兔颞下颌关节盘前移位的X线研究

目的　通过影像学检查了解颞下颌关节盘前移位的病理变化过程,证实关节盘前移位与退行性改变之间的关系。方法　在手术组动物一侧关节区显露颞骨颧突根部,用丝线垂直穿过关节盘前带的延伸部并拉缝线向前并固定,使颞下颌关节盘前移位。手术对照组的手术步骤与手术组相同,但不缝合关节盘前带的延伸部,也不将关节盘位向前方。正常对照组5只,手术组和手术对照组动物术后1、2、4、8、10、12和16周分别处死。拍摄关节X线片,观察38只兔颞下颌关节X线表现。将兔左、右关节区锯成组织块,肉眼观察兔关节盘的位置。结果　手术组关节盘位置与形态均发生了改变,13侧为部分关节盘前移位,完全性关节盘前移位为11侧,关节盘穿孔为9侧。部分关节盘前移位出现关节间隙狭窄或消失,髁状突骨密度增高。完全性关节盘前移位与关节盘穿孔表现为髁状突骨质增生、破坏及肥大,关节结节磨平以及硬化。结论　颞下颌关节盘前移位可导致关节骨质改变。完全性关节盘前移位和关节盘穿孔与骨关节病的关系密切。     

家兔一侧颞颌关节手术非手术侧髁状突表面扫描电镜观察

目的　观察一侧颞下颌关节手术对非手术侧颞颌关节的影响。方法　通过扫描电镜观察对比研究一侧家兔关节髁状突高位切除加关节盘摘除术后 ,对非手术侧颞颌关节髁状突表面的影响 ,并与相同月龄的正常家兔关节进行比较。结果　颞下颌关节髁状突高位切除加关节盘摘除术会对非手术侧关节产生影响 ,主要表现为髁状突表层结构遭到破坏 ,如网状胶原纤维暴露 ;凝胶样物质剥脱、堆积、表面裂缝、缺损和胶原纤维暴露、断裂及崩解等。结论　一侧颞颌关节手术可导致非手术侧颞下颌关节髁状突表层结构的退行性改变     

家兔-侧颞颌关节手术非手术侧髁状突表面扫描电镜观察

目的 观察一侧颞下颌关节手术对非手术侧颞颌关节的影响。方法 通过扫描电镜观察对比研究一侧家兔关节髁状突高位切除加关节盘摘除术后，对非手术侧颞颌关节髁状突表面的影响，并与相同月龄的正常家兔关节进行比较。结果 颞下颌关节髁状突高位切除加关节盘摘除术会对非手术侧关节产生影响，主要表现为髁状突表层结构遭到破坏，如网状胶原纤维暴露；凝胶样物质剥脱、堆积、表面裂缝、缺损和胶原纤维暴露、断裂及崩解等。结论 一侧颞颌关节手术可导致非手术侧颞下颌关节髁状突表层结构的退行性改变。     

颞下颌关节盘前移位后髁突软骨细胞基质基因表达的变化

目的　探讨颞下颌关节盘前移位后髁突软骨细胞基质基因表达的变化。方法　建立40只大白兔颞下颌关节盘前移位动物模型,用地高辛标记cRNA探针原位杂交技术,检测术后不同病变时期髁突软骨细胞Ⅱ型胶原和蛋白多糖聚合体基因表达的改变。结果　正常髁突的增殖层深层、肥大层和钙化层细胞胞浆内可见大量Ⅱ型胶原和蛋白多糖聚合体mRNA表达。术后1周蛋白多糖聚合体开始下调,至2周达低谷,6周后恢复至正常水平。Ⅱ型胶原4周后开始持续下降,其表达下降程度较蛋白多糖聚合体显著,8周后逐渐恢复正常。结论　关节盘前移位后髁突软骨的基质基因表达发生有序、协调的变化,这种变化意味着适应性改建的启动。     

下颌前伸后大鼠颞下颌关节盘的组织学和组织化学研究

应用组织学和组织化学的方法，对幼年ＳＤ雄性大鼠功能矫形前伸下颌后颞下颌关节盘的变化进行研究。结果显示；功能矫形前伸下颌后，关节盘胶原纤维束排列致密，前后向排列明显，纤维束粗大，关节盘后分软骨细胞增多，糖胺多糖及强硫酸化氨基己糖含量增加；未发现关节盘有病理性改变。提示关节盘随的翼外肌张胃衣髁突压     

