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核素骨显像诊断颞下颌关节病变的临床价值 总被引:3,自引:0,他引:3
目的: 探讨利用放射性核素骨三相显像和SPECT检查颞下颌关节紊乱病患者的价值.材料和方法: 66例颞下颌关节紊乱病患者接受X线片、放射性核素骨三相显像和SPECT检查.通过骨扫描结果进行定性和半定量分析,选择23例患者接受外科手术治疗.结果: 选择保守治疗者43例,血池相和延迟相影像及SPECT两侧关节区影像对称.接受颞下颌关节重建术者23例,血池相和延迟相影像及SPECT影像两侧关节区影像不对称,患侧关节区放射性强度和髁状突放射性计数比值稍高于对侧;术中发现,髁状突表面软骨有破坏,术后患者症状缓解.结论: 骨扫描可以作为颞下颌关节紊乱病的早期器质性病变的检测手段,选择为治疗方法提供参考. 相似文献
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【摘要】 目的?评估超声引导下关节腔中注射富小板血浆(PRP)治疗颞下颌关节紊乱病的有效性。方法?2016年4月至2018年4月,门诊诊治45例确诊为颞下颌关节紊乱患者,超声引导将采集于患者自身的PRP注射于患者病变的颞下颌关节腔内。观察患者在治疗前和治疗后1、3和6个月的最大张口度,及颞下颌关节在静息、运动和咀嚼时VAS评分。结果?关节腔内注射PRP可有效改善最大口腔开放程度,颞下颌关节在静息,运动和咀嚼时VAS评分与治疗前相比显著降低。结论?超声引导下关节腔内注射PRP可显著改善颞下颌关节紊乱患者的体征和症状。 相似文献
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目的:探讨牵张成骨技术在颞下颌关节强直伴小下颌畸形治疗中的应用效果。方法:对6例颞下颌关节强直伴严重小下颌畸形的患者采用一期下颌骨双向牵张成骨、二期颞下颌关节成形术进行治疗。结果:所有患者术后均顺利完成牵引计划,并在3个月后拆除牵张器,面容获得极大改善,张口度达到25mm以上,睡眠呼吸暂停症状消失,营养状况改善,口内咬合关系基本恢复。结论:牵张成骨技术为临床上治疗颞下颌关节强直伴严重小下颌畸形提供了有效方法。 相似文献
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目的:研究颞下颌关节紊乱病在歼击机飞行员中的发病情况,并对照心理测量结果,探索颞下颌关节紊乱病与焦虑心理的关系。方法:对112名歼击机飞行员与130名地面人员,检查颞下颌关节紊乱病发病情况,并对照焦虑自测量表(SAS量表)和SCL-90临床症状自评量表进行对照研究。结果:歼击机飞行员颞下颌关节紊乱病发病率高于地面人员(P〈0.05),并与焦虑指数有相关关系(P〈0.01)。结论:颞下颌关节紊乱病在歼击机飞行员中有较高发病率,并与焦虑指数有相关关系,提示持续正加速度(+Gz)与焦虑心理可能是飞行人员颞下颌关节紊乱病的主要致病因素。 相似文献
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合板作为颞下颌关节紊乱病(TMD)严重器质病变患者关节重建术后重要的辅助治疗手段之一,可增加颞下颌关节(TMJ)间隙,减少髁突负荷,使临床治疗效果明显提高〔1、2〕。对于牙合板在关节重建术后的应用及术后修复的病理改变,已有报道〔3〕。但是,有关牙合板治疗行关节重建术的TMD器质性改变患者下颌骨应力分布的变化,国内外尚未见报道。采用三维有限元分析方法,对关节重建术后患者牙合板戴前与戴后下颌骨应力分布分化进行定量分析,旨在探讨牙合板对关节重建术后患者治疗的生物力学作用机制。1 材料和方法 选取TM… 相似文献
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颞下颌关节慢性损伤所致颞下颌关节紊乱病(Temporo-mandibular disorders,TMD)是临床上常见病,采用(牙合)间矫治的方法治疗该病的作用机制尚在探讨之中.本文运用该法对患者进行治疗与分析,并对疗效作出综合评价. 相似文献
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腭裂修复术及年龄对中耳功能的影响 总被引:1,自引:1,他引:0
目的 探讨腭裂患者中耳功能障碍听力损失发病特点、腭裂修复术及术前年龄对听力的影响 ,了解腭裂患者分泌性中耳炎鼓室分泌物细菌培养情况 ,为临床治疗提供依据。方法 对住院 12岁以下腭裂患者 6 0例 ,在术前、术后 6个月分别用脑干听觉诱发电位 ,声阻抗进行听力及中耳功能检查 ,术前鼓室分泌物进行细菌培养。结果 腭裂患儿术前听力损失发生率为 74% ,异常鼓室图为 80 % ,3岁前达 81% ,术后 6个月患者听力有一定程度恢复 ,异常鼓室图占 42 % ,鼓室分泌物细菌培养 ,G+ ,G-细菌阳性率分别为 2 3% ,2 4% ,且多为低毒性条件致病菌。结论 腭裂患者听力损失在婴儿时期已经存在 ,且听力损失严重 ,随年龄增大听力有所改善 ,听力损失与腭裂部位类型无关 ,早期修复腭裂有助于咽鼓管功能恢复 ,避免或减少听力损失 ,有利于语言发育 ,腭裂伴有分泌性中耳炎的治疗 ,有别于化脓性中耳炎的治疗 ,早期中耳置管能改善听力 ,并对腭裂患者听力损失原因及腭裂修复时间进行了讨论。 相似文献
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鼓室穿刺治疗腭裂渗出性中耳炎的临床评价 总被引:1,自引:0,他引:1
目的 探讨腭裂修复同期 ,鼓室穿刺对腭裂伴分泌性中耳炎患者中耳功能及听力损失的影响。方法 将 80例 ( 14 6耳 )患有分泌性中耳炎的腭裂患者 ,随机分为实验组 ( 78耳 ) :常规腭裂修复术 ,术毕作鼓室穿刺。对照组 ( 68耳 ) :单纯腭裂修复术。术后 6个月两组均进行鼓室图、脑干听觉诱发电位检查 ,并进行比较。结果 实验组术后无论与术前比较 ,还是与对照组术后比较 ,鼓室图、V波反应阈值及轻、中度听力损失 ,均有显著进步 (P <0 0 1) ;术后半年内实验组听力恢复早 ,而且治愈率高 ( 96 2 % ,75 /78) ,明显优于对照组 ( 3 8 2 % ,2 6/68)。结论 腭裂修复同期鼓室穿刺 ,不仅有助于改善伴有分泌性中耳炎腭裂患者的中耳功能 ,提高听力 ;而且可避免或减少粘连性中耳炎的发生 相似文献
