后的扫描序列中充分而完整显示关节盘、关节间隙、关节窝、关节盘随张闭口改变而位置变化情况,关节周围软组织与骨组织亦充分清楚显示。10例TMD均完全显示出关节盘移位情况,与临床症状一致。结论：3T磁共振扫描机成像速度快,视野内成像矩阵高,解剖细节显示充分,组织分辨力高,对于TMJ等小关节的结构异常与细微病变的显示充分,是其它医学检查设备无法比拟的。     

145例颞下颌关节紊乱病患者的磁共振影像分析

目的 研究145例颞下颌关节紊乱病（TMD）患者的磁共振（MRI）影像学表现,为临床治疗提供依据。方法 利用MRI对145例TMD患者的290侧关节完成开闭口斜矢状位、闭口斜冠状位T1/T2加权成像,观察盘突关系,髁突骨质改变,关节腔积液,关节盘形态改变等情况,并进行分类统计。结果 MRI检查结果显示：37.2%患者双侧TMD病变,71%患者伴有不可复关节盘前移位,10.3%患者伴有可复性关节盘前移位,6.9%患者伴有髁突骨质改变,4.8%患者伴关节腔积液,52.4%患者伴关节盘明显变形。结论 TMD患者中以关节盘不可复性前移位最为常见,提示正常盘突关系的重要性。MRI可以为临床医师提供可靠的影像学诊断依据。     

间接性TMJ损伤的MRI表现及意义

目的:研究间接性颞下颌关节损伤的MRI表现及其在颞下颌关节病诊断中的意义. 方法:用多功能生物撞击机以10 Mpa的气压推动撞击杆,使0.845 kg的钢质圆柱形抛射体以(18.46±0.31) m/s的撞击速度在开口状态下撞击山羊颏部,撞击能量为139.2~148.8 J,间接造成幼年山羊双侧颞下颌关节的间接性损伤,分别于3 h、7 d、 2 周、1 月及3 月行MRI检查,采用斜矢状闭、开口位梯度回波T1W/3D/WATS、自旋回波PDW/TSE、T1W/SE和T2W/TSE序列及冠状闭口位T1W/3D/WATS、PDW/TSE扫描观察TMJ结构变化,并进行组织学观察. 结果:通过组织学观察可见间接性创伤可导致幼年山羊TMJ损伤,早期表现为髁突表面软骨碎裂,关节盘挫裂和移位,关节间隙减小及关节腔内有出血,损伤后期可见髁突表面软骨破坏,关节盘畸形,关节间隙减小.MRI可较清楚的显示上述改变.结论:间接性颞下颌关节损伤可导致幼年山羊TMJ软、硬组织结构和形态的变化,MRI能全面地观察TMJ损伤后组织改变,对颞下颌关节损伤的诊断有重要价值.     

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.     

基于光谱CT的钙抑制技术评估颞下颌关节紊乱病患者关节盘位置

目的探索钙抑制光谱CT技术在评估颞下颌关节盘位置及测量关节盘后带厚度中的应用。方法对2019年2至7月解放军总医院海南医院放射科门诊就诊的23例颞下颌关节紊乱病患者[平均年龄23岁(12~62岁),男性14例,女性9例]行MRI斜矢状位、斜冠状位质子密度加权成像及光谱CT扫描,共纳入可评估关节45侧,依扫描设备分为MRI测量组及钙抑制光谱CT测量组。采用钙抑制算法对光谱CT进行去钙处理,并重建斜矢状位及冠状位钙抑制光谱CT图像。基于斜矢状位及冠状位图像评估关节盘位置,基于斜矢状位图像测量关节盘后带最大厚度。结果45侧颞下颌关节盘位置在MRI图像及钙抑制光谱CT图像上基本一致。MRI测量组与钙抑制光谱CT测量组所测后带厚度的组内相关系数为0.843(0.712,0.914),Bland-Altman图分析MRI与钙抑制光谱CT测量关节盘后带厚度的差值点[95.6%(43/45)]位于95%一致性界限内。Wilcoxon配对检验提示MRI测量组[2.57(1.76,3.65)mm]与钙抑制光谱CT测量组[2.67(1.74,4.56)mm]差异无统计学意义(P=0.07)。结论钙抑制光谱CT成像可以准确评估关节盘位置及关节盘后带厚度。     

