颞下颌关节骨关节病发病机制研究进展

颞下颌关节骨关节病发病机制至今未完全明了，因而其治疗尚未取得实质性突破。颞下颌关节骨关节病的发病机制已成为近年来国内外研究的重点，作者对近年来有关研究进展情况进行综述。     

颞下颌关节骨关节病动物模型的构建研究

目的建立能够很好地反映颞下颌关节骨关节病(temporomandibular joints osteoarthritis,TMJOA)的发病情况并为治疗打下良好基础的动物模型。方法选择37只新西兰白兔,分为实验组、阴性对照组和健康对照组,通过颞下颌关节(TMJ)内注射Ⅱ型胶原酶来诱导兔产生TMJOA,并动态全程观察4、8、12、16、20、24周兔颞下颌关节大体和组织病理学的发生、发展过程。结果随时间的延长,病变先是表现为逐渐加重,以后出现缓解趋势,实验组中均于4周后出现较明显的骨关节病损,其中12周组达到病变高峰,20、24周组出现局部修复现象。结论胶原酶注射后的兔颞下颌关节大体和组织病理学改变与人TMJOA的基本病理改变一致,具有良好的可比性和相似性,成功地构建了一种TMJOA的动物模型。     

透明质酸钠治疗颞下颌关节骨关节病的临床研究

目的研究透明质酸钠关节腔注射对颞下颌关节骨关节病的治疗效果。方法对22例颞下颌关节骨关节病患者进行透明质酸钠关节腔注射治疗,按照颞下颌关节Fricton指数进行治疗前后临床功能障碍指数评价。结果22例颞下颌关节骨关节病患者,治疗前功能障碍指数0.358,治疗后功能障碍指数0.144(P<0.05);治疗前疼痛指数5.96,治疗后疼痛指数1.62(P<0.05)。结论透明质酸钠关节腔注射治疗可减轻临床症状,促进功能恢复。     

颞下颌关节骨关节病动物模型的建立

为了研究胶原酶这一基质金属蛋白酶（ＭＭＰｓ）在骨关节病的发病机制中重要作用，本实验采用胶原酶关切腔内一次性注射方法，建立障碍 颞下颌关节骨关节病（ＴＭＪＯＡ）实验动物模型。该动物模型的建立为ＴＭＪＯＡ病理实质、发病机理及治疗方法的研究提供具了具有可比性的，便利的实验条件。     

颞下颌关节骨关节病临床病理研究

目的:研究颞下颌关节骨关节病的病理特点.方法:选取30例颞下颌关节骨关节病患者,均进行手术治疗.所有获取的新鲜标本用4%的福尔马林固定,然后用5%的甲酸脱钙,梯度酒精脱水,石蜡包埋,5 μm厚连续切片,HE染色,光镜观察.结果:关节软骨表层纤维毛糙,排列紊乱,纤维水肿,互相分离,有的纤维断裂,出现水平裂隙及垂直裂隙;增殖带变薄甚至消失,有的软骨层明显增厚,增殖带内未分化间充质细胞较多;肥大带内可见到较多软骨细胞,细胞内有空泡形成;钙化层与非钙化层之间出现明显的潮标线;密质骨变薄,软骨直接与松质骨骨髓腔相通.结论:骨关节病的主要病理特征表现为关节软骨的破坏和增生,有时伴随软骨下骨质的破坏与改建.     

透明质酸钠治疗颞下颌关节骨关节病的动物实验研究

目的:评价透明质酸钠对山羊颞下颌关节骨关节病的治疗效果。方法:对8只山羊的双侧颞下颌关节上腔一次性注射胶原酶而诱导骨关节病病变。分2组,4只/组。治疗组,透明质酸钠关节上腔封闭;对照组,关节上腔注射生理盐水。3月后处死,对髁突应用光镜和扫描电镜观察。结果:在光镜和扫描电镜下观察,对照组的髁突、关节盘、关节凹表现为骨关节病变化,治疗组骨关节病表现不明显。结论:通过3个月的观察和研究,证明透明质酸钠关节上腔封闭对颞下颌关节骨关节病具有显著疗效。     

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 。     

颞下颌关节骨关节病的病理改变特征

人颞下颌关节是具有特殊的功能，结构的滑液关节，它易于罹患骨关节病，本文对患ＴＭＪＯＡ时ＴＭＪ关节软骨、软骨下骨组织、关节滑膜、关节盘及关节滑液的各种病理改变进行了系统的描述。ＴＭＪＯＡ与颞下颌关节紊乱综合征及颞下颌关节内紊乱症密切相关，但其因果尚不明确。对ＴＭＪＯＡ病理改变特更深层次的研究对于揭示ＴＭＪ关节病的发病机理，准确、有效地进行该疾病诊治均具重要意义。     

