急性和慢性不可复性盘前移位临床对比研究

目的　探讨颞下颌关节紊乱病不可复性盘前移位急性和慢性分类对临床诊断、治疗和预后的指导意义。方法　分析连续接诊的 10 0例不可复性盘前移位病例 (急性 4 5例、慢性 5 5例 ) ,比较两组之间临床主诉、开口度、颞下颌关节功能、髁突和关节盘的影像学改变。结果　急性不可复性盘前移位主诉开口受限 ,下颌运动功能严重障碍 ,大部分病例髁突骨质正常 ,关节盘形态良好 ;慢性不可复性盘前移位主诉多为开口痛和 (或 )咀嚼痛 ,下颌运动受限 ,部分病例伴有咀嚼肌疼痛 ,相当一部分病例髁突骨质吸收破坏 ,关节盘变形、变性 ,关节盘附着松弛、撕裂 ,甚至关节盘穿孔。结论　对急性不可复性盘前移位应早期采取积极的治疗 ,恢复良好的盘 突关系 ,阻止关节盘和髁突的进一步损伤。     

无牙牙合患者修复前后双侧颞下颌关节盘-髁关系的初步分析

目的:观察无颞下颌关节症状和体征的无牙颌患者修复前后双侧颞下颌关节(TMJ)盘-髁关系、关节腔积液及髁突骨质异常的变化。方法:通过8例无牙颌患者全口义齿修复前后双侧颞下颌关节的磁共振成像(MRI)检查,比较其修复前后双侧颞下颌关节MRI影像表现的差异。结果:修复前,8例无牙颌患者的16个关节中,10个关节盘移位(62.5%),包括7个关节盘内侧移位(43.8%),2个关节盘外侧移位(12.5%),1个关节盘前移位(6.25%);关节腔积液7个关节(43.8%);髁突骨质异常4个关节(25.0%)。修复后,8例无牙颌患者的16个关节中,10个关节盘移位(62.5%),包括7个关节盘内侧移位(43.8%)、2个关节盘外侧移位(其中1个关节盘外侧移位好转)和1个关节盘前移位(6.25%);关节腔积液7个关节(43.8%);髁突骨质异常4个关节(25.0%)。除1个关节的积液增加外,其余关节积液无变化。结论:长期缺牙可能引起无牙颌患者颞下颌关节的结构紊乱。无牙颌患者全口义齿修复后近期,关节盘移位、关节腔积液及髁突骨质异常无明显改变。     

透明质酸钠注射治疗不可复性关节盘前移位的CBCT影像学评价

目的:对比治疗前后CBCT影像,观察透明质酸钠治疗颞下颌关节不可复性盘前移位后髁突位置及形态变化.方法:对40例患者进行3次透明质酸钠关节上腔注射治疗.通过治疗前、治疗后3、9、12个月CBCT影像学检查及临床检查,从髁突位置形态变化、疼痛度(VAS)、最大开口度(MMO)、Fricton指数观察透明质酸钠对颞下颌关节不可复性关节盘前移位的治疗效果.结果:CBCT显示不可复性关节盘前移位伴骨关节病患者治疗前与治疗后9、12个月比较,髁突骨质有明显改建,骨面变得平整光滑,骨赘减小(P =0.026,P=0.001),部分单纯不可复性关节盘前移位患者治疗后9个月髁突可以向前移动(P=0.038);治疗后患者MMO增大,VAS减小(P＜0.05),Fricton指数降低.治疗后3～12个月Fricton指数无显著变化(P＞0.05).结论:CBCT显示透明质酸钠可促进已破坏髁突表面骨质改建,但不能使后移位的髁突回到关节窝中央.     

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。     

锥形束CT颞下颌关节上腔造影在诊断关节盘病变中的应用

目的探讨颞下颌关节（TMJ）骨关节病中关节盘前移位、穿孔及髁突骨质改变类型的关系。 方法选择中山大学附属口腔医院颞下颌关节专科就诊的96例骨关节病患者共145侧TMJ行锥形束CT（CBCT）关节造影检查,分为关节盘穿孔组和非穿孔组,两组病例以CBCT按照关节盘移位及髁突骨质改变类型进行分类比较,应用SPSS 18.0对关节盘穿孔与关节盘移位类型进行Pearson χ²独立性检验,两组间骨质分型构成比进行χ²检验。 结果所有关节发生关节盘前移位,其中123侧为不可复性盘前移位、22侧为可复性盘前移位。86侧TMJ发生关节盘穿孔,59侧关节造影未检出穿孔。关节盘是否发生穿孔与关节盘前移位类型存在相关性（χ²= 6.866,P= 0.015）,关节盘穿孔组不可复性盘前移位发生率（91.86%）高于非关节盘穿孔组（76.3%）。 结论TMJ骨关节病患者均存在不同程度的关节盘移位,关节盘移位类型与关节盘穿孔相关,髁突骨质改变类型与关节盘是否穿孔无明显相关性。     