颞下颌关节磁共振影像形态与解剖形态相关性研究

目的：探讨颞下颌关节（TMJ）的磁共振成像（MRI）和相应解剖形态的相关关系。方法：4具尸体，①双侧TMJMRI（头部线圈、SE序列T1加权）检查和解剖学测量，并作相应的相关性分析；②翼外肌正矢状位与髁状突翼颌斜位（CPMOP）图像及相关性分析。结果：TMJ骨质结构MRI影像检查结果与解剖测量结果具有高度一致性，关节盘内1／3两种测量结果有相关性；翼外肌正矢状位MRI和髁状突翼颌斜位MRI图像具有高度相关关系。结论：MRI（头部线圈、SE序列T1加权）可用以TMJ硬组织形态的观察和测量，翼刈肌正矢状位片可用以对翼外肌上下头形态测量。     

关节盘前移位颞下颌关节仿真模型的建立

目的:通过CT及MR数据结合三维重建软件建立关节盘前移位颞下颌关节的数字化仿真模型。方法:根据马绪臣颞下颌关节病分类标准,选取成年颞下颌关节紊乱病志愿者1名,X线片及CT检查排除颌骨疾患及颌面部肿瘤,MR斜矢状位扫描明确右侧颞下颌关节盘分界角向前为12.21°,盘前分界超过关节结节顶点。通过Simpleware及Ansys等三维重建软件处理其右侧颞下颌关节的CT薄层扫描数据及3D-MR扫描数据,建立关节盘前移位颞下颌关节的数字化仿真模型。结果:建立了包括骨皮质、骨松质、软骨和关节盘在内的关节盘前移位颞下颌关节数字化仿真模型,客观反应了关节盘前移位时颞下颌关节的外形及解剖特点。结论:成功建立了关节盘前移位颞下颌关节的数字化仿真模型,为关节盘前移位的研究奠定了基础。     

张口位MRI动态研究在诊断颞下颌关节盘前移位中的应用

目的：探讨颞下颌关节张口位磁共振动态成像在颞下颌关节盘前移位中的诊断价值。方法：对30例有颞下颌关节疼痛或弹响MRI患者60侧颞下颌关节行常规MRI静态扫描,并用快速自旋回波扫描获得开口度为0．5cm的图像,依次进行到患者达到最大开口位。然后采用模拟动态观察。分别由两名专科医师对动态扫描和常规静态扫描时关节盘移位进行诊断,并比较诊断结果。结果：静态MRI检查中关节盘可复性前移位21侧,关节盘不可复性前移位18侧,关节盘侧向移位2例,位置正常19例。动态MRI检查中关节盘可复性前移位23侧,关节盘不可复性前移位19侧,位置正常18例。结论：张口位动态MRI联合静态MRI观察对髁突、关节盘运动功能的评价非常重要,对区别可复性与不可复性关节盘前移位具有重要作用。     

无症状颞下颌关节关节盘位置磁共振成像观察

为了解国人无症状人群中是否存在颞下颌关节关节盘移位，并探讨其对临床工作的参考意义，应用颞下颌关节斜矢状位和斜冠状位磁共振成像，对５０侧（３９例）无症状志愿受试者关节盘位置进行观察，发现盘移位率达３２％。对关节盘前移位和旋转移位的诊断及无症状关节存在盘移位在临床工作中的参考意义进行了讨论     

颞下颌关节病变的CT检查

随着影像技术的飞速发展 ,对颞下颌关节疾病诊断提到了一个新的高度。本文介绍了ＣＴ检查 ,尤其三维ＣＴ成像在颞下颌关节中的应用。一、ＴＭＪＣＴ检查及用途[1～ 6]80年代初ＣＴ开始用于ＴＭＪ病变的检查。常用位置有横断位、直接矢状位和冠状位扫描。主要观察 :①ＴＭＪ关节结节和关节窝形态、位置及骨质结构改变。②关节间隙周围的关系并进行关节间隙测量。③髁状突骨质形态、边缘、解剖结构和活动范围并进行髁状突水平角、垂直倾斜角及内外前后径测量。④ＴＭＪ关节盘改变 (闪烁法显示 )。另外 ,横断位扫描还易于进行矢状、冠状和任意…     

