超声引导膝关节腔注射对患者满意度、关节功能和生活质量的影响

【摘要】 目的 评估接受超声引导定位和体表解剖定位膝关节腔注射复方倍他米松对患者满意度、关节功能和生活质量方面是否存在差异。方法 选取2018年10月到2019年12月64例膝关节腔注射患者分为超声引导定位组和体表解剖定位组。分别于治疗前、治疗后即刻（注射后15～30 min）、治疗后5周进行膝关节VAS疼痛评分,同时评估治疗后即刻和治疗后5周患者满意度以及膝关节损伤和骨关节炎预后评分（KOOS）。结果 有5例患者失访,最终59例患者进入最终分析（超声引导定位组30例,体表解剖定位组29例）。治疗后即刻及治疗后5周超声引导定位组VAS疼痛评分显著低于体表解剖定位组（1.63±1.60比4.05±2.50,P=0.001）及（2.91±1.96比5.88±3.42,P=0.003）; 治疗后即刻及治疗后5周超声引导定位组的患者满意度评分显著高于体表解剖定位组（4.76±0.27比3.97±0.96,P=0.002）及（4.55±0.93比3.21±1.57,P=0.031）;超声引导定位组在随访的第5周其KOOS评分中的症状、疼痛、活动、娱乐功能和生活质量评分均有显著的改善（P＜0.05）。 结论 超声引导膝关节腔注射可增强患者的诊疗体验并提高满意度,并显著改善膝关节腔注射的临床疗效。     

板对颞下颌关节紊乱病治疗作用及对脑血流的影响

颞下颌关节（TMJ）为人体结构复杂的关节之一，参与咀嚼、语言等多项复杂性生理功能，活动很灵活，易受损伤，人群发病率很高，但统计数字差异较大。颞下颌关节紊乱病（TMD）症状复杂，一般有颞下颌关节区及相应的软组织包括肌肉的疼痛；下颌运动异常和伴有功能障碍；关节弹响、破碎声及杂音等三类症状，可伴有头痛、眼及耳部症状，影响咀嚼功能并可引起全身不适。颞下颌关节紊乱病针对不同的病因和致病机制有多种治疗方法，     

腭裂术后下颌关节紊乱的病因分析及治疗效果观察

目的探讨腭裂术后出现的颞下颌关节紊乱病的病因及治疗方法。方法根据颞下颌关节紊乱病的临床症状及病因,采取不同的治疗方法,如局部热敷、按摩咀嚼肌、口服止痛药、给予心理暗示和安慰等。结果经上述治疗后几乎所有患者的颞下颌关节区疼痛及张口受限均在短期内消失,仅有少数患者仍有颞下颌关节区弹响。结论腭裂修补术后并发颞下颌关节紊乱病极其常见,但经积极治疗后,多数患者的临床症状可在短时间内消失,预后较好。     

封闭冲洗与单纯封闭治疗颞下颌关节紊乱效果比较

颞下颌关节紊乱病 (ＴＭＤ)是口腔颌面部常见疾病。传统的糖皮质激素关节腔内封闭注射治疗疗效并不十分理想 ,且可导致病变的滑膜组织块分离脱落进入关节腔 ,成为炎症激惹物[1] 。关节腔注射糖皮质激素后再行关节腔冲洗可能会使糖皮质激素治疗ＴＭＤ的疗效更显著。为此 1999年 5月～2 0 0 0年 3月 ,我们分别使用关节腔注射糖皮质激素后 ,再行关节腔加压冲洗和关节腔内仅注射糖皮质激素两种方法治疗ＴＭＤ ,以比较两者的疗效。1　对象和方法1 1　对象　 60例中 ,男 3 2例 ,女 2 8例 ;年龄 15～60岁 ,平均 2 4 5岁。术前检查包括临床检查、许…     

