髁突骨软骨瘤并发滑膜软骨瘤病的临床治疗:附3例报道

目的 :探讨颞下颌关节骨软骨瘤并发滑膜软骨瘤病的诊断与治疗。方法 :回顾2001—2013年颞下颌关节骨软骨瘤和滑膜软骨瘤病患者的临床资料,最终确诊为原发性骨软骨瘤并发滑膜软骨瘤病患者共3例。对病史、临床表现、影像学检查和病理特征,以及之后3个月~5年的随访结果进行总结。结果:CT和MRI可提供精确的术前诊断,骨软骨瘤中发现游离软骨化或钙化小体,提示骨软骨瘤并发滑膜软骨瘤病可能。结论:治疗过程中需注意游离小体的存在,常提示骨软骨瘤并发滑膜软骨瘤病的可能,以免漏诊或误诊。     

颞下颌关节滑膜软骨瘤病3例临床分析

目的:探讨颞下颌关节滑膜软骨瘤病的临床特点。方法:报告3例(3侧)颞下颌关节滑膜软骨瘤病,对其临床表现、影像、诊断及治疗进行分析。结果:3例患者均有关节区疼痛(3/3),2例开口受限(2/3),1例关节区肿胀(1/3)。3例X线平片均见关节间隙增宽(3/3),2例关节造影发现关节内占位性改变(2/3),1例CT显示颅底骨质破坏(1/2),1例MRI发现关节腔积液和游离体(1/1),关节镜检查可早期诊断本病(3/3)。3例患者均行开放性关节手术。结论:颞下颌关节滑膜软骨瘤病临床上罕见,无特征性临床表现,好发于关节上腔。需结合影像学、关节镜和病理学进行诊断,游离体是最重要的特征。本病需手术治疗,常用手术方法为关节切开后行游离体和受累滑膜切除。     

颞下颌关节滑膜软骨瘤病2例报告

结合2例颞下颌关节滑膜软骨瘤病的临床表现,X线、CT和MRI特征,以及术中所见,分析发生于颞下颌关节的滑膜软骨瘤病的临床特点、诊断及治疗方法.2例患者术前均有关节区疼痛、肿胀,无开口受限.X线片见颞下颌关节间隙增宽,其中1例CT显示颞下窝关节面骨质破坏并硬化,MRI可见关节腔内多发小结节状影.术后未出现咬合紊乱及开口受限.颞下颌关节滑膜软骨瘤病少见,临床表现无特异性,好发于关节上腔,钙化性游离体是其影像学特征,组织病理学常见软骨结构样小体,伴周围组织慢性炎症及纤维增生,一般需手术治疗.     

颞颌关节镜诊治滑膜软骨瘤病附一例报道

多数学者[1]认为滑膜软骨瘤病是一种滑膜化生,多见于大关节,通常单侧患病,其中膝关节患病率最高,其次分别为肘、腕、肩及髋关节[1,2]。TMJ患此病罕见[1]。以往的术前诊断依靠关节片、CT和MRI,但如果软骨体过小,且无钙化现象,则不易被检出[2～4]。本文介绍对关节腔灌洗出的软骨样游离体行病理检查以明确术前诊断的方法,及一例经关节镜手术治疗滑膜软骨瘤病的经验,并进行讨论。1　病例报道患者女,44岁,自1993年9月感左耳前区疼痛,进食时加剧,并向颞区放射,颌运动中左颞颌关节区有连续摩擦音。曾经针灸、药物等治疗,无效,现症状渐加剧。于1…     