Correlation between direction and severity of temporomandibular joint disc displacement and reduction ability during mouth opening

The most common temporomandibular joint (TMJ) internal derangement is an abnormal relationship of the disc with respect to the mandibular condyle, articular eminence and glenoid fossa‐disc displacement. The aim of our study was to analyse the correlation between partial/complete disc displacement in the intercuspal position (IP) and its reduction in the open‐mouth position (OMP) in both oblique sagittal and coronal planes on magnetic resonance imaging (MRI) in patients with temporomandibular disorders. Multisection MRI analysis of 382 TMJs was conducted in 191 patients with disc displacement according to the RDC/TMD criteria (148 women, 43 men; aged 14‐60 years). The disc position was evaluated on all oblique sagittal and coronal images in the IP and the OMP. Univariate logistic regression analysis showed that the severity of disc displacement in the sagittal plane is a statistically significant predictor of reduction ability during mouth opening (B = 3.118; P < .001). Moreover, the severity of disc displacement in both planes is also a significant predictor of disc reduction in OMP (B = 2.200; P < .05). In conclusion, reduction ability during mouth opening is associated with the severity of disc displacement in IP, in both sagittal and coronal planes. Multisection analysis of all MR images allows distinguishing the correct disc position from disc displacement and can improve the ability to distinguish between various stages of TMJ internal derangement.     

A magnetic resonance imaging study on the temporomandibular joint disc–condyle relationship in young asymptomatic adults

The aim of this study was to assess the temporomandibular joint (TMJ) disc–condyle relationship in asymptomatic young adults. Ninety-three volunteers aged 19–23 years without temporomandibular disorder (TMD) symptoms underwent TMJ magnetic resonance imaging (MRI). The condylar centre and apex methods were used to measure and analyse the position of the disc in the oblique sagittal plane, and the reliability of the two methods was compared by calculating the intra-class correlation coefficient (ICC). Furthermore, 18 of the volunteers were randomly selected for three-dimensional (3D) reconstruction of the TMJ structure and the disc–condyle relationship. The 3D TMJ structure was established by semi-automatic segmentation of the condyle and articular disc in ITK-SNAP software; the condylar apex method was then performed. It was found that only 33.3% of the posterior edge of the articular discs were located in the normal 12 o’clock position with respect to the condyle. Moreover, this study suggests that the condylar centre method lacks accuracy when compared to the condylar apex method in regard to the measurement of the TMJ disc–condyle relationship (0 < ICC_cen < ICC_apex < 1). The position of the articular disc (left and right) was more forward in young women when compared to young men. However, there was no significant difference in the TMJ disc–condyle position between the left and right sides in the same individual, although the two joint discs in the same individual were not completely symmetrical.     

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。     

无髁突骨折颞下颌关节急性创伤后的变化:影像学和手术所见

目的:通过CT、MRI及手术探查观察无髁突骨折颞下颌关节急性创伤后的变化,为该疾患的早期诊治提供依据。方法:上海交通大学医学院附属第九人民医院口腔颌面外科关节组2009—2010年收治的无髁突骨折颞下颌关节急性创伤患者7例11侧关节纳入研究。所有患者伤前均无关节症状,但在伤后出现长时间的关节区疼痛和开口受限,其中6例合并面部骨折,曾在其他医院或由其他医师手术治疗。所有患者均进行了关节区的MRI检查,对受伤后即刻和再次就诊的CT进行比较。所有病例进行了手术探查,术中所见进一步证实影像学的变化。结果:CT显示,87.5%(7/8)的髁突在受伤即刻表面骨质"完好",而伤后1个月至1a出现骨质破坏。伤后1个月至1a的MRI检查显示,所有11侧关节均出现盘前移位,90.9%(10/11)的髁突伴骨质破坏。手术探查显示,2侧关节出现骨性黏连,3侧关节髁突表面骨质破坏与关节窝纤维性黏连,5侧关节髁突表面软骨变性伴黏连,1侧关节髁突表面软骨无明显破坏,关节盘前移位但形态尚可。结论:无髁突骨折的颞下颌关节急性创伤如伴关节盘前移位,可导致骨关节病和(或)关节强直。     