关节盘复位锚固术术后稳定性的影像学评价

目的　通过MRI评价颞下颌关节盘复位锚固术术后稳定性及髁突的改建情况。方法　选择2009年2月至2017年7月在上海交通大学医学院附属第九人民医院口腔外科行关节盘复位锚固术的150例颞下颌关节盘前移位（anterior disc displacement,ADD）患者（210侧关节）。经术后1周和至少1年MRI随访,评估关节盘的位置和髁突骨质变化。随访期间若出现不可复性ADD,则认为术后复发,根据骨质状态,将髁突改变分为再生或吸收。结果　术后1周MRI显示所有移位关节盘均复位。经12～96个月（平均26.73 个月）的随访,MRI显示95.71%（201/210）的关节盘位置良好,而5.71%（12/210）的关节盘前移复发。77.62%（163/210）的髁突有新骨形成,20.48%（43/210）的髁突无骨质变化,1.90%（4/210）的髁突发生骨吸收。结论　关节盘复位锚固术是治疗ADD的有效手段,盘复位位置稳定,并能刺激髁突骨再生。     

青少年单侧颞下颌关节盘不可复性前移位对髁突高度的影响

目的 基于磁共振测量,研究青少年单侧颞下颌关节盘不可复性前移位对髁突高度的影响。方法 选择2010年1月—2013年6月就诊并行随访观察的单侧颞下颌关节盘不可复性前移位青少年患者124例,平均年龄16岁,平均随访时间13.6个月。在磁共振片上测量髁突高度、盘长度及盘移位距离,比较健、患侧以及随访前、后的差异。采用SAS 9.13软件包对所得数据进行统计学分析。结果 患侧关节盘移位距离从5.44 mm增大至6.83 mm（P<0.05）;患侧关节盘长度从9.06 mm缩短为8.12 mm（P<0.05）;健侧髁突高度从26.07 mm增加至26.82 mm（P<0.05）;患侧髁突高度从24.22 mm降低为23.81 mm（P<0.05）;健、患侧髁突高度差异从1.85 mm扩大为3.00 mm（P<0.05）。结论 在青少年单侧颞下颌关节盘不可复性前移位患者病程中,患侧器质性病变继续进展,可能是单侧关节盘移位患者发生下颌偏斜的主要原因。     

手法复位辅助

目的 探讨关节腔扩张后手法复位辅助再定位垫治疗颞下颌关节紊乱病急性不可复性盘前移位.方法 2%局麻药2～3 ml 注入关节上腔,手法复位解除不可复性前移位的关节盘,复位后即刻戴用再定位垫保持良好的盘-突关系.结果近期临床观察表明①开口度恢复,最大开口度从治疗前的25.8 mm增大到46.6 mm;②疼痛症状消失,疼痛分值视觉模拟尺从治疗前的2.62下降到0.43; ③颞下颌关节功能改善,Fricton关节功能障碍指数和颞下颌关节紊乱指数分别从治疗前的0.337和0.185下降到0.021和0.011.结论颞下颌关节紊乱病急性不可复性盘前移位药物治疗和理疗无效的情况下,关节盘复位辅助定位垫是一有效的治疗方法.远期效果如何尚需进一步观察.     