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目的 了解咽扩约肌成形术对腭裂术后腭咽闭合不全的治疗作用。方法 选择腭裂修复术后 1年以上 ,经语音训练仍有语言障碍 ,分别令其朗读《汉语腭裂字表》同时录音 ,然后 7名听力语音正常的医护人员试听录音并计算正确率 ,正确率在 70 %以下患者 3 0例 ,分别行咽扩约肌成形术治疗。结果 术前语音正常 0人 ,基本正常 0人 ,中度发音异常1 1人 ,明显发音异常 1 4人 ,严重发音异常 5人。术后语音正常 1 6人 ,基本正常 1 1人 ,中度发音异常 2人 ,明显发音异常1人 ,严重发音异常 0人。结论 咽扩约肌成形术能使腭裂术后仍有腭咽闭合不全患者语音明显改善。 相似文献
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Facial skeleton remodeling due to temporomandibular joint degeneration: an imaging study of 100 patients 总被引:1,自引:0,他引:1
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. 相似文献
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Facial skeleton remodeling due to temporomandibular joint degeneration: an imaging study of 100 patients 总被引:3,自引:0,他引:3
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. 相似文献
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K P Schellhas C H Wilkes H M Fritts M R Omlie L B Lagrotteria 《AJR. American journal of roentgenology》1989,152(3):551-560
We studied 40 patients exhibiting radiologic changes of either osteochondritis dissecans (OCD) or avascular necrosis (AVN) involving the mandibular condyle to evaluate the structural changes associated with these lesions when using high-field-strength MR imaging. Various clinical indications for imaging each patient with routine radiography, tomography, and surface-coil MR included headache, temporomandibular joint (TMJ) and/or ilsilateral facial pain, joint crepitus, clicking, locking, and either recently acquired or changing (unstable) occlusal disorder. Radiologic findings included alterations in condyle morphology and MR signal characteristics compatible with either OCD or AVN or, in some cases, both. Previous nonsurgical mandibular trauma was temporally related to the onset of symptoms in eight patients. Five patients exhibiting either unilateral or bilateral AVN involving the condyles and condylar necks had undergone previous orthognathic surgery, including sagittal split mandibular osteotomies followed by intermaxillary fixation. One patient exhibiting condylar AVN with articular surface collapse and osseous destruction had undergone previous TMJ meniscectomy followed by insertion of a permanent Proplast implant. Thirty-one of 34 patients with no prior surgery and MR changes of condylar OCD/AVN had associated internal derangement of the TMJ meniscus. There was surgical confirmation of findings in 10 joints. We assert that OCD and AVN are relatively common, clinically significant lesions of the mandibular condyle often associated with preexisting internal derangement of the temporomandibular joint. 相似文献