Clinical investigation of early post-traumatic temporomandibular joint ankylosis and the role of repositioning discs in treatment

This study investigated the development of temporomandibular joint (TMJ) ankylosis after condylar fracture and the functional results of surgery that included repositioning of the articular discs. In a total of 18 patients, there were 13 cases of fibrous ankylosis (type I) and 11 of partial bony ankylosis (type II). CT scans for both groups and MRI scans for type I patients were analysed. Intraoperative inspection of the damaged disc, the sites of adhesion or bony fusion, and remaining intra-articular movement was recorded. After release arthroplasty and repositioning of discs, follow-up was for 1 to 3.5 years (mean 2.2 years). Post-traumatic TMJ ankylosis was highly associated with sagittal and comminuted condylar fractures. Type I ankylosis usually formed in the 4th to 5th month post-trauma with mean interincisal opening distance of 18.3+/-5.5mm. Progression from type I to II ankylosis occurred 1 year post-trauma and caused a reduction of 5mm in the range of mouth opening. The disc was displaced for each of the involved joints, and intra-articular adhesions or ossification initiated at the site where there was no intervening disc present. After surgical repositioning of the disc, stable joint function and mouth opening from 30 to 45 mm were obtained in all patients but one (recurrence due to dislocation). Sagittal and comminuted condylar fractures predispose the TMJ to ankylosis, and the displacement of the articular disc plays a critical role. Early surgical intervention to reposition the disc was successful for early trauma-induced TMJ ankylosis.     

The influence of pre- and intraoperative positioning of the condyle in the centre of the articular fossa on the position of the disc in orthognathic surgery. A magnetic resonance study

OBJECTIVE: We investigated the changes in the temporomandibular joint (TMJ) after bilateral sagittal split osteotomy of the mandible for orthognathic surgery and the influence of positioning of the condylar process in the centre of the articular fossa before and during the operation for preventing changes in the TMJ postoperatively. STUDY DESIGN: A total of 28 patients with mandibular retrognathism had bilateral sagittal split osteotomies for mandibular advancement. In one group of 14 patients (28 TMJ), the condyles were placed in the centre of the articular fossa before and during the operation, and in the other group they were not. Differences on magnetic resonance imaging (MRI) were calculated and the results were evaluated. RESULTS: The main differences were found at maximal mouth opening. 15/28 TMJs (54%) that had not been positioned changed the position of the disc from physiological to anterior disc derangement with and without reduction postoperatively. In the 28 that had been positioned, changes were found in only 3 TMJs (11%) postoperatively. CONCLUSIONS: Fixing the condylar process in the centre of the articular fossa intraoperatively before bilateral sagittal split osteotomy is a factor in preventing postoperative structural changes in the temporomandibular joint.     

Association between temporomandibular joint disc position evaluated by magnetic resonance imaging and mandibular condyle inclination evaluated by computed tomography

Temporomandibular joint disc displacement is common in the world's population and could be associated with bone and functional characteristics of the temporomandibular joint. The aim of these study was to analyse the association between temporomandibular joint disc position evaluated by magnetic resonance imaging (MRI) and the inclination of the mandibular condyle evaluated by computed tomography (CT). One hundred and seventy temporomandibular joints (TMJ) were retrospectively analysed. The temporomandibular disc position was evaluated by MRI and classified into three types: normal (N), disc displacement with reduction (DDWR) and disc displacement without reduction (DDWoR). The mandibular condyle measurements evaluated by CT included horizontal, sagittal and coronal inclination. ANOVA followed by post hoc Tukey's test was used to evaluate the interaction between condylar inclination and disc position. There was an association between disc position and the horizontal and sagittal condylar inclination (P < .05). There are statistically significant differences in the mean of horizontal and sagittal inclination of the mandibular condyle between the DDWoR and the other disc positions (P = .002 and P = .004). Disc position was not statistical associated with coronal inclination of condyle (P > .05). These results indicate that the inclination of the mandibular condyle may be different in TMJ with various disc position. A more medial horizontal inclination and a more posterior sagittal inclination of the mandibular condyle are associated with DDWoR.