关节腔内给药治疗颞下颌关节炎临床研究

目的评价关节腔内给药治疗颞下颌关节炎的临床效果。方法将280例颞下颌关节炎患者随机分为观察组和对照组,每组各140例。对照组给予超短波物理治疗,观察组于关节腔内注射透明质酸钠抗炎治疗。观察并对比治疗后两组患者症状、体征改善情况。结果治疗后,观察组患者有效率(97.86%)优于对照组(91.43%),差异有统计学意义(P<0.05)。结论关节腔内给药疗效优于物理治疗,且具有治疗次数少、治疗时间短等优点,适于临床推广。     

浮针治疗颞下颌关节紊乱综合征36例

颞下颌关节紊乱综合征是临床上最为常见的疾病,治疗上极为棘手,笔者从2000~2005年运用浮针疗法,治疗颞下颌关节紊乱综合征36例,取得了满意的效果,现报道如下:临床资料(1)一般资料:36例中男性24例,女性12例;其中早期患者33例,中期患者3例;单侧患病者13例,双侧患病者23例。年龄26~48岁,平均34.6岁。病程5~46 d,平均18 d。临床主要表现为颞下颌关节疼痛,关节弹响,张口和咀嚼困难。经X光摄片检查,符合颞下颌关节紊乱综合征诊断标准。(2)治疗方法:在患侧颞下颌关节处常规消毒,选用5号肌肉注射针头,在距耳门4 cm处进针,针尖对着耳门,以15~20°角…     

不是牙病的"张嘴疼"

近日，笔者的一位同学打电话来说，他因从小左侧牙齿不好，常用右侧牙齿咀嚼食物。最近一段时间，他感觉吃东西或开口说话时，右侧颞下颌关节部疼痛，尤其是打哈欠和大声说笑时，疼痛更加明显，并且张大口时颞下颌关节部有弹响。到医院一检查，方知患了颞下颌关节紊乱综合征。颞下颌关节是颌面部惟一可以活动的联动关节，有咀嚼、语言、吞咽与表情等功能。在两侧升颌肌群、降颌肌群的协调作用下，它可以完成开闭口、前伸、侧方等各种生理功能运动。如果咀嚼肌群失衡，颞颌关节各组成部分之间的功能、结构失常，甚至出现器质性破坏，就会引起…     

穴位注射治疗颞下颌关节紊乱综合征56例

颞下颌关节紊乱综合征是口腔颌面部常见疾病之一。近年来,我们采用穴位注射治疗颞下颌关节综合征56例,疗效满意。现分析报告如下。     

颞下颌关节内紊乱影像解剖及磁共振诊断

颞下颌关节内紊乱（TMJID）指关节盘和关节面之间的位置及功能异常,是引起颞下颌关节疼痛及颞下颌关节紊乱病（TMD）的最主要的原因。本文就颞下颌关节内紊乱的磁共振成像特征及影像解剖基础进行综述。     

玻璃酸钠关节腔填充对踝关节骨折后创伤性关节炎的疗效分析

目的探讨玻璃酸钠关节腔填充对踝关节骨折后创伤性关节炎的疗效及安全性。方法将2006年12月—2010年7月收治的95例患者作为研究对象,随机分为观察组(n=47)和对照组(n=46),其中观察组患者骨折术后关节腔填充玻璃酸钠,对照组仅进行常规功能恢复性锻炼。结果两组患者治疗前VAS评分及ROM均无统计学差异,治疗后VAS评分均有明显降低,ROM明显改善,而观察组VAS及ROM改善程度明显优于对照组;观察组不良反应率为4.26%,对照组为19.57%,观察组不良反应及无痛行走能力均明显优于对照组。结论术后关节腔填充注射玻璃酸钠能够显著降低患者关节红肿、疼痛现象,对提高关节活动范围、降低并发症有重要意义,且安全性良好。     

Incremental hydraulic jaw opener for MR imaging of the temporomandibular joint.