颞下颌关节紊乱症薛氏位平片,上腔造影对比研究

本文通过55例颞下颌关节紊乱症99侧关节薛氏位平片和上腔造影X线影象对比分析,对平片所显示之髁状突位置,骨结构改变与造影片中所见之关节盘、关节囊等软组织病变的相互关系进行了研究。指出:颞下颌关节紊乱症患者平片所示髁状突位置不能提示关节盘移位方式和程度。髁突状骨结构改变多伴有关节盘破坏。关节盘移位多出现关节囊前份松弛。关节囊粘连关节骨结构吸收性改变和关节盘穿孔密切相关。关节囊粘连多见于关节囊内侧份。     

颞下颌关节盘穿孔改良外科手术治疗的实验研究

颞下颌关节囊内髁状突高位削切加关节盘复位术是近年治疗关节盘穿孔、移位的一种改良手术式。本实验用健康成年山羊６只,模拟临床造成双侧颞下颌关节盘穿孔的动物模型,并于一侧颞下颌关节施以髁状突高位削切术,通过对比观察该手术式对盘穿孔组织的修复及影响。结果见关节盘穿孔自身有一定修复能力,关节囊内髁状突高位削切术侧,穿孔关节盘完全恢复,而对侧关节盘穿孔末修复。     

髁状突骨折与颞颌关节骨性强直关系的初步探讨

目的　探讨髁状突骨折与发生颞颌关节骨性强直的关系。方法　对 2 8例有髁状突骨折病史的颞颌关节骨性强直患者 ,术前拍颞下颌骨全景X线片 ,CT横断或冠状扫描 ,部分病侧同时行二维和三维重建 ,并与外伤后X线片对照。在施行颞颌关节成形关节重建术中 ,采用颧弓根水平高位截骨 ,探查髁状突和关节盘的存在。结果　 2 8例伤后的X线片均提示 :发生颞颌关节强直的病例为髁状突高位 (囊内 )横断骨折。而且 ,髁状突骨折块移位大 ,下颌升支明显上移。术前冠状CT显示髁状突移位于关节骨性强直区的内侧 ,上移的下颌升支与关节窝骨性融合。术中探查发现 2 0例 2 2侧有明显移位的完整的髁状突和关节盘。结论　在髁状突颈部高位 (囊内 )横断骨折病例 ,若髁状突骨折块发生严重移位、脱出关节窝外 ,可同时伴发关节盘移位。而下颌升支则在升颌肌群牵引下明显上移 ,形成对关节窝的继发损伤 ,最终导致颞颌关节骨性强直。对该类髁状突骨折应积极开放复位固定     

兔颞下颌关节盘前移位后髁突软骨细胞Fas及Caspase-8表达研究

目的:研究颞下颌关节盘前移位后髁突软骨细胞的凋亡途径.方法:17只日本大白兔随机分组,实验组行右侧颞下颌关节手术,人工造成颞下颌关节盘前移位,分别经1、2、4周后处死动物,Western blot法检测髁突关节软骨Fas、caspase-8表达.结果:实验组较对照组Fas、caspase-8蛋白含量增加,且术后4周内其表达随时间的延长而增加.结论:Fas与其配体相互作用在颞下颌关节盘前移位后引起的关节软骨细胞凋亡中可能起到重要作用.     

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。     

Experimental induction of anterior disk displacement of the rabbit craniomandibular joint: an immuno-electron microscopic study of collagen and proteoglycan occurrence in the condylar cartilage

BACKGROUND: Results from our previous studies suggest that surgical induction of anterior disk displacement (ADD) in the rabbit craniomandibular joint (CMJ) leads to histopathological alterations consistent with osteoarthritis. In addition, molecular changes in collagens and glycosaminoglycans (GAGs) were observed using immunohistochemistry. The purpose of the present study was to further characterize those molecular changes in collagens and GAGs using immuno-electron microscopy. METHODS: The right joint of 15 rabbits was exposed surgically and all discal attachments were cut except for the posterior attachment (the bilaminar zone). The disc was then repositioned anteriorly and sutured to the zygomatic arch. The left joint was used as a sham-operated control. Ten additional joints were used as non-operated controls. Mandibular condyles were removed 2 weeks following surgery and processed for light and immuno-electron microscopy using colloidal gold-labeled antibodies against collagen type I, II, VI and IX and against keratan sulfate, chondroitin-4 and -6-sulfate, and link protein. RESULTS: Light microscopic results showed osteoarthritic changes. Immuno-electron microscopy of osteoarthritic cartilage demonstrated a decline in type II collagen, the abnormal presence of type I collagen and loss of type VI and IX collagens. Quantitative colloidal gold immuno-electron microscopy confirmed the depletion of keratan sulfate, chondroitin-4 and -6-sulfate, and link protein in osteoarthritic cartilage. CONCLUSION: Anterior disk displacement leads to molecular alterations in both the collagen and the proteoglycans of rabbit condylar cartilage characteristic of osteoarthritis in other synovial joints. These alterations are consistent with loss of the shock absorber function of the cartilage and injury of the underlying bone.     