37例颞下颌关节盘不可复性前移位患者自然转归的临床及磁共振成像特征分析

目的 了解颞下颌关节盘不可复性前移位患者自然病程的临床、影像学变化及不同年龄段的差异性。方法 选择2016年1月—2023年6月在郑州大学第一附属医院口腔颌面外科就诊的颞下颌关节盘不可复性前移位患者37例（45侧）,男性4例,女性33例,平均年龄23.5岁,平均病程14.4个月。收集初诊及复诊时临床及磁共振成像（MRI）资料,测量关节盘的长度和厚度、关节盘前移角度、髁突高度,使用SPSS 25.0进行统计分析,比较临床及影像学的变化。结果 37例（45侧）患者复诊与初诊相比较：3例3侧自愈为可复性盘前移位;48.4%患者自觉张口受限未缓解或加重;58.3%患者张口疼痛无改善;54.5%咀嚼疼痛无改善;33.3%患者面部偏斜呈现加重趋势,仅1例缓解。关节盘前移角度从初诊时61.63°增长至67.81°,关节盘长度从8.20 mm缩短至7.27 mm,髁突高度从23.17 mm降为22.76 mm,以上差异有统计学意义（P<0.05）,髁突吸收比例上升。青少年组与成人组颞下颌关节盘不可复性前移位患者关节软硬组织变化的差异无统计学意义（P>0.05）。结论 在颞下颌关节盘不可复性...     

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.     

Efficacy of temporomandibular joint arthrocentesis with and without injection of sodium hyaluronate in treatment of internal derangements.

PURPOSE: This study was designed to investigate the efficacy of arthrocentesis with and without injection of sodium hyaluronate (SH) into the upper joint space in the treatment of temporomandibular joint (TMJ) internal derangements. PATIENTS AND METHODS: Forty-one TMJs in 5 males and 26 females aged 14 to 53 years comprised the study material. The patients' complaints were limited mouth opening, TMJ pain and tenderness, and joint noises during function. Patients were randomly divided into 2 groups in which only arthrocentesis was performed in 1 group and arthrocentesis plus intra-articular injection of sodium hyaluronate was performed in the other group. Both groups contained patients with disc displacement with reduction and with closed lock. Clinical evaluation of the patients was done before the procedure, immediately after the procedure, on postoperative day 1, and at 1, 2, 3, 4, 5, 6, 9, 12, 18, and 24 months postoperatively. Intensity of TMJ pain, jaw function, and clicking sounds in the TMJ were assessed using visual analog scales. Maximal mouth opening and lateral jaw movements also were recorded at each follow-up visit. RESULTS: Both techniques increased maximal mouth opening, lateral movements, and function, while reducing TMJ pain and noise. CONCLUSIONS: Although patients benefitted from both techniques, arthrocentesis with injection of SH seemed to be superior to arthrocentesis alone.     

Comparison of treatment efficacy between hyaluronic acid and arthrocentesis plus hyaluronic acid in internal derangements of temporomandibular joint

The aim of the study was to compare the effectiveness of hyaluronic acid (HA) injection and arthrocentesis plus HA injection for treating disc displacement with reduction (DDwR) and disc displacement without reduction (DDwoR). In this randomized clinical trial, patients were divided into 2 main groups: group I (DDwR) and group II (DDwoR). Sub-groups were made depending on allocated treatment: group Ia (arthrocentesis plus HA), group Ib (single HA), group Ic (control), group IIa (arthrocentesis plus HA), group IIb (single HA), and group IIc (control). The primary outcome variable was maximum pain on chewing, while maximum pain at rest, maximum non-assisted and assisted mouth opening, chewing efficiency, temporomandibular joint (TMJ) sounds, quality of life, treatment tolerability, and treatment effectiveness were secondary outcomes. The influences of individual study variables (gender, involved side, and duration of symptoms) on clinical outcomes were also examined. The study consisted of 116 TMJs of 90 patients (n = 45 in both main groups, TMJs = 58) aged 15–82 years. At the 6-month follow-up, improvement in all parameters, except for TMJ sounds, was recorded in all treatment groups, with no improvements in control groups. Notably, arthrocentesis plus HA showed superior improvement in chewing efficiency (p = 0.041) and quality of life (p = 0.047) of group I and quality of life (p = 0.004) in group II, compared to single HA. Furthermore, the duration of symptoms correlated with clinical outcomes. Both procedures successfully improved the symptoms of DDwR and DDwoR patients, but arthrocentesis plus HA injection seemed superior.     

Efficacy of Temporomandibular Joint Arthrocentesis with Sodium Hyaluronate in the Management of Temporomandibular Joint Disorders: A Prospective Randomized Control Trial

Purpose

This study was designed to investigate the efficacy of the temporomandibular joint arthrocentesis with and without injection of sodium hyaluronate (SH) in the treatment of temporomandibular joint disorders.

