口腔曲面体层片判断上颌牙根突入上颌窦的敏感度与特异度分析

目的:评价口腔曲面体层片判断上颌牙根突入上颌窦的敏感度与特异度.方法:纳入110例患者,男42例,女68例;年龄15～36岁,上颌第二磨牙已完全萌出,拍摄全牙列锥形束CT(CBCT)及口腔曲面体层片.分别根据2种影像数据观察上颌尖牙、上颌第一前磨牙、上颌第二前磨牙、上颌第一磨牙及上颌第二磨牙牙根是否突入上颌窦.以CBCT观察结果为金标准,收集四格表资料,计算口腔曲面体层片进行判断的敏感度、特异度、准确度、阳性似然比、阴性似然比及牙根进入上颌窦的发生率.结果:口腔曲面体层片判断牙根是否突入上颌窦的敏感度分别为上颌尖牙100％,上颌第一前磨牙100％,上颌第二前磨牙96％,上颌第一磨牙99％,上颌第二磨牙96％.特异度分别为上颌尖牙94％,上颌第一前磨牙92％,上颌第二前磨牙84％,上颌第一磨牙55％,上颌第二磨牙67％.结论:口腔曲面体层片判断上颌牙根是否进入上颌窦的敏感度高,但是对于第二前磨牙、第一磨牙及第二磨牙判断的特异度较低.正畸临床不能以之作为上颌后牙支抗设计的依据.     

颞下颌关节骨关节病的诊治进展

颞下颌关节骨关节病(temporomandibul1ar joint osteoarthrosis,TMJOA)是一种常见的颞下颌关节疾病,主要表现为开口受限、关节区疼痛、摩擦音等一系列症状,严重影响患者的生活质量,甚至危及生命.近年来,随着影像学和组织工程等技术的发展,TMJOA的诊治方法不断得以提高和完善.本文就TMJOA的诊治进展做一综述.     

L-单甲基-精氨酸对颞下颌关节骨关节病治疗作用的实验研究

目的　研究一氧化氮合酶抑制剂L 单甲基 精氨酸对山羊实验性颞下颌关节骨关节病的治疗作用及可能机制。方法　通过双侧颞下颌关节上腔内注射胶原酶建立骨关节病模型 ,从注射胶原酶第 4周起 ,在左侧关节上腔内每隔 3d注射 0 5 %L 单甲基 精氨酸 0 5ml,共 7次 ,右侧同期注射生理盐水 0 5ml。注射胶原酶后 1 2周处死所有动物 ,取双侧关节标本作组织学检查并根据改良Mankin骨关节病评价标准评分。结果　评分结果 :L 单甲基 精氨酸侧为 3 83 ,而对照侧为 6 33 ,两者比较差异有高度显著性 (P <0 0 1 )。结论　L 单甲基 精氨酸关节腔内注射对山羊实验性颞下颌关节骨关节病的发展有抑制作用 ,其作用机制可能与L 单甲基 精氨酸抑制一氧化氮合酶在关节局部产生过多的一氧化氮有关     

颞下颌关节关节盘前移位与骨关节病的关系

颞下颌关节骨关节病(temporomandibular joint osteoarthrosis,TMJOA)是一种常见的颞下颌关节疾病,主要表现为开口受限、关节区疼痛、摩擦音等一系列症状。虽然骨关节病不是致命性疾病,但是骨关节病的发生会严重危害患者的生活质量。而在颞下颌关节结构紊乱病中,颞下颌关节盘前移位(anterior disc displacement,ADD)发生率最高,是最常见的关节紊乱病。本文就TMJ ADD与OA之间的相关性作一综述。     

The relationship between temporomandibular joint effusion and pain in patients with internal derangement