透明质酸钠治疗颞下颌关节骨关节病的临床研究

目的:探讨透明质酸钠(Hyaluronate acid,HA)关节腔注射治疗骨关节病的临床效果.方法:选取经过颞下颌关节门诊治疗的早期OA患者20例行关节腔透明质酸钠注射治疗.20例患者中,男性8例,女性12例,年龄从16～68岁,平均年龄35.8岁.所有患者均进行颞下颌关节Fricton指数评价,进行术前及术后评分,并对所有患者术前进行颞下颌关节经颅侧位片及关节造影检查,治疗后6个月、12个月再进行侧位平片检查.结果:20例经HA治疗的早期OA患者,治疗前功能障碍指数0.358,治疗后功能障碍指数0.144,经统计学处理,有统计学意义(P<0.05);治疗前疼痛指数5.96,治疗后疼痛指数1.62,经统计学处理,有统计学意义(P<0.05).X线检查表明治疗前后关节间隙、骨质破坏等方面有明显好转.结论:HA关节腔注射能够有效地减轻早期OA患者的临床症状,阻止OA的进展,使其进入修复稳定期.     

颞下颌关节骨关节病基因治疗的研究进展

骨关节病是常见的关节退行性疾病,以软骨损伤为特征,常规治疗效果不理想,基因治疗作为新的技术近年来已经开始用于关节病的治疗.颞下颌关节是活动最频繁的滑膜关节之一,出生后即开始发生不断地改建,以适应不同年龄阶段咀嚼功能的需要,其结构与功能对于维持口颌系统的平衡起着重要作用.颞下颌关节虽然体积小,但却承担了相对较大的咀嚼力,因此较其他的大关节更容易发生骨关节病.本文对颞下颌关节骨关节病基因治疗的靶细胞、目的 基因和载体等的研究进展作一综述.     

Arthrocentesis with or without additional drugs in temporomandibular joint inflammatory-degenerative disease: comparison of six treatment protocols*

The aim of the present pilot investigation was to compare the effectiveness of six treatment protocols providing temporomandibular joint (TMJ) arthrocentesis with or without additional drugs to manage symptoms in patients with inflammatory-degenerative TMJ disease. A consecutive series of 72 patients with TMJ osteoarthritis (axis group IIIb) with pain lasting from more than 6 months were randomly assigned to one of the groups receiving the following treatment protocols: single-session two-needle arthrocentesis (A), single-session two-needle arthrocentesis plus corticosteroid (B), single-session two-needle arthrocentesis plus low molecular weight hyaluronic acid (HA) (C), single-session two-needle arthrocentesis plus high molecular weight HA (D), 5 weekly two-needle arthrocenteses plus low molecular weight HA (E) and 5 weekly single-needle arthrocenteses plus low molecular weight HA (F). At the 3-month follow-up, improvement with respect to mean baseline values was recorded in all the five treatment groups completing the protocol. No significant differences emerged between groups in any outcome variable. The protocol providing five sessions of two-needle arthrocenteses plus low molecular weight HA allowed achieving the highest improvement in almost all the outcome variables. Findings suggested that no statistically significant differences existed between the treatment groups. The clinical significance of these findings needs to be tested with future studies on larger samples with longer follow-up periods.     

Predictive factors of hyaluronic acid injections short-term effectiveness for TMJ degenerative joint disease

This study attempted to identify baseline predictors of positive outcome of arthrocenteses plus hyaluronic acid injections in degenerative temporomandibular joint disease (TMJ DJD). Ninety (n=90) consecutive patients with Research Diagnostic Criteria for Temporomandibular Disorders TMJ osteoarthritis (RDC/TMD 1.0 Axis I Group IIIb) underwent a cycle of five arthrocenteses with injections of 1mL hyaluronic acid and were followed up for 3months. Eight potential predictors of positive treatment outcome (sex, age, pain duration, baseline pain at chewing, presence of uni- or bilateral arthritis, presence of other concurrent RDC/TMD diagnoses, type of intervention and tolerability of treatment) were included in a logistic regression model to identify baseline predictors of treatment effectiveness. At follow-up, 85·6% of patients improved with respect to baseline VAS values, and 64·4% had a 50% or more decrease (positive outcomes). Correlation with positive outcomes existed only for unilateral osteoarthritis, and the logistic regression identified the side of arthritis (unilateral/bilateral) as the only predictor of positive treatment outcome (P=0·032). The achievement of any treatment improvement was predicted by high baseline pain levels (P=0·016). The regression models explained only 7·7-15% of the variance in the outcome variable. The attempts to find predictors of positive treatment outcome with HA injections for TMJ degenerative joint disease have been successful only in part. The search for other outcome predictors is likely to benefit from the assessment of psychosocial features associated with TMJ disorders.     