颞下颌关节盘前移位和穿孔的关节内窥镜研究

目的 :探讨颞下颌关节内窥镜下颞下颌关节盘移位和关节盘穿孔的病理改变特征。方法 :76例 84侧临床诊断为颞下颌关节盘前移位以及关节盘穿孔的病例进行颞下颌关节内窥镜检查。结果 :可复性关节盘前移位的病例出现滑膜炎 ,关节腔内有絮状物 ,关节结节表面有纤维形成。不可复性关节结节表面纤维形成 ,关节软骨软化 ,软骨剥脱 ,同时伴有纤维粘连。关节盘穿孔大多数位于双板区与后带。关节盘穿孔出现滑膜增生 ,关节窝及关节结节表面纤维形成 ,软骨剥脱甚至骨质暴露。结论 :关节内窥镜检查可诊断关节盘前移位与关节盘穿孔 ,并能发现病理性改变 ,如滑膜炎 ,滑膜增生 ,纤维变性 ,软骨软化 ,关节内粘连等。在不可复性盘前移位病例中发现关节退行性改变 ,关节盘穿孔为严重的骨关节病。     

兔关节盘前移位后髁突软骨PRG4 mRNA表达改变的研究

目的 分析兔颞颌关节盘前移位后髁突软骨PRG4 mRNA表达的动态改变及其意义。方法 62只日本大耳白兔,48只建立关节盘前移位的动物模型,分期处死。6只为手术对照组,8只为空白对照。合成兔PRG mRNA探针,原位杂交检测关节盘前移位后髁突软骨PRG4 mRNA表达的动态改变。结果 PRG4 mRNA表达于髁突全层软骨。关节盘前移位后,PRG4 mRNA表达一过性升高,8周后回落至正常。4只样本术区骨关节病样表现,软骨崩解区域PRG4 mRNA的表达水平显著下降。结论 关节盘前移位后,髁突软骨细胞PRG4 mRNA一过性升高以保护髁突软骨表层的完整性,促进滑液润滑,有利于实现关节的适应性改建。?     

颞下颌关节盘前移位关节盘及盘后区超微结构变化的实验研究

目的通过建立关节盘前移位实验动物模型的方法,研究颞下颌关节盘前移位后关节盘及盘后区早期超微结构的变化。方法10只兔左侧关节经手术诱导为关节盘前移位模型,右侧为手术对照组;2只为正常对照组。术后24小时、1周、2周、3周、4周,麻醉下活体各切取2只手术组实验动物同一部位的关节盘和关节盘后区组织,制成透射电镜标本观察。结果关节盘组织中软骨样细胞逐渐增多,细胞周围的淡区逐渐变小并消失,胞浆中微丝增加,胶原纤维间排列紊乱数量减少,并见新生毛细血管及神经纤维,最后软骨样细胞转化为纤维母细胞和肌纤维母细胞。盘后区早期出现幼稚的软骨样细胞,有排列相对致密的胶原纤维,最后转化成类似于关节盘样组织。结论颞下颌关节盘前移位后,关节盘失去纤维软骨盘的特性转化为纤维结缔组织;盘后区则由疏松的结缔组织变成纤维软骨盘样组织。     

Histopathological changes in rabbit craniomandibular joint associated with experimentally induced anterior disk displacement (ADD)