ObjectivesThe purpose of this study was to evaluate the relationship between temporomandibular joint (TMJ) effusion and joint pain in patients with internal derangement based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD).MethodsA total of 240 TMJs from 120 patients with unilateral painful joints (103 females and 17 males, mean age 29.9 ± 12 years) were evaluated. Clinical assessments were carried out according to the DC/TMD guidelines. Magnetic resonance imaging (MRI) was used to evaluate the degree of effusion in each joint. The radiological and clinical findings were analysed for statistically significant correlations.ResultsAlthough the results indicated a statistically significant association between moderate joint effusion and disc displacement (p < 0,05), there was no statistically significant association between moderate effusion and joint pain (p > 0,05). There were, however, statistically significant associations between marked effusion and both disc displacement and joint pain (p < 0,05).ConclusionTMJ effusion is associated with both disc displacement and joint pain: the effusion increased in direct proportion to the severity of pain and disc displacement. The possibility that there are various aetiologies for the condition should also be considered.     

关节内注射曲安奈德对山羊颞下颌关节骨关节病的影响

目的:观察关节内注射曲安奈德后,山羊颞下颌关节骨关节病的组织病理学变化。方法:在10只山羊的双侧颞下颌关节上腔一次性注射Ⅰ型胶原酶0.8ml,诱导制作山羊骨关节病模型;随机将动物分为对照组和治疗组,每组5只,分别在注射Ⅰ型胶原酶后30、60d后,进行第1次和第2次治疗;第1次治疗90d后,处死2组动物,切取关节标本,进行光镜和扫描电镜观察,并对2组关节光镜下9个区的组织病理学变化进行评分,每个区得出平均分后,应用SAS统计软件GLM模型对治疗组和对照组的分数进行统计学处理,评价有无差异。结果:光镜和扫描电镜下观察,对照组髁突、关节盘、关节窝表现为骨关节病变化,治疗组表现出较对照组更严重的病理变化。光镜下治疗组与对照组的组织学得分有显著性差异(P<0.01)。结论:关节上腔注射曲安奈德,能加重骨关节病的程度。     

关节盘穿孔致大鼠颞下颌关节骨关节病的形态学及组织病理学观察

目的通过关节盘穿孔建立大鼠颞下颌关节骨关节病(temporomandibular joint osteoarthrosis,TMJOA)模型,并观察颞下颌关节(temporomandibular joint,TMJ)髁突的形态学特征及组织病理学变化。方法8只12周龄雄性SD大鼠购自重庆医科大学,体质量200~250 g,通过随机数表法将其分为1周组和4周组,每组各4只。用齿科慢机球钻在每只大鼠左侧(模型侧)关节盘中后部形成直径1.5 mm的规则圆形穿孔,右侧(对照侧)不予处理。1周组和4周组大鼠分别于处理后1、4周时处死,获取双侧TMJ组织,通过形态学观察、影像学检查分析关节软骨的退化程度及软骨下骨的结构变化。通过免疫组织化学染色、苏木精染色、番红O-固绿染色、抗酒石酸酸性磷酸酶(tartrate-resistant acid phosphatase,TRAP)染色,分析大鼠TMJ髁突软骨的组织病理学变化。结果形态学观察显示1周组模型侧关节盘红肿明显,4周组模型侧可见典型的骨关节病鸟嘴样改变,1周组和4周组模型侧髁突的高度[分别为(2.73±0.14)和(2.49±0.25)cm]均显著低于对照侧[分别为(3.30±0.09)和(3.30±0.12)cm](P<0.01);影像学结果显示4周组模型侧骨小梁微观结构破坏明显;番红O-固绿染色结果显示1周组及4周组模型侧的蛋白聚糖均显著低于对照侧(P<0.01);TRAP染色结果显示1周组及4周组模型侧的破骨细胞数目均显著多于对照侧(P<0.01);免疫组织化学染色、苏木精染色结果显示1周组及4周组模型侧的胶原纤维密度较对照侧均显著减少(P<0.01),而基质金属蛋白酶显著增多(P<0.01)。结论大鼠关节盘穿孔后,模型侧髁突软骨出现了典型的TMJOA病理改变。     

