翼外肌在创伤性颞下颌关节骨强直中的病理性作用

目的:创伤性颞下颌关节强直病理学机制仍不清楚,本研究目的是验证翼外肌在创伤性颞下颌关节骨性强直病理学机制中的作用.方法:7只6个月大的雄性绵羊,双侧颞下颌关节模拟髁突矢状骨折,关节盘外侧1/3切除建立创伤性颞下颌关节骨强直绵羊动物模型.左侧颞下颌关节作为实验组,切断左侧翼外肌;右侧关节作为对照组,保留右侧翼外肌.所有绵羊均在术后12周实施安乐死.所有颞下颌关节复合体通过大体解剖、螺旋CT、显微CT、组织病理学等检查进行评估.结果:大体解剖发现,对照组颞下颌关节发生了骨强直,而实验组颞下颌关节只发生纤维粘连;螺旋CT和显微CT检查发现,与实验组比较,对照组颞下颌关节间隙可见钙化影像,上下关节面可见新骨长入关节间隙的不规则钙化影像,对照组的髁突最大内外径及最大前后径明显大于实验组;显微CT显示,两组所有显微结构参数均有统计学差异(P<0.05),对照组髁突新生骨小梁总体表达方向与翼外肌的牵拉方向一致,而实验组髁突骨折区新生骨小梁的主要方向与翼外肌的牵拉方向不一致;组织病理学检查发现,对照组关节发生了骨强直,但实验组无骨强直发生.结论:当髁突发生矢状骨折时,翼外肌对骨折块有牵拉(类似牵张成骨)的病理性作用是创伤性颞下颌关节骨强直发生的重要因素.     

Temporomandibular Joint Osteoarthrosis and Temporomandibular Joint Hypermobility

For studying the relationship between condylar hypermobility of the temporomandibular joint (TMJ) and osteoarthrosis (OA), 13 patients with bilateral condylar hypermobility were evaluated clinically and radiographically, 30 years after non-surgical treatment. The evaluation included range of motion, joint and muscle tenderness to palpation, joint sounds and masticatory function. Radiographs of the TMJs were evaluated for the absence or presence of degenerative changes. The hypermobile group (HG) was compared with a control group (CG) (n= 13). The CG was evaluated in the same way as the HG. Statistics included t-tests (to compare ranges of motion in the HG over time and to compare ranges of motion in HG and CG), non-parametric tests (to compare tenderness of muscles and joints, joint sounds, masticatory function and radiographic changes over time in the HG). The tests were also used to compare the same variables between the HG and CG group. The groups' only difference was the presence of radiographic signs of OA. In the HG the number of joints with radiographic degenerative changes increased significantly over time and was significantly higher than the CG. Clinically and functionally, the HG and CG did not differ. Therefore, it is concluded that TMJ hypermobility is a subsidiary factor in the development of TMJ OA.     

Tissue Reactions of the Temporomandibular Joint Following Retrusive Guidance of the Mandible

Tissue reactions in monkey temporomandibular joints (TMJs) were studied following retrusive guidance of the mandible. Eleven adult Macaca fascicularis monkeys were used (four experimental animals and seven controls). Interferences between intercuspal position and retruded position were eliminated in the experimental animals. Bilateral interferences were then introduced to guide the mandible into retruded position during mouth closure. The experimental period lasted for five weeks.

After radiographic examination, the joints were histotechnically processed, and sagittal sections were taken throughout the joints for light microscopy. In contrast to the untreated animals, the experimental monkeys demonstrated pathological changes in the posterior band of the disk and posterior disk attachment. The flattening of the posterior band of the disk that occurs with retrusive guidance may predispose subjects to anterior disk displacement.     

Nuclear Magnetic Resonance Imaging of the Temporomandibular Joint: Preliminary Observations

Magnetic resonance imaging (MRI) is a new technique used by radiologists to give images of the body in a manner similar to that of computed tomography (CT). This is done without ionizing radiation, and the technique has no known biological aftereffects. MRI promises to replace CT scanning in the diagnosis of many disorders throughout the body. We feel that it has the potential to replace arthrography and CT in diagnosing internal derangements of the temporomandibular joint. This report briefly explains the principles of MRI and describes our initial experience in obtaining images of the disk of the temporomandibular joint.     

