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颌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例临床诊断为颞下颌关节盘胶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。不可复笥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。     

急性和慢性不可复性盘前移位临床对比研究

目的　探讨颞下颌关节紊乱病不可复性盘前移位急性和慢性分类对临床诊断、治疗和预后的指导意义。方法　分析连续接诊的 10 0例不可复性盘前移位病例 (急性 4 5例、慢性 5 5例 ) ,比较两组之间临床主诉、开口度、颞下颌关节功能、髁突和关节盘的影像学改变。结果　急性不可复性盘前移位主诉开口受限 ,下颌运动功能严重障碍 ,大部分病例髁突骨质正常 ,关节盘形态良好 ;慢性不可复性盘前移位主诉多为开口痛和 (或 )咀嚼痛 ,下颌运动受限 ,部分病例伴有咀嚼肌疼痛 ,相当一部分病例髁突骨质吸收破坏 ,关节盘变形、变性 ,关节盘附着松弛、撕裂 ,甚至关节盘穿孔。结论　对急性不可复性盘前移位应早期采取积极的治疗 ,恢复良好的盘 突关系 ,阻止关节盘和髁突的进一步损伤。     

颞下颌关节盘摘除术关节区组织病理学变化的实验研究

目的 建立兔颞下颌关节盘摘除术实验动物模型,研究关节盘摘除术早期,关节区组织形态学变化.方法 用10只新西兰大白兔,实验组8只行双侧关节盘摘除术;2只为正常对照组.术后1周、2周、4周、10周各处死2只,切取关节组织,进行组织病理学观察.结果 髁突及关节结节关节软骨连续性破坏,功能区关节软骨下骨组织直接暴露于关节腔内,非功能区则软骨细胞各层增生明显,表面纤维层增生变厚,呈现出纤维性粘连样改变.暴露在关节腔部分的骨组织表面致密,髓腔内的骨小梁吸收,伴微小囊肿形成.髁突关节软骨、骨组织及滑膜出现早期骨关节炎样改变.结论 兔关节盘摘除术后早期,关节区组织表现为骨关节炎样改变,不是适应性改变.     

锥形束CT颞下颌关节上腔造影在诊断关节盘病变中的应用

目的探讨颞下颌关节（TMJ）骨关节病中关节盘前移位、穿孔及髁突骨质改变类型的关系。 方法选择中山大学附属口腔医院颞下颌关节专科就诊的96例骨关节病患者共145侧TMJ行锥形束CT（CBCT）关节造影检查,分为关节盘穿孔组和非穿孔组,两组病例以CBCT按照关节盘移位及髁突骨质改变类型进行分类比较,应用SPSS 18.0对关节盘穿孔与关节盘移位类型进行Pearson χ²独立性检验,两组间骨质分型构成比进行χ²检验。 结果所有关节发生关节盘前移位,其中123侧为不可复性盘前移位、22侧为可复性盘前移位。86侧TMJ发生关节盘穿孔,59侧关节造影未检出穿孔。关节盘是否发生穿孔与关节盘前移位类型存在相关性（χ²= 6.866,P= 0.015）,关节盘穿孔组不可复性盘前移位发生率（91.86%）高于非关节盘穿孔组（76.3%）。 结论TMJ骨关节病患者均存在不同程度的关节盘移位,关节盘移位类型与关节盘穿孔相关,髁突骨质改变类型与关节盘是否穿孔无明显相关性。     

颞下颌关节盘前移位关节区组织病理变化的实验研究

目的通过建立关节盘前移位实验动物模型的方法,来研究人类关节盘前移位病变早期阶段的发展过程和病理学改变。方法１２只新西兰大白兔左颞下颌关节经实验诱导为关节盘前移位模型,右侧为手术对照组。于术后２４ｈ、１周、２周、３周、４周、１０周各处死２只,切取关节组织,ＨＥ染色,光镜观察。结果早期：关节结节、髁突关节软骨增生明显,髁突软骨下出血,骨组织内血管网消失;后期：髁突关节软骨、骨组织及滑膜出现骨关节炎（ＯＡ）样改变。结论实验诱导关节盘前移后关节区的病理学变化与人类相似;关节盘前移位关节区的创伤可引起关节骨关节炎样改变。     