Three-dimensional comparative evaluation of articular disc position and other temporomandibular joint morphology in Class II horizontal and vertical cases with Class I malocclusion:: A magnetic resonance imaging study

ObjectiveTo evaluate and compare articular disk position, condylar position, and joint spaces in Class II vertical, Class II horizontal, and Class I cases. The purpose was to assess the potential for development of temporomandibular disorders (TMDs) in the three groups.Materials and MethodsA sample of 75 cases, 25 cases in each group of Class I, Class II vertical, and Class II horizontal, were selected based on inclusion and exclusion criteria. Magnetic resonance imaging (MRI) assessments were made with a 1.5-Tesla basic system with a closed-mouth technique for evaluating articular disk position in the sagittal and transverse planes, condylar position, and joint spaces in the sagittal plane. Philips 3.0 software was used to analyze the MR images.ResultsThere was evidence of alterations in the temporomandibular joint (TMJ) morphology in both Class II vertical and Class II horizontal cases, with maximum discrepancy in Class II vertical cases. MRI evaluation suggested a tendency for antero-medial disk displacement with anteriorly positioned condyles in Class II vertical cases. The discrepancy was milder in the Class II horizontal group.ConclusionsClass II vertical cases are more susceptible to the development of TMDs and should be subjected to TMJ evaluation before starting any orthodontic treatment to intercept and prevent a mild asymptomatic TMD from developing into a more severe form. Class II vertical cases should be subjected to MRI evaluation before starting any orthodontic treatment.     

无症状志愿者颞下颌关节盘位置的磁共振观察

目的 通过磁共振成像了解无症状志愿者颞下颌关节关节盘位置的类型及其与年龄和性别的关系.方法 100名无症状志愿者分5组(11岁～、21岁～、31岁～、41岁～、51～60岁),每组男女各10名;利用Siemens Trio Tim 3.0 T磁共振扫描系统对双侧颞下颌关节进行开闭口斜矢状位扫描,共200侧关节;对每侧关节中间层及其相邻内、外各一层磁共振图像进行视觉诊断.结果 100名无症状志愿者中59名(59.0%)双侧关节盘位置正常.关节盘位置正常、关节盘前移位和隐匿性前移位的关节侧数分别为140侧(70.0%)、14侧(7.0%)和46侧(23.0%),在5个年龄组及不同性别之间的分布比较,差异均无统计学意义(P＞0.05).受试者最大开口度平均为(46.3±5.5)mm,不同关节盘位置的受试者间最大开门度比较,差异无统计学意义(P＞0.05).结论 在无症状志愿者中颢下颌关节盘移位确实存在,其分布与年龄和性别无关;盘移位以隐匿性前移位为主;关节盘移位的影像学表现与临床症状之间不存在确定的相关关系.     

颞下颌关节及下颌骨的磁共振三维重建

探讨对颞下颌关节进行ＭＲ影像三维重建的可行性,方法在对颞下颌关节颌骨进行磁共振扫描的基础上,运用计算机工作站的三维重建功能,对磁共振断层影像进行三维重建。结果重建后的髁突,关节盘、关节窝及下颌骨均具有较好的形态进行不同角度的旋转,可清楚地观察到关节窝、关节和髁突的位置关系。     

肌激动器治疗前后关节盘矢状位置与颞下颌关节临床症状和体征的关系

目的 探讨功能矫治中关节盘矢状位置对颞下颌关节临床功能的影响.方法 选择20个AngleⅡ1错(牙合)患者,采用Activator功能矫治器治疗.用MRI检查治疗前后关节盘位置, Helkimo指数评价功能矫形前后的颞下颌关节功能.探讨治疗前后关节盘位置的改变及其与颞下颌关节症状之间的关系.结果 治疗前关节盘位置正常者,治疗后临床检查指数有下降趋势;治疗前关节盘前移位者,治疗后临床检查指数升高.结论 功能矫形虽然不会导致关节盘前移位的发生,但对于治疗前已经存在关节盘前移位者,治疗后可能会引发或加重其TMD症状和体征.     