Magnetic resonance (MR) imaging in the open- and closed-mouth positions is the method of choice for visualizing the temporomandibular joint (TMJ). To analyze the TMJ in response to various degrees of mouth opening, the authors constructed a hydraulic incremental jaw opener. This apparatus enables obtaining of reproducible and stable positions of TMJ articulation. With modified gradient pulse sequences, the technique yields good spatial resolution of joint anatomy, including that of the articular disk. The application of a cine program allows cinematographic display of TMJ motion, which in conjunction with static open- and closed-mouth views can be useful in the diagnosis of TMJ dysfunction. The authors used the incremental jaw opener to examine the disk-condyle complex at each open-mouth position, with particular attention to extreme open-mouth positions.     

Dynamic MRI of temporomandibular joint: technique and application

Internal derangements or disk dysfunctions represent the most frequent pathology of the temporomandibular joint (TMJ). The radiological study of TMJ dysfunction was, for a long time, restricted to arthrography. More and more MR is used to study the TMJ, because MR, allows non-invasive visualisation of without the use of X-rays. Moreover a "dynamic" MR technique can be used to study disk movements during mouth opening. A lot of the internal derangement problems can be solved with this technique and arthrography can often be avoided. This dynamic MR technique is described and some cases are discussed.     

Interventional radiology of synovial chondromatosis in the temporomandibular joint using a thin arthroscope

This case report describes, for the first time, the use of interventional radiology following arthroscopy with a thin arthroscope for the diagnosis and treatment of synovial chondromatosis (SC) of the temporomandibular joint (TMJ). Therapeutic joint irrigation concomitant with arthroscopic observation of the superior joint compartment (SJC) was performed in a patient with functional TMJ pain caused by SC. The thin arthroscope was inserted with the aid of an X-ray fluoroscope. Arthroscopy confirmed that the SC was at disease stage II and that synovitis existed throughout the SJC. The initial maximal interincisor opening (MIO) was 30 mm, while after the joint-irrigation procedure the MIO was 40 mm. In addition, the TMJ pain was greatly reduced after joint irrigation. Our findings demonstrate that interventional radiology with a thin arthroscope is clinically useful for the diagnosis and primary treatment of patients with painful SC in the TMJ.     

Dynamic display of the temporomandibular joint meniscus by using "fast-scan" MR imaging

In order to display temporomandibular joint (TMJ) images as a dynamic or motion study, a protocol was developed to obtain MR images of the TMJ in multiple phases of opening by using the "fast-scanning" capabilities of the GE Signa MR scanner. To facilitate this procedure a prototype device was also developed to passively open the patient's mouth from resting (closed) to fully open in user-defined increments (minimum 1 mm). MR imaging (surface coil) was carried out at each successive station using the GRASS, pulse-sequence data base of the GE Signa system operating at 1.5 T. Image-acquisition parameters were optimized in studies of cadavers and volunteers to obtain the clearest delineation of the TMJ meniscus and to determine any potential tradeoffs between total imaging time per slice (image quality), patient tolerance, and other practical considerations. For viewing, the images were sequentially placed in the video memory of the operating console and displayed in a back-and-forth-closed cine loop or "movie" mode at variable (operator-selectable) speeds. The dynamic sequences in four individuals were compared with static open- and closed-mouth views obtained with routine pulse sequences. Any single image from the dynamic display lacked the high resolution of the routine static images because of technical limitations of the pulse-sequence data base. However, in the movie mode the pertinent joint structures (such as meniscus and condyle) were clearly delineated, as were several of the important muscles of mastication. The anterior motion (translation) of the meniscus during jaw opening is particularly evident and suggests great potential for functional evaluation. These results show the feasibility of dynamic TMJ imaging with MR. The added information of the cine display potentially complements the routine static images and may prove extremely valuable in the assessment of TMJ dysfunction.     