Patients and Methods

A total of sixty two TMJs in 34 males and 28 females aged 20–65 years comprised the study material. The patients’ complaints were limited mouth opening, TMJ pain, and joint noises during function. Patients were randomly divided into 2 groups in which arthrocentesis plus intra-articular injection of sodium hyaluronate was performed in 1 group and only arthrocentesis was performed in the other group. Both groups contained patients with disc displacement with reduction and without reduction. Clinical evaluation of the patients was done before the procedure, immediately after the procedure, at 1 week and 1, 3 and 6 months postoperatively. Intensity of TMJ pain was assessed using visual analog scales. Maximal mouth opening and lateral jaw movements also were recorded at each follow-up visit.

Results

Both techniques increased maximal mouth opening, lateral movements, and function, while reducing TMJ pain and noise.

Conclusions

Although patients benefitted from both techniques, arthrocentesis with injection of SH seemed to be superior to arthrocentesis alone.

     

Intra-articular injection of tenoxicam following temporomandibular joint arthrocentesis: a pilot study

This study examined the clinical and radiological effects of intra-articular tenoxicam injection following arthrocentesis and compared them with arthrocentesis alone in patients with disc displacement without reduction (DDwoR). 24 temporomandibular joints (TMJs) in 21 patients with DDwoR were studied. Patients were divided randomly into Group A in which only arthrocentesis was performed (14 TMJs in 14 patients) and Group AT which received arthrocentesis plus intra-articular injection of tenoxicam (10 TMJs in 7 patients). Patients were evaluated before the procedure, on postoperative day 7, then 2, 3, 4 weeks, and 2, 3, 4, 5, 6 months postoperatively. Intensity of joint pain was assessed using a visual analog scale. Maximum mouth opening was recorded at each follow-up. TMJ sounds and palpation scores were noted as positive or negative. Magnetic resonance imaging (MRI) was performed before and 6 months after treatment in both groups. Disc form, disc location during neutral position, reduction with movement, joint effusion, structures of the articular surfaces, and bone marrow anomalies were evaluated all in MRIs. Both treatments succesfully increased maximum mouth opening and reduced TMJ pain; there were no complications. Difference between the groups was not statistically significant and a larger controlled study is necessary to clarify this use of tenoxicam.     

单纯透明质酸注射治疗对颞下颌关节功能和结构的影响

目的：利用MRI评价颞下颌关节功能和结构在透明质酸治疗前后的变化。方法：选取经过颞下颌关节门诊治疗的TMJ结构紊乱患者23例行单纯关节上腔透明质酸钠注射治疗。23例患者中,男性3例,女性20例,年龄16~58岁,平均年龄27.8岁。利用MMO及VAS评价患者颞下颌关节功能治疗前后的变化;并对所有患者进行治疗后颞下颌关节MRI检查,评价颞下颌关节结构变化。结果：23例经HA治疗的患者,治疗前MMO 25.90、VAS5.78。治疗后MMO 35.12、VAS1.42,经统计学处理,有统计学意义（P〈0.05）。MRI检查显示治疗后23例患者中均未发现颞下颌关节盘复位。结论：单纯经关节上腔注射HA治疗颞下颌关节结构紊乱可有效改善患者功能,但对颞下颌关节结构无明显影响。     

Internal Derangement of Temporomandibular Joint: An Evaluation of Effect of Corticosteroid Injection Compared with Injection of Sodium Hyaluronate after Arthrocentesis

Aims and Objectives

Internal derangements are the commonest disorders of temporomandibular joint (TMJ). Different treatment modalities including conservative and surgical methods have been proposed to treat the same. Arthrocentesis is gaining popularity in the treatment of internal derangement of TMJ. Being minimally invasive it does not have the demerits of surgical approaches and at the same time is producing better results than conservative approaches. This study evaluates and compares corticosteroid and sodium hyaluronate after arthrocentesis in the treatment of internal derangement of TMJ.

Materials and Methods

Sixteen patients with internal derangement were randomly selected and divided into 2 groups (8 in each group). Arthrocentesis of the upper joint space was then performed using Ringer lactate under local anaesthesia followed by injection of either betamethasone or sodium hyaluronate into the joint. Clinical data was collected in the form of pain (visual analog scale), maximum mouth opening, joint sound and deviation before and after treatment up to 6 months.

Results

Both groups of patients were benefited from the treatment at the 6 month follow up and there was slightly less intensity of pain in sodium hyaluronate group compared with corticosteroid group. Maximum mouth opening was also increased in both groups. A decrease in clicking and deviation were seen in both groups. There was no statistically significant difference between betamethasone and sodium hyaluronate.