内镜辅助开放性手术治疗颞下颌关节滑膜软骨瘤病36例临床分析

目的:利用内镜辅助开放性手术治疗颞下颌关节滑膜软骨瘤病,探讨其适应证及应用效果。方法 :选择2010年9月—2015年2月间收治的36例滑膜软骨瘤病患者,术前进行临床资料采集及影像学检查,明确诊断并确定病灶范围。对其中病变位于关节上腔,且MRI冠状位重建上显示关节囊内侧沟扩张低于髁突内侧嵴而未达颞下间隙的患者,选择开放性手术配合内镜行游离体摘除,并彻底进行关节囊及滑膜清扫。术后临床检查关节-颌骨-咬合情况并进行远期影像学随访,以评价应用效果。结果:36例患者先行开放性手术摘除关节腔内可见游离体,再利用内镜行关节上腔探查,发现14例患者在内侧沟、前后隐窝等区域存在游离体残余,配合杯状钳取出,最后行关节囊清扫和病变滑膜切除,术后病理提示滑膜软骨瘤病。术后33例患者完成随访,其颞下颌关节功能恢复良好,咬合及面型稳定,平均33.3个月的磁共振随访显示无肿瘤复发。结论:颞下颌关节镜辅助开放性手术可观察关节腔各个位置,以彻底清除病灶,避免术中截骨和病灶残留,减小手术创伤并缩短手术时长,是传统手术方案的有力补充。     

171例颞下颌关节滑膜软骨瘤病MRI分析

目的 通过分析颞下颌关节滑膜软骨瘤病（synovial chondromatosis, SC）的磁共振成像（magnetic resonance imaging, MRI）特点,对其在MRI影像上进行分型,并通过MRI影像探讨其潜在侵袭性。方法 收集2004年4月—2015年12月间治疗的171例颞下颌关节滑膜软骨瘤病患者的MRI影像资料。依据MRI特点,将瘤体分为游离体型、均质型以及混合型;依据骨质破坏程度分为无侵袭期、软骨破坏期、骨吸收期以及骨穿孔期,对两者关系以及术中所见进行对比分析。应用SAS 16.2软件包对数据进行χ²检验或Fisher检验。结果 游离体型患者55例（32.16%）,均质型84例（49.12%）,混合型32例（18.71%）。术中所见,70例（40.94%）有关节窝骨质破坏,而MRI无法识别软骨破坏期。14例骨穿孔期患者中,11例（78.57%）属于均质型,3例（21.43%）属于混合型;与无侵袭期患者相比,存在显著差异（P=0.009）。2例患者复发,均为均质型。结论 在MRI影像上,均质型和混合型滑膜软骨瘤病更具有侵袭性,应行滑膜切除术,甚至部分截骨术。     

颞下颌关节滑膜软骨瘤病的研究进展

颞下颌关节滑膜软骨瘤病是一种临床上少见的疾病，其发病率低，症状不具特异性，普通检查不易发现，保守治疗无效。本文综述近年来对该疾病的认识，有助于颞下颌关节滑膜软骨瘤病的诊断与治疗。     

自体耳廓软骨瓣置换或重建颞下颌关节盘MRI评价

目的　通过磁共振成像 ( MRI)对自体耳廓软骨瓣修复关节盘的术后情况进行评估 ,以观察软骨生长情况。方法　对 11例关节病患者 13侧关节进行自体耳廓软骨瓣移植修复关节盘手术 ,所有患者均经临床检查和信访答卷进行随访 ,症状均得到缓解 ,并对其中 5例患者 (滑膜软骨瘤病和关节强直各 1例 ,结构紊乱 2例 ,骨关节病 1例 )行 MRI检查。结果　 MRI矢状位、张闭口位及冠状位扫描均显示移植软骨无明显破碎或吸收。结论　 MRI可作为检测软骨生长情况的指标之一 ,自体耳廓软骨瓣置换 /重建关节盘是可行的手术方式     

颞下颌关节滑膜软骨瘤病:病例报告及文献复习

发生于颞下颌关节的滑膜软骨瘤病非常少见。主要临床表现有:耳前区肿块并可有触痛、开口受限、开口型歪斜、开闭口过程中关节区有杂音等。当关节积液过多时,可穿通关节窝骨板向颅内生长,出现面瘫、耳聋等。X线平片表现为关节活动受限,关节间隙增宽,骨关节面粗糙、增生等,有时可显示钙化程度较高的游离体。CT对于发现游离体相当灵敏,同时也能发现关节腔增宽。MRI对于关节腔积液显示十分清楚。该病的治疗以摘除游离体和切除病变的滑膜为主,术后一般不复发。若在短期内复发,应注意有无恶变的可能。     