Web-based calibration of observers using MRI of the temporomandibular joint

Objectives

Research diagnostic criteria for temporomandibular disorders (RDC/TMDs) were proposed in 1992 with the aim of standardizing and testing methods for diagnosing TMDs. RDC/TMDs have so far been lacking standardized methods for imaging and criteria for imaging diagnosis of disorders of the temporomandibular joint (TMJ). Criteria for disorders of the TMJ have recently been proposed for MRI. The aim of this study was to publish MR images of the TMJ on the web and to test the agreement of five observers using the criteria.

Methods

20 cases of MRI of the TMJ were published on the web together with the criteria. The MR images were taken in closed and open mouth positions, and sagittal and coronal views. Five observers diagnosed disc position, disc shape, joint effusion and loose calcified bodies in the TMJ.

Results

In all cases except one, three or more observers agreed upon the diagnosis. All agreed on whether a loose calcified body was present or not. The second best agreement was obtained for disc position in the sagittal view, where all observers agreed in 16 of the 20 cases. For disc position in the coronal view and the evaluation of the disc shape, observer agreement was lower.

Conclusion

Criteria were useful in order to standardize and simplify evaluation and thereby probably increase the diagnostic outcome among different observers for MRI of the TMJ. We recommend that the criteria be used internationally to facilitate comparisons between different studies.     

Magnetic resonance evidence of joint fluid with temporomandibular joint disorders

OBJECTIVES: The relationship between temporomandibular joint (TMJ) effusion and TMJ disorders is controversial. The frequency of TMJ effusion has varied as shown in previous studies. Furthermore, though some authors have suggested a correlation between TMJ effusion and pain, others question the relationship. In order to clarify the relationship, it is necessary to quantify the degree of effusion and thoroughly investigate its relationship to other factors. The purpose of this study was to analyze the amount of TMJ fluid present in joints with TMJ disorders and to see how TMJ effusion is related to TMJ status and pain. METHODS: We studied 577 joints in 293 patients referred to us for magnetic resonance imaging. The joints were divided into painful and nonpainful categories and also classified according to Westesson's criteria for the status of the TMJ. The grading system of Larheim et al was used for categorizing the amount of fluid. Statistical methods were used for analyzing the relationship between TMJ fluid and TMJ status and pain. RESULTS: TMJs with disk displacement without reduction showed the largest amount of fluid while TMJs with normal superior disk position showed the least fluid (Kruskal-Wallis test, P<0.001; Scheffe test, P<0.001). There was a significant difference in the amount of the fluid between painful and nonpainful joints in the group of disk displacement without reduction (Wilcoxon rank sum test, P<0.001). No significant differences were found between other groups. CONCLUSIONS: Joint effusion is likely to appear in painful TMJs with disk displacement without reduction. Joint effusion may be an abnormal entity just suited to joints with disk displacement without reduction.     

Internal derangement of the temporomandibular joint

Internal Derangement is one of the most common disorders of the Temporomandibular joint. It is defined as an abnormal anatomical relationship between the discus articularis and the other structures of the temporomandibular joint. More than 2/3 of patients with clinical symptoms of the temporomandibular joint have an internal derangement. The most frequent finding in internal derangement is an anterior dislocation of the disc with reduction after mouth opening. In more severe cases a complete anterior dislocation is found without reduction of the disc. Internal derangement is a risk factor for developing osteoarthritis with remodeling of the condylus and the fossa mandibularis. The most important modalities of radiologic diagnosis are arthrography, CT and MRI. The diagnosis of craniofacial dysfunction has been improved dramatically by modern imaging techniques, which have become essential tools for primary diagnostic and evaluation after conservative or surgical therapy. MRI has become the gold standard.     