关节盘前移位颞下颌关节仿真模型的建立

目的:通过CT及MR数据结合三维重建软件建立关节盘前移位颞下颌关节的数字化仿真模型。方法:根据马绪臣颞下颌关节病分类标准,选取成年颞下颌关节紊乱病志愿者1名,X线片及CT检查排除颌骨疾患及颌面部肿瘤,MR斜矢状位扫描明确右侧颞下颌关节盘分界角向前为12.21°,盘前分界超过关节结节顶点。通过Simpleware及Ansys等三维重建软件处理其右侧颞下颌关节的CT薄层扫描数据及3D-MR扫描数据,建立关节盘前移位颞下颌关节的数字化仿真模型。结果:建立了包括骨皮质、骨松质、软骨和关节盘在内的关节盘前移位颞下颌关节数字化仿真模型,客观反应了关节盘前移位时颞下颌关节的外形及解剖特点。结论:成功建立了关节盘前移位颞下颌关节的数字化仿真模型,为关节盘前移位的研究奠定了基础。     

CT双对比颞下颌关节造影术的临床应用

目的介绍CT双对比领下颌关节造影技术，并评价其在颞下颌关节功能紊乱综合征中的诊断价值。方法对14例常规关节造影诊断困难的病例，进行CT双对比颞下颌关节造影检查。结果14例患者经CT双对比造影检查为正常考1例，可复性盘前移位者1例，不可复性盘前移位老2例，关节盘穿孔2例，关节盘粘连8例。结论CT双对比颞下颌关节造影术是常规关节造影的重要补充，对关节盘粘连有特殊的诊断价值。     

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。     

手法复位辅助

目的 探讨关节腔扩张后手法复位辅助再定位垫治疗颞下颌关节紊乱病急性不可复性盘前移位.方法 2%局麻药2～3 ml 注入关节上腔,手法复位解除不可复性前移位的关节盘,复位后即刻戴用再定位垫保持良好的盘-突关系.结果近期临床观察表明①开口度恢复,最大开口度从治疗前的25.8 mm增大到46.6 mm;②疼痛症状消失,疼痛分值视觉模拟尺从治疗前的2.62下降到0.43; ③颞下颌关节功能改善,Fricton关节功能障碍指数和颞下颌关节紊乱指数分别从治疗前的0.337和0.185下降到0.021和0.011.结论颞下颌关节紊乱病急性不可复性盘前移位药物治疗和理疗无效的情况下,关节盘复位辅助定位垫是一有效的治疗方法.远期效果如何尚需进一步观察.     

Ⅳ型胶原在病变颞下颌关节盘组织中的表达

颞下颌关节盘前移位和穿孔是临床上常见的颞下颌关节紊乱病 ,病理学变化主要是关节组织的退行性改变。Ⅳ型胶原是一种基膜胶原 ,主要存在于上皮和内皮的基板或基膜上。我们利用免疫组织化学方法检测在病变关节盘和盘后组织中Ⅳ型胶原的表达 ,探讨Ⅳ型胶原与颞下颌关节紊乱病之间的关系。1.材料和方法 :19例为ＴＭＪＤ包括不可复性盘前移位 3例 ,盘前移位伴关节盘穿孔 5例 ,骨关节病伴关节盘穿孔 11例。男 4例 ,女 15例 ,年龄 2 4～ 6 0岁。经手术切除部分病变的ＴＭＪ盘与盘后组织 ,另 1例为正常关节盘与盘后组织作为对照。 2 0例标本经生理…     

Arthrographic findings in the temporomandibular joint in patients with rheumatic disease

Hypocycloidal multisection tomography and lower-space arthrotomography with videofluoroscopy were performed on 20 symptomatic temporomandibular joints (TMJs) of 17 patients. All patients (16 women, one man, aged 17 to 38 years) had definite or suspected rheumatoid arthritis (adult or juvenile type), ankylosing spondylitis, or psoriatic arthropathy. Bone abnormalities were found in 14 TMJs, primarily cortical erosion (11 joints), but also condylar flattening (three joints). Irregularity in outline of the contrast material, bone contour-contrast material gaps, evidence of adherent discs and/or small joint compartments indicated synovial hyperplasia/pannus formation in 15 joints. Six of these (four with normal disc position) showed perforation between the joint compartments. In those with normal disc position the perforation seemed to occur in the central portion. Ten of the 15 joints had normal disc position; the remaining five had anterior disc displacement without reduction. One joint showed only disc displacement. Most joints with bone abnormalities (12 of 14) showed arthrographic signs of rheumatic involvement. Such signs were also observed in two of the six joints with no bone abnormalities, indicating the value of arthrography in the early diagnosis of patients with rheumatic disease and TMJ problems.     