颌面颈部恶性肿瘤侵犯颈动脉的CT诊断

目的　研究颌面颈部恶性肿瘤侵犯颈动脉的CT诊断价值。方法　共收集记录完整、经手术切除治疗的颌面颈部恶性肿瘤 5 3例 (5 5侧病变 )。所有病例均在术前行横断面增强CT检查 ,并与其手术结果对照。结果　CT检查显示颈动脉的异常表现形式有 5种类型 :Ⅰ型 :动脉受压变形(6侧病变 ) ;Ⅱ型 :动脉移位 (15侧病变 ) ;Ⅲ型 :肿瘤围绕颈部血管超过 180°(8侧病变 ) ;Ⅳ型 :位于肿瘤和颈动脉之间的脂肪带或筋膜部分或完全消失 (2 5侧病变 ) ;Ⅴ型 :动脉壁缘模糊 (12侧病变 )。手术记录显示 :2 0侧颌面颈部恶性肿瘤与颈动脉粘连 ,其中 14侧病变的CT异常表现呈多样性 (70 % )。对照手术记录 ,上述CT异常表现的敏感性、特异性和准确率分别为 :30 0 % ,10 0 0 %和 74 .5 % (Ⅰ型 ) ;2 0 .0 % ,6 8.6 %和 5 0 .9% (Ⅱ型 ) ;2 2 .2 % ,10 0 .0 %和 4 9.1% (Ⅲ型 ) ;90 0 % ,80 0 %和 83.6 % (Ⅳ型 ) ;4 5 0 % ,88.6 %和 72 .7% (Ⅴ型 )。结论　颌面颈部恶性肿瘤侵犯颈动脉的CT表现以多样性表现为主。尽管存在不足 ,但部分CT征象 (Ⅰ型、Ⅲ型和Ⅳ型 )对准确判断颌面颈部恶性肿瘤侵犯颈动脉仍具有一定的参考价值     

双侧拉杆式口腔矫治器治疗阻塞性睡眠呼吸暂停综合征的临床应用

目的探讨双侧拉杆式口腔矫治器在阻塞性睡眠呼吸暂停综合征（OSAS）治疗中的应用价值。方法用双侧拉杆式阻鼾器治疗OSAS患者18例，3-5个月后复查主观症状及多导睡眠图（PSG）。结果该矫治器的耐受率为89％，鼾声、白日嗜睡、夜间憋醒、口干及咽痛等症状改善或消失，PSG五项监测结果治疗前后有显著性差异，症状明显改善。结论该矫治器制作简单，戴用舒适，易于推广应用。     

Low stimulation of peripheral lymphocytes, following in vitro application of Emdogain®

Abstract. Fast tissue regeneration after therapeutic manipulations is a central problem of periodontology, oral surgery and trauma of the periodontal tissues, including bone. Several products, which augment tissue regeneration, have been manufactured and assayed in clinical practice with positive results. Emdogain® is a recent addition in this field, as a tissue-regenerating product. The substance is a derivative of amelogenin, obtained from porcine embryonic tissues. At the present time, it is not known whether the substance can induce a local (due to the uptake of the substance) or systemic immune response. The aim of the present study was to evaluate, in vitro, the ability of Emdogain® to influence, in vitro, the immune system. Peripheral blood lymphocytes, isolated for 10 healthy donors, were cultured in the presence of various concentrations of the substance, in order to determine the rate of cell proliferation, the expression of surface antigens and the production of cytokines and immunoglobulins. Under our experimental conditions, Emdogain® produced a slight increase of the proliferation of lymphocytes, restricted to the CD25 (IL-2 receptor) fraction of the CD4 positive T-lymphocytes, and a concomitant decrease of CD 19 positive B-lymphocytes. Other cell fractions (CD8 positive T-cells. B-cells and NK-cells) were not affected. Under our conditions too, immunoglobulin and cytokin (IL-2 and IL-6) production was not modified, even after a 3-day application of concentrations much higher than those used in clinical practice. Our data suggest that Emdogain® slightly induce an immune response, restricted to the activated fraction of CD4 T-lyniphocytes in vitro.     