MR of 2270 TMJs: prevalence of radiographic presence of otomastoiditis in temporomandibular joint disorders

OBJECTIVE: The purpose of this study is to determine the prevalence of radiographic presence of otomastoiditis while examining temporomandibular joint (TMJ) disorders in magnetic resonance images (MRI) in a series of 2270 temporomandibular joint magnetic resonance images and to examine the relationship between otomastoiditis and TMJ disorders. MATERIALS AND METHODS: 2270 temporomandibular joint magnetic resonance images and patients' data were retrospectively investigated. Magnetic resonance images were obtained from the patients who referred to Osaka University Dental Hospital Outpatient Clinic with TMJ complaints for the last four years (from January 1998 to January 2003). The patients, who were diagnosed as otomastoiditis based on their temporomandibular joint magnetic resonance images, were sent to Osaka University Hospital Department of Otolaryngology for a medical consultation in order to have their pathologies certified following their MR process. Age and sex were recorded for all patients and for otomastoiditis cases; location of the disease, symptoms of patients and TMJ findings were noted as well. RESULTS: Seven patients were diagnosed as acute otomastoiditis and one patient diagnosed as chronic active otitis media with cholesteatoma in the series of 2270 MR, which were representing a prevalence of 0.39%. Neurilemoma diagnosed in left mastoid process in one patient. The final diagnoses of all patients were made after medical consultation. CONCLUSION: While examining temporomandibular joint magnetic resonance images; it is not only important to examine just the TMJ structures, but also to look at the nearby anatomical features to check evidence for inflammatory disease.     

盐酸氨基葡萄糖片治疗颞颌关节炎疗效分析

目的探讨盐酸氨基葡萄糖片治疗颞颌关节炎的临床疗效。方法回顾性分析自2013年1月至2015年5月在宜宾市三医院治疗的颞颌关节炎患者120例的临床资料。其中,60例患者给予常规治疗设为A组,60例患者在常规治疗基础上给予盐酸氨基葡萄糖片设为B组。比较两组患者的最大张口度、视觉模拟评分(VAS)及张口偏斜程度。结果两组患者治疗第2周,最大张口度均升高,高于治疗前(P<0.01);在治疗第3、4周,B组的最大张口度显著升高,高于A组,组间比较,差异有统计学意义(P<0.01)。在治疗第2、3、4周,B组的张口疼痛VAS评分、张口偏斜程度均显著低于A组,组间比较,差异均有统计学意义(P<0.01)。结论在常规治疗基础上给予盐酸氨基葡萄糖片治疗颞颌关节炎,能够提高临床疗效,值得推广应用。     

Association between high signal intensity in the posterior disc attachment seen on T2 weighted fat-suppressed images and temporomandibular joint pain

OBJECTIVES: We sought to determine whether high signal intensity in the posterior disc attachment (PDA) seen on T2 weighted fat-suppressed MRI is associated with temporomandibular joint (TMJ) pain and joint pathology. METHODS: This study was based on 283 TMJs of 177 patients (31 males and 146 females, mean age 32.7 years) with TMJ disorders showing anterior disc displacement. MRI evaluation included assessment of signal intensity in the PDA and TMJ status (disc displacement with reduction, disc displacement without reduction and disc displacement with bone changes). Clinical criteria that were considered positive indicators of TMJ pain included the presence of pre-auricular pain during palpation, jaw function and assisted or unassisted mandibular opening. Association of signal intensity in the PDA with joint pain and TMJ status was analysed using chi2 test. RESULTS: Joint pain was reported in 47 (77.0%) out of 61 joints with high signal intensity in the PDA and in 97 (43.7%) out of 222 joints with low signal intensity in the PDA (P<0.0001). High signal intensity in the PDA correlated closely with more advanced joint pathology. In joints with anterior disc displacement with bone changes, TMJ pain was more commonly reported in joints with high signal intensity in the PDA than with low signal intensity in the PDA (P<0.0001). CONCLUSIONS: High signal intensity in the PDA on T2 weighted fat-suppressed MRI is associated with TMJ pain in TMJ disorders with anterior disc displacement with bone changes in the mandibular condyles.