Cinematic Study of Temporomandibular Joint Motion Using Ultra-fast Magnetic Resonance Imaging

Magnetic Resonance Images (MRI) of the temporomandibular joint (TMJ) are usually performed to study the opening/closing movements of the mandible and have up to now been pseudodynamic step-by- step images simulating condylar motion by post-processing reconstruction. The aim of this study was: 1. to optimize a TMJ cine-imaging method to give a better clinical result than the step-by-step methods; 2. to develop an ultra-fast MRI Gradient Echo (GE) sequence for this purpose; and 3. to analyze condylar movements in the sagittal, coronal and para-axial planes during border mandibular displacements and chewing. Both TM joints were studied in six asymptomatic volunteers. The method involved a compromise between in-plane resolution, slice thickness, signal-to-noise ratio and time resolution. Routine clinical use was found to be a GE pulse sequence providing three images per second with an isometric voxel resolution of approximately two millimeters in ridge. This did not allow visualization of the disk. Using this sequence enabled real and simultaneous condylar displacement observation in the three planes of space and therefore contributed to a better functional diagnosis of pathologic TMJ motions.     

纯钛金属片为间置物防止颞颌关节强直术后复发

目的 通过植入纯钛金属片为间置物，观察是否能减少颞下颌关节真性强直术后的复发。方法 作者在1995－2000年的5年中对46例颞下颌关节真性强直患者在进行关节重建手术同时均以纯钛金属片做为间置物植入，并在手术后1年随访，测量并记录张口度。结果 46例患者中只有2例复发，术后复发为4％，复发率较低。结论 该方法可以有效地防止颞颌关节真性强直重建术后复发，操作简便而且技术容易掌握。     

Cine-CT of the Temporomandibular Joint

This article describes a new imaging device, the cine-CT scanner, and its application in diagnosing internal derangement of the temporomandibular joint. This scanner has a rapid operating time that allows motion to be evaluated in the form of a video computed tomography examination. In this way, reducible anteriorly displaced disks can be directly imaged and evaluated. Advantages of cine-CT over conventional CT include rapid imaging, decreased radiation dose and evaluation of joint dynamics.     

Facial Skeleton Remodeling Due to Temporomandibular Joint Degeneration: An Imaging Study of 100 Patients

One hundred patients with recently acquired, externally visible mandibular deformity and no history of previous extraarticular mandible fracture were selected for retrospective analysis. All had been investigated clinically and with radiography, tomography, and high-field surface-coil MR imaging to determine the presence or absence and extent of temporomandibular joint degeneration. Temporomandibular joint degeneration was found in either one or both joints of each patient studied. Chin deviation was always toward the smaller mandibular condyle or more diseased joint, and many patients either complained of or exhibited malocclusion, often manifested by unstable or fluctuating occlusion disturbances. Three radiologically distinct forms of degenerative vs adaptive osteocartilaginous processes—(1) osteoarthritis, (2) avascular necrosis, and (3) regressive remodeling—involving the mandibular condyle and temporal bone were identified in joints most often exhibiting meniscus derangement. Osteoarthritis and avascular necrosis of the mandibular condyle and temporal bone were generally associated with pain, mechanical joint symptoms, and occlusion disturbances. Regressive remodeling was less frequently associated with occlusion disturbances, despite remodeling of the facial skeleton, and appears to result from regional osteoporosis. Forty patients (52 joints) underwent open arthroplasty procedures, including either meniscectomy or microsurgical meniscus repair, at which time major radiologic diagnoses were confirmed. Surgical and pathologic findings included meniscus displacement, disk degeneration, synovitis, joint effusion, articular cartilage erosion, cartilage healing/fibrosis, cartilage hypertrophy, osseous sclerosis, osteophyte formation, osteochondritis dissecans, localized or extensive avascular necrosis, and decreased mandibular condyle mass and vertical dimension.

We conclude that temporomandibular joint degeneration is the principal cause of both acquired facial skeleton remodeling and unstable occlusion in patients with intact dentition and without previous mandible fracture.     

关节源性颞下颌关节痛患者关节内窥镜检查结果

目的　探讨颞下颌关节紊乱病伴关节源性关节痛患者的关节腔内状况。方法　对20例颞下颌关节紊乱 病伴关节源性关节痛患者(按Truelove等关于颞下颌关节紊乱病的诊断分类标准确定)的23侧颞下颌关节先后进 行X线片检查和关节内窥镜检查。结果　关节镜下23侧关节内至少存在1种不同程度的腔内病变,最多有6种病 变共存。结论　局限于颞下颌关节的关节痛可能与关节腔内病理改变有关,可能是炎症(滑膜炎)引起疼痛。     

Temporomandibular Joint Osteoarthrosis and Generalized Joint Hypermobility

Peripheral joint mobility of temporomandibular joint (TMJ) osteoarthrosis and internal derangement patients (n = 25) and of a control group (n = 29) was measured according to a rigidly standardized protocol, in order to study the relationships between TMJ osteoarthrosis and internal derangement and generalized joint hypermobility. No significant differences in peripheral joint mobility between the two groups were found. Therefore, generalized joint hypermobility cannot be considered as a predisposing factor for TMJ osteoarthrosis.