杀灭幽门螺旋杆菌是治疗扁平苔藓的一种有效方法

为了探索扁平苔藓（ＬＰ）与系统疾病的关系，本研究以系统因素中的消化系统为背景，对１５０例ＬＰ患者进行严格分组进行治疗，结果显示：（１）病理性舌苔１４６例（９７．３％），其中１２０例伴有不同程度的口臭（８０％）。（２）在１５０例胃粘膜活检标本中，１２０例为ＨＰ阳性（８０％）。据此，我们采用杀灭幽门螺旋杆菌（ＨＰ）治疗以观察疗效，其中，单纯铋剂疗法呈联合疗法组怀传统疗法组在显效率与总有效率方面均有显著     

牙龈卟啉单胞菌超声提取物对人牙周膜干细胞骨向分化的影响

目的 本研究目的是检测牙龈卟啉单胞菌(Porphyromonas gingivalis,P.gingivalis)2561超声提取物对人牙周膜干细胞(Human periodontal ligament stem cells,hPDLSCs)的增殖及其骨向分化相关蛋白表达的影响.方法 标准厌氧培养环境下培养P.gingivalis.收集细菌菌落,离心,制备细菌的超声提取物,然后以不同的浓度加入hPDLSCs的培养液中.培养六天后观察hPDLSCs的增殖及碱性磷酸酶(Alkaline phosphatase,ALPase)的表达.提取蛋白并用Western Blotting检测骨黏结蛋白(Osteonectin,ON)的表达.结果 与对照组相比,P.gingivalis明显抑制hPDLSCs的生长(P＜0.05),显著降低了hPDLSCs中ALPase的表达(P＜0.05);1μg/ml P.gingivalis上调ON的表达,而100μg/ml P.gingivalis明显下调ON的表达.结论 这些结果提示作为牙周炎病原菌,大量的P.gingivalis可能,至少部分通过抑制hPDLSCs的增殖及其骨向分化能力,抑制了牙周炎症所致牙周组织破坏后牙周组织的自我修复能力.     

正常成人颞颌关节的CT和MRI影相分析

本文对10名正常成人双侧TMJ进行了CT扫描,其中3名作了MRI扫描。对所有CT片作了TMJ骨性结构的三维分析,观察了正常人髁状突和关节凹的形态类型,并发现双侧形态均为同型,双侧髁状突运动范围一致。同时,还用CT软组织窗位相(闪烁相)对关节盘进行了正中(牙合)位和尽力开口位的观察,并用MRI对其结果加以证实。本研究所得结果较其它方法准确,更具有可比性。因为本研究选用CT对双测TMJ进行同时扫描,消除了以往X光片需分侧和多种投照检查所造成的误差。     

Oral lichen planus: an immunohistochemical study of heat shock proteins (HSPs) and cytokeratins (CKs) and a unifying hypothesis of pathogenesis

The expression of heat shock proteins HSP60 and HSP70 and cytokeratins CK1/10 and CK7/18 were compared in epithelium of oral lichen planus (OLP) lesions and oral fibromas using an avidin-biotin-peroxidase complex (ABC) immunohistochemical method. An immunostaining intensity distribution (IID) index was developed to assess staining intensity and the proportion of positively stained cells in different layers of the epithelium. The expression of HSP60 in the basal layer was significantly higher in OLP than in fibromas. No difference in HSP70 expression was evident between OLP and fibromas. The expression of CK1/10 in the epithelial basal and suprabasal layers was significantly higher in OLP than in fibromas. There was no demonstrable staining for CK7/18 in either OLP or fibromas. A significant correlation was evident between the expression of HSP60 and CK1/10 in the basal epithelial cells in OLP. The findings support a role for HSP60 in the pathogenesis of OLP. A unifying hypothesis of the pathogenesis of OLP, involving two sequential immune reactions, is proposed.     