颞下颌关节内粘连的影像学诊断

目的探讨颞下颌关节内粘连的影像学诊断标准。方法从１０３例颞下颌关节内疾患的病例中收集了２６例颞下颌关节内粘连病例，将临床检查、关节造影检查与颞下颌关节内窥镜检查相对照。结果颞下颌关节内粘连的关节造影检查可见：关节腔造影剂量减少，关节上腔造影剂变薄、狭窄；开闭口位时关节盘后带的压迹部位始终位于同一位置；造影剂边缘不整齐或造影剂中断以及关节内粘连伴有关节盘前移位。结论以上结果可作为关节造影诊断关节内粘连的依据。     

Magnetic resonance imaging of the temporomandibular joint: a study of inter- and intraobserver agreement

Objective The purpose of this study was to estimate the inter- and intraobserver agreement for interpreting magnetic resonance (MR) images of the temporomandibular joint (TMJ).Methods The study was based on MR images of 30 TMJs. The images were interpreted by seven observers for disk configuration, disk position, joint fluid, bone marrow changes, and diagnosis. The observers were not calibrated. Kappa statistics were used.Results The kappa values were, for interobserver agreement of disk configuration, 0.10; for disk position in the sagittal plane with closed mouth, 0.35; for a combination of closed mouth and open mouth, 0.44; for disk position in the coronal plane, 0.17; for joint fluid, 0.36; for bone marrow changes, 0.01; and for diagnosis, 0.39. Intraobserver agreement was generally higher than interobserver agreement.Conclusion Agreement on disk position in the sagittal plane, on presence and amount of joint fluid, and on diagnosis was fair to moderate. Agreement on disk configuration, on disk position in the coronal plane, and on bone marrow changes was poor.     

无症状人群颞下颌关节盘位置的核磁共振研究

目的 观察无症状志愿者颞下颌关节盘的位置,了解无症状人群中是否存在关节盘位置的异常,及其性别、左右侧分布特点.方法 无颞下颌关节病症状及病史的志愿者30名,共60例关节,其中男、女各15名,对其双侧颞下颌关节行开闭口轴位、斜矢状位和斜冠状位扫描,根据扫描结果对关节盘位置进行分类.结果 30名无症状志愿者中,正位关节盘45例,发生率为75%,其中女性20例,男性25例,右侧23例,左侧22例;前移位关节盘7例,发生率为11.67%,其中女性5例,男性2例,右侧5例,左侧2例;外侧移位关节盘6例,发生率为10%,其中女性3例,男性3例,右侧2例,左侧4例;内侧移位关节盘2例,发生率为3.33%,其中女性0例,男性2例,右侧0例,左侧2例;后移位关节盘0例,发生率为0.不同性别比较,差异无统计学意义(P>0.05),左右侧关节比较,差异无统计学意义(P>0.05).结论 无症状志愿者关节盘多为正位,但无症状人群的关节盘移位确实存在,且以前外侧旋转移位最为常见,关节盘移位类型与性别无关,左右侧分布无差异.     

Agreement between Research Diagnostic Criteria for Temporomandibular Disorders and magnetic resonance diagnoses of temporomandibular disc displacement in a patient population

The aim of this work was to evaluate the agreement between the clinical Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) examination and magnetic resonance (MR) findings of temporomandibular joint (TMJ) disc position abnormalities in a sample of clinically symptomatic patients, recruited from a population seeking TMD treatment. Two-hundred and thirty-two TMJs of 116 patients were evaluated to detect disc position abnormalities by means of a standardized clinical assessment according to RDC/TMD guidelines and MR performed blind by a radiologist. The overall kappa value for agreement between clinical examination according to RDC/TMD classification system and MR imaging for assessment of the disc-condyle relationship was fairly good (K=0.63). The kappa values for the agreement between RDC/TMD and MR diagnosis of disc displacement with reduction (DDR), disc displacement without reduction (DDNR) and normal disk position were 0.69, 0.57, and 0.61, respectively. The observation that clinically predicted cases of DDR and DDNR show good to excellent agreement with MR findings, and the potential MR over-diagnosis of DDR and DDNR in the absence of clinical symptoms, support the usefulness of a standardized examination conducted by a trained investigator in the evaluation of patients with TMD.     