Several studies have shown that anterior disk displacement (ADD) of human temporomandibular joint (TMJ) can lead to cellular and extracellular alterations in the disk proper, bilaminar zone (BZ), condyle, articular eminence and synovial membrane. Due to lack of an animal model for this disease, it is not known whether the mechanical displacement of the disk could lead to the observed histopathological changes. The purpose of this experiment was to investigate the histopathological changes that occur in the rabbit craniomandibular joint (CMJ) following surgical induction of ADD. The right CMJ was exposed surgically and the discal attachments were severed except for the BZ attachments. Then the disk was displaced anteriorly and sutured to the zygomatic arch. The left joint served as surgical control. The CMJs were removed after 24 h, 1 week, 2 weeks or 6 weeks and stained with H&E or modified Masson stain. The results showed neovascularization, cell clustering and fibrillation of the displaced disk. The BZ showed marked fibrosis. The condyle showed subchondral hemorrhage and fibrosis followed by osteoarthritic changes in the articular cartilage. The articular eminence showed chondrocytic clustering and an increase in the amount of chon-droid bone. Synovial membrane exhibited marked hyperplasia. We concluded that surgical induction of ADD in the rabbit CMJ leads to cellular and extracellular alterations in the disk proper, BZ, condyle, articular eminence and synovial membrane similar to those described previously in human ADD. It appears that the mechanical trauma resulting from ADD could lead to a cascade of reparative and degenerative changes of the affected joints similar to those described for osteoarthritis.     

An animal model for inducing anterior disc displacement of the temporomandibular joint

AIMS: To develop an animal model of anterior disc displacement (ADD) without the need for opening the temporomandibular joint (TMI) capsule. METHODS: Thirty-two healthy adult Japanese white rabbits were used in this study. Four rabbits were dissected to familiarize the investigators with the anatomy of the TMJ. Sixteen animals were subjected to surgical ADD in the right TMJ, 8 animals had a sham operation, and 4 animals were not operated (normal controls). Four rabbits from the experimental ADD group and 2 from the sham group were sacrificed 1, 2, 4, and 8 weeks, respectively. The rabbits in normal control group were sacrificed at the beginning of the experiment. Animal behaviors as well as macro- and microchanges in the TMJs were investigated. RESULTS: Fifteen right TMJ discs in the 16 experimental rabbits were successfully displaced anteriorly, and the degree of ADD in the experimental group was similar. The mandible of each ADD rabbit deviated to the left side with inclined attrition of the incisors. Some histologic changes appeared in the experimental TMJs. CONCLUSION: This ADD technique without the need for opening the TMJ capsule is effective, and the model is suitable for studying ADD of the TMJ.     

兔关节盘前移位后髁突软骨细胞中OPG和OPGL的表达及意义

目的:探讨关节盘前移位后髁突软骨中护骨素(osteoprotegerin,OPG)及其配体(osteoprotegerinligand,OPGL)表达的变化及意义。方法:20只日本大耳白兔,16只用弹力丝牵引关节盘前伸部,建立颞下颌关节盘前移位的动物模型,分别于术后1、2、4、8周处死。2只行模拟手术作为手术对照组,术后2周处死;另2只不行手术,作为空白对照。取颞下颌关节标本,HE染色,观察其镜下结构,SP免疫组化法检测髁突软骨中OPG和OPGL的表达与分布,并对各标本OPG和OPGL的表达进行灰度测定。用单因素方差分析法对所得数据进行统计学分析。结果:各实验组动物术后体重无明显减轻,伤口愈合良好,大体及显微镜下观察,关节盘明显前移位。OPG和OPGL在各组髁突软骨的增殖层及肥大层浅层均有表达,其中关节盘移位组OPG、OPGL染色较强,染色灰度值与对照组均有显著性差异(P<0.05),但OPG/OPGL比率基本稳定。结论:关节盘移位后OPG和OPGL的表达均有升高,可能参与关节盘移位后髁突软骨病变的发展及转归。     

An animal model for studying mechanisms in human temporomandibular joint disc derangement

: A method for producing disc displacement is presented in which remodeling events in the disc and posterior attachment (PA) are similar to those occurring in patients suffering from disc displacement (DD). : Thirty-three adult New Zealand White rabbits were used in this study. A unilateral anterior DD was surgically induced in 18 animals. Six animals were sham operated and nine animals served as controls. : Macroscopically, DD was associated with gross thickening of the posterior band (PB), shortening of the disc anteroposteriorly, flexure of the intermediate zone (IZ), and loss of the biconcave shape. Microscopically, dramatic internal structural changes were observed in displaced discs, including extensive collagenous fiber reorganization and changes in cell morphology associated with a generalized loss of metachromatic staining. As in humans, the disc displacement caused abnormal loading of the PA and remodeling of this tissue into a disc-like structure characterized by the appearance of coarse collagenous fiber bundles and scattered chondrocytes surrounded by a matrix-containing cartilage-like glycosaminoglycans (GAGs). : These pathoanatomic changes bear a remarkable similarity to those described in human disc derangements and support the use of this method as an experimental model for the study of remodeling events in human DD arthropathies.