牙周韧带细胞与骨髓基质细胞表面抗原表达的比较

目的：比较骨髓基质细胞与正常人牙周韧带细胞表面抗原的表达情况,探讨牙周韧带细胞与骨髓基质细胞的关系。方法：体外培养人牙周韧带细胞及骨髓基质细胞,采用免疫组化SP法检测细胞中CD14、CD44、CD105、CD34的表达,并进行图像分析。结果：与骨髓基质细胞相似,人的牙周韧带细胞上表达CD44、CD105,不表达CD34、CD14结论：人的牙周韧带细胞与骨髓基质细胞在表面抗原特性上有相似性。     

A model for internal derangement and osteoarthritis of the temporomandibular joint with experimental traction of the mandibular ramus in rabbit

OBJECTIVES: The purpose of this study is to make a model of internal derangement (ID) and osteoarthritis (OA) by postero-superior displacement of the mandible in the rabbit temporomandibular joint (TMJ). MATERIALS AND METHODS: Sixteen Japanese white rabbits (8 months old) were subjected to traction of the mandibular ramus in the postero-superior direction unilaterally using elastic force and five rabbits were used as the control. The operations were performed without surgical invasion of the TMJ capsule. Temporomandibular joint tissue was removed after 4 weeks and Technovit and paraffin sections with or without decalcification were observed histologically. RESULTS: In contrast to the control group, it showed anterior disc displacement, disc deformity, resorption of subchondral bone and osteophyte formation in the drawing side of the experimental group. Intra-articular fibrous adhesions were observed in both sides. CONCLUSION: It is concluded that posterosuperior displacement of the mandible caused ID and OA in the rabbit TMJ. This model may contribute to the understanding of the etiology of human temporomadibular disorders (TMD).     

透明质酸酶诱导兔颞下颌关节骨关节病的实验研究

目的：建立兔颞下颌关节骨关节病动物模型。方法：将不同浓度透明质酸酶（ＨＤ）一次性注入两组兔颞下颌关节下腔内,分别于注射后２４ｈ、１、４、８、１２周后处死动物,对颞下颌关节标本进行组织学观察。结果：注射ＨＤ４周后出现关节软骨破坏,关节盘腔原纤维暴露,滑膜慢性炎症等骨关节病表现。结论：本实验研究建立了颞下颌关节骨关节病模型可用于颞与颌关节骨关节病早、中期病变的研究 。     

Is the osseointegration of immediately and delayed loaded implants the same?—comparison of the implant stability during a 3‐month healing period in a prospective study

Objectives: The objectives of the present study were (1) to compare the stability of delayed loaded (DL) and immediately loaded (IL) ITI SLA implants during the first 3 months of the healing period using resonance frequency analysis (RFA) and (2) to determine the factors that affect implant stability during the healing period.
Materials and methods: To compare implant stability, RFA was performed on two groups of patients (12 patients received 25 IL implants and 47 patients received 79 DL implants) with a total 104 ITI SLA implants. Implant stability was measured directly by RFA at implant placement and consecutively once a week for 12 weeks. Statistical analyses were carried out to study implant stability differences between IL and DL groups.
Results: One of the 25 implants in the IL group failed, and no implant was lost in the DL group. Implant stability between the IL and DL groups showed a statistically significant difference ( P <0.05). The mean implant stability quotient of all measured implants from implant insertion to 12 weeks was 72.88 ± 5.39 for the DL and 75.86 ± 3.60 for the IL types. The lowest stability was at 4 weeks for DL implants (mean: 71.58 ± 5.11) and 2 weeks for IL implants (mean: 71.33 ± 2.97). In both groups, bone types I and II showed higher implant stability than bone type III ( P <0.05).
Conclusions: The findings of this study indicate that differences in osseointegration between IL and DL implants may be predicted according to differential implant stability.