Chondrocyte clusters in the condylar cartilage of an ankylosed temporomandibular joint

A complete condyle specimen from a female patient who had temporomandibular joint (TMJ) ankylosis and associated craniofacial deformities was obtained. Abundant chondrocyte clusters were found in the remaining cartilage of the enlarged condyle. The implications of the clusters in this patient are discussed.     

Effectiveness of treatment with viscosupplementation in temporomandibular joints with or without effusion

The objective of this study was to determine whether the effectiveness of viscosupplementation with hyaluronic acid (HA) in patients with temporomandibular joint (TMJ) degenerative disorders depends on the presence of intra-articular effusion. In this study of case–control design, two groups of 25 patients were recruited: patients with a clinical diagnosis of painful chronic TMJ osteoarthritis and magnetic resonance imaging (MRI) signs of TMJ degeneration, with (effusion group) or without (no effusion group) MRI evidence of TMJ effusion. All patients underwent five weekly single-needle arthrocenteses plus medium molecular weight HA and 6 months of follow-up. Several clinical outcome parameters were assessed. For all variables, analysis of variance (ANOVA) for repeated measures was performed to assess the existence of significant within-group and between-group treatment effects. Over time, both groups showed significant improvements in all outcome parameters, which were maintained at the 6-month follow-up (P < 0.05). Between-group comparisons showed that the treatment effects did not differ significantly for either the primary outcome variable (pain levels: F = 0.849, P = 0.548) or secondary outcome variables (chewing efficiency: F = 0.854, P = 0.544; functional limitation: F = 1.35, P = 0.226; mouth opening: F = 0.658, P = 0.707). The null hypothesis that there are no differences in treatment effectiveness between patients with and without effusion could not be rejected.     

Temporomandibular joint osteoarthritis: an open label trial of 76 patients treated with arthrocentesis plus hyaluronic acid injections

This study is an open-label trial on a sample of 76 consecutive patients with temporomandibular joint (TMJ) osteoarthritis treated with a cycle of five weekly arthrocenteses plus hyaluronic acid injections. Patients had a diagnosis of osteoarthritis according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD Axis I Group IIIb). They underwent a cycle of five arthrocenteses with injections (1 per week) of 1 ml hyaluronic acid and four follow-up assessments after the end of the treatment (at 1 week, 1 month, 3 months, 6 months). At each appointment, several subjective and objective outcome variables were assessed to test the efficacy of the treatment protocol. Marked improvements were reported for all variables during the treatment phase. The improvements were maintained over the 6-month follow-up period. The p-value of the multivariate permutation test for the efficacy of the treatment over time (with Tippett's combination) was 0.001, and significant changes at the end of the follow-up period were detected for almost all the outcome variables. Data from this study lend further support to the usefulness of serial hyaluronic acid injections performed after arthrocentesis for the treatment of TMJ osteoarthritis and for the maintenance of improvements over a 6-month follow-up period.     

Differential expression of IGF1, IGFR1 and IGFBP3 in mandibular condylar cartilage between male and female rats applied with malocclusion

Summary This study was designed to investigate the expression differences of insulin‐like growth factor‐1 (IGF1), IGF type 1 receptor (IGFR1) and IGF‐binding protein‐3 (IGFBP3) in mandibular condylar cartilage between male and female rats with experimentally created malocclusion. A total of 40 male and 40 female rats were used, and malocclusion was created by moving the first molars mesially and the third molars distally in the experimental group. Animals were killed at the end of the second and fourth weeks. Haematoxylin and eosin (HE) staining was performed to monitor the changes in cartilage morphology and thickness. Immunohistochemistry and real‐time PCR were used to detect the expression of IGF1, IGFR1 and IGFBP3. Osteoarthritis (OA)‐like changes were observed in the experimental groups, with 2‐week females showing larger OA‐like regions than 2‐week males (P < 0·05). Compared to their age‐ and sex‐matched controls, both 2‐ and 4‐week males in the experimental groups displayed increased cartilage thickness in the posterior regions (P < 0·05). Compared to their age‐ and sex‐matched controls, the expression of IGF1 was lower in 2‐week female group (P < 0·05), but higher in 4‐week female, 2‐ and 4‐week male experimental groups (P < 0·05). Similarly, the expression of IGFR1 was lower in 2‐week female experimental group (P < 0·05), but higher in 2‐week male experimental group (P < 0·05). The higher expression of IGFBP3 was observed in 2‐week female, 2‐ and 4‐week male experimental groups (P < 0·05). These results indicate that condylar cartilage from male and female rats respond differently to the malocclusion in early stage of OA, with more serious degeneration in females.