Conclusion

Intra articular injection of corticosteroid or sodium hyaluronate after arthrocentesis had considerable effect on the TMJ. Both betamethasone and sodium hyaluronate can be used after arthrocentesis with similar results.     

Prognostic indicators of the outcome of arthrocentesis with and without sodium hyaluronate injection for the treatment of disc displacement without reduction: a magnetic resonance imaging study

This study analysed the prognostic factors for successful arthrocentesis with and without sodium hyaluronate (SH) injection for the treatment of temporomandibular joint (TMJ) disc displacement without reduction (DDwoR) using clinical and radiological results. 29 TMJs in 25 patients with DDwoR were included. Patients were treated with arthrocentesis or arthrocentesis followed by intra-articular (i.a.) injection of SH. Treatment was evaluated for postoperative range of maximum mouth opening and the degree of postoperative pain on a VAS. Prognostic factors analysed were age, sex, duration of locking, trauma history, previous TMJ treatment, depression, bruxism, malocclusion and missing teeth. Degenerative changes were evaluated as probable prognostic factors. After treatment, 24 joints (83%) fulfilled the criteria for success. Duration of locking and present preoperative degenerative changes were the most significant factors for treatment outcome. The results suggest it is sufficient to use only arthrocentesis in patients without preoperative degenerative changes and arthrocentesis with SH in patients with degenerative changes on their preoperative MRIs, but because there were some significant differences between the two groups preventing the authors from comparing them statistically, they cannot come to that conclusion. To clarify the use of SH in such cases, standardized study groups are necessary for future studies.     

透明质酸钠关节下腔注射治疗颞下颌关节盘前移位的疗效分析

目的：探讨透明质酸钠治疗颞下颌关节盘前移位的临床疗效。方法：50例患者临床表现与核磁共振成像检查确诊为颞下颌关节盘前移位（可复性或不可复性）,进行关节下腔灌洗及透明质酸钠注射治疗.观察分析治疗前、治疗1、2、3次和治疗后3个月临床疗效和Helkimo指数分析。结果：治疗1、2、3次、治疗后3个月与治疗前相比较,临床疗效及Helkimo指数差异有统计学意义（P〈0.05）,治疗3次与治疗后3个月差异无统计学意义。结论：应用透明质酸钠关节腔注射治疗颞下颌关节盘前移位具有良好的效果,治疗效果稳定。     

应用颞颌关节镜治疗颞颌关节盘前移位的临床研究

目的：探讨颞颌关节镜治疗颞颌关节不可复性盘前移位的临床应用效果。方法：对98例颞颌关节不可复性盘前移位患者分别采用颞颌关节镜进行关节盘前松解复位灌洗、关节上腔粘连松解灌洗、单纯关节上腔灌洗等治疗方法,通过观察疼痛程度、张口度及侧向运动度的改变,评价其临床疗效。结果：灌洗治疗后患者张口度、侧向运动度和疼痛程度较治疗前均明显改善。关节盘前松解复位灌洗组和粘连松解灌洗组治疗后疼痛减少值、张口度及侧向运动度增加值明显高于单纯灌洗组。关节盘前松解复位灌洗组在张口度增加值及疼痛减少值的改变优于粘连松解灌洗组。结论：关节上腔灌洗可以作为颞颌关节内紊乱疾病的有效治疗方法,而针对不可复性盘前移位的患者,颞颌关节镜下关节盘前松解复位灌洗治疗则具有更好的疗效。     

Analysis of post-treatment electromyographs in patients with non-reducing disc displacement of the temporomandibular joint

The purpose of this study was to clarify the electromyographic property of chewing movement before and after treatment in patients with non-reducing disc displacement of the temporomandibular joint (TMJ). Twenty patients who were diagnosed with unilateral non-reducing disc displacement of the TMJ were treated by pumping and injection of sodium hyaluronate into the joint. Chewing movement in these patients was evaluated by electromyography (EMG) at the initial visit and at mean 19-month follow-up and the results were compared. Chewing movement in 23 normal controls were also examined. Duration of contraction, cycle time and integrated value at the initial visit which were different from those in the controls without TMJ dysfunction tended to be at the control level mean 19 months after treatment of pumping and injection of sodium hyaluronate into the joint in patients with non-reducing disc displacement of the TMJ. Electromyography appeared to be a method of documenting the chewing movement which was impaired at initial visit improved after treatment in patients with non-reducing disc displacement of the TMJ.