Dynamic MR imaging of the temporomandibular joint and the related structures using 0.5 T unit: The normal study

Gradient-field-echo technique was employed to evaluate the movement of the temporomandibular joint meniscus and the related structures combined with the opening of the mouth for asymptomatic TM joints in the use of a 0.5 T super-conductive MR system. The examination for the mouth opening phase took less than one minute. The movement of the meniscus was clearly presented especially by using a cine-mode display. The signal intensity in the retro-meniscus and the lateral pterygoid muscle was increased by the opening. These findings indicate that the MR dynamic imaging may be promising in diagnosing not only the shape of the meniscus but also the function of the TM joint.     

Imaging temporomandibular disorders: Reliability of a novel MRI-based scoring system

The aim of this study was to assess the inter- and intrarater reliability of a recently proposed scoring system for temporomandibular disorders (TMD), based upon radiological findings from magnetic resonance imaging (MRI).Patients with clinically suspected uni- or bilateral TMD, and subsequently conducted MRI examination of both temporomandibular joints, were included in this study. MRI data were independently evaluated by two experienced radiologists according to the DLJ scoring system proposed by Wurm et al., which includes assessment of the following categories: articular disk (prefix ‘D’), direction of disk luxation (prefix ‘L’), and osseous joint alterations (prefix ‘J’).60 patients (49 female and 11 male) were eligible for analysis. No significant differences were found between both observers regarding ‘D’ and ‘L’ scores (p = 0.13 and p = 0.59, respectively). Significant differences were found for the assessment of subtle osseous changes (‘J0’ category: p = 0.041; ‘J1’ category: p = 0.018). Almost perfect intra- and interrater agreements were found for ‘D’ and ‘L’ categories (intrarater and interrater agreements for ‘D’: κ = 0.92 and κ = 0.84, respectively; intrarater and interrater agreements for ‘L’: κ = 0.93 and κ = 0.89, respectively). However, the assessment of ‘J’ categories revealed only moderate interrater agreement (κ = 0.49).The DLJ scoring system based upon MRI findings is feasible for routine clinical TMD assessment, and may help to simplify interdisciplinary communication between radiologists and clinicians.     

儿童颞下颌关节骨关节病的临床X线特征及追踪研究

目的　探讨儿童颞下颌关节骨关节病的临床、X线特征及预后等。方法　收集 1 6岁以下因颞下颌关节紊乱症状就诊儿童 348例 ,均无全身系统性疾病 ,血清学检查正常。结合临床及X线检查 ,诊断为儿童颞下颌关节骨关节病 40例 ,对其中 2 0例进行追踪观察。结果　儿童颞下颌关节骨关节病多见于女性 ,关节弹响为最常见症状 ,髁状突骨破坏为最常见的X线表现。结论　儿童颞下颌关节骨关节病的自然发展过程中临床症状及X线表现均可以加重 ,应引起临床重视     

颞下颌关节MRI技术的应用和进展

颞下颌关节疾病是较为常见的头颈部疾病之一。目前,磁共振成像(magnetic resonance imaging,MRI)已成为检查颞下颌关节的首选方法之一。本文简要介绍了应用于颞下颌关节解剖和疾病诊断的常规及特殊MRI方法(包括增强MRI、MR关节造影、动态MRI和三维MRI),并简述了这些技术的研究进展状况。