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Bilateral arthrotomography was performed in 50 consecutive patients with unilateral symptoms of disc displacement to evaluate the frequency of temporomandibular joint disc displacement in asymptomatic joints. Using well-defined clinical criteria, there were no false-positive findings of either reducing or non-reducing discs. On the other hand, a risk of false-negative diagnosis of non-reducing disc was apparent. Sixty per cent of the patients had a non-reducing displaced disc in the asymptomatic joint. Most of these patients could recall a previous spell of discomfort from this joint. Severe or moderate deformation had taken place in non-reducing discs, while reducing discs were normal in shape or had, at most, a thickening of the posterior band. The duration of symptoms was significantly correlated with the degree of deformation in the symptomatic joints (P less than 0.01). Perforation was statistically, significantly correlated with disc deformation and, in symptomatic joints, hard tissue changes. Fifty-seven per cent of the asymptomatic joints with displaced discs developed pain following the onset of symptoms from the contralateral side, most within 2 years. Less than half of them were free of pain at the end of the 5 year follow-up period. In view of this tendency for an asymptomatic joint with a displaced disc to subsequently develop pain refractory to treatment, such a joint must be considered a weakened link in the craniomandibular system, vulnerable to changes in mandibular function such as, for instance, displacement of the disc on the contralateral side. 相似文献
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目的 了解咽扩约肌成形术在治疗腭裂中临床效果。方法 腭裂修复时同期咽扩约肌成形 ,并对部分 3年以上患者 36人与同期用咽后壁瓣移植术后患者 30人进行比较 ,分别令其朗读《汉语腭裂字表》同时录音 ,然后 7名听力语音正常的医护人员试听录音并计算正确率。结果 咽扩约肌成形组 :语音正常 2 5人 (6 9.4% ) ,基本正常 8人 (2 2 2 % ) ,中度发音异常 2人 (5 6 % ) ,明显发音异常 1人 (2 8% ) ,严重发音异常 0人。咽后壁瓣移植组 :语音正常 15人 (5 0 0 % ) ,基本正常 7人 (2 3 3% ) ,中度发音异常 5人 (16 7% ) ,明显发音异常 2人 (6 7% ) ,严重发音异常 1人 (3 3% )。结论 咽扩约肌成形术后能使腭裂患者语音明显改善 ,临床效果优于咽后壁瓣移植术 相似文献
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Thirty-two children were evaluated by means of medical history and physical examination for signs and symptoms of internal derangement (ID) of the temporomandibular joint (TMJ) and mandibular dysfunction. These children also underwent magnetic resonance (MR) imaging of the TMJs. The study was double blind. At clinical examination, 19 patients (59%) had at least one positive finding of ID of the TMJ and/or mandibular dysfunction. MR images of the TMJ obtained in 60 of the 64 TMJs demonstrated 57 normal joints (95%) and three abnormal joints (5%). Two of these three joints had a mild anterior-lateral disk displacement, and one joint had an anterior dislocated disk. There were no false-positive MR examinations. MR imaging failed to depict abnormalities in 16 patients who had positive findings at history and/or physical examination. Although MR imaging may fail to depict ID of the TMJ in some patients, clinical techniques commonly used in population surveys probably overstate the prevalence of ID of the TMJ in children. 相似文献
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总结<2周岁早期腭裂手术105例,无瘘孔、裂开及死亡。具有出血少、术后反应轻、愈合能力强等优点,介绍了手术操作及术后管理的要点,指出早期手术是安全可行的,除语言效果好外,且有利于患儿的心理发育,并认为唇腭裂患者的上颌骨发育障碍,尚与唇裂的手术方法有关。 相似文献