Expression of matrix metalloproteinase-2 and -9 in synovial fluid of the temporomandibular joint accompanied by anterior disc displacement

The purpose of this study was to determine whether or not matrix metalloproteinases (MMPs) in synovial fluid are helpful in the biochemical diagnosis of temporomandibular joint (TMJ) disorder (TMD). We examined the synovial fluid from 38 TMD patients with disc displacement and 20 volunteers by gelatin zymography and immunoblotting analysis to clarify the involvement of the joint pathology from the viewpoint of expression of MMPs. Two gelatinolytic enzymes, MMP-2 and -9, were detected in the samples. The incidences of expression, except for pro-MMP-2, in anterior disc displacement (ADD) without reduction (ADD w/o R) were significantly higher than in ADD with reduction (ADD w R) (P<0.05). Quantitative analysis showed that the degree of MMP-2 and -9 expression in ADD w/ o R were higher than in ADD w R. These data suggest that the presence or absence of disc reduction is a major turning point in the process of joint destruction, and these MMPs are useful as biochemical markers for TMD diagnosis.     

The correlation of temporomandibular joint sounds with joint morphology in fifty-five autopsy specimens

Joint sounds from 55 fresh temporomandibular joint autopsy specimens were correlated with the macroscopic examination of joint morphology. Fifty-eight per cent of the joints were silent. Two thirds of these showed normal superior disc positions and remodeled articular surfaces, whereas one third exhibited anterior disc displacement. Twenty per cent of the joints elicited clicking and showed anterior disc displacement. Twenty-two per cent of the joints elicited crepitation and exhibited mostly arthrosis of the articular surfaces and perforation of the discs. Our results confirm previous statements that clicking and crepitation may be looked upon as signs of abnormal joint morphology, clicking indicating anterior disc displacement and crepitation usually indicating arthrosis. Absence of sound alone, however, should not be accepted as an indication of a normal joint.     

Synovial chondromatosis associated with experimental osteoarthritis in adult monkeys

This report describes the synovial response to temporomandibular joint disc perforation in an experimental animal model. Histologic examination revealed the presence of marked synovial membrane hypertrophy in all experimental joint recesses. Gradual transformation of synovial islands from a cellular to a metaplastic stage, with chondroid or even osteochondroid-containing tissue also was seen. The cartilage was arranged in a lobular pattern with intervening fibrous septae within the synovial islands. These synovial islands were observed in the anterior recess of three joints and in the posterior recess of another joint. The experimental findings suggest a relation between synovial chondromatosis and osteoarthritis.     

Comparison of clinical and magnetic resonance imaging diagnoses in patients with TMD history

The aim of this study was to evaluate the diagnostic accuracy of a well-defined clinical examination for diagnosing anterior disc displacement with and without reduction. A series of 40 patients with temporomandibular disorder (TMD) history were examined according to well-defined routine criteria. This examination included detailed history-taking, standardized clinical head and neck examination that included measurements of the range of motion, palpation of the temporomandibular joints and muscles of mastication for pain and auscultation of joint sounds. Magnetic resonance images of the joints were used as 'gold standard'. Diagnostic accuracy of the clinical examination was 83% for determining normal disc-condyle relationship, 72% for diagnosing anterior disc displacement with reduction, and 81% for diagnosing anterior disc displacement without reduction. Our results suggest that anterior displacement of the disc can be diagnosed with considerable accuracy using a well-defined clinical examination only. Therefore, we conclude that not all patients with TMD symptoms require magnetic resonance imaging examination before treatment.     

Osteoarthritis and internal derangement of the temporomandibular joint: a light microscopic study

To describe osteoarthritic changes of the temporomandibular joint (TMJ) and their relation to internal derangements, 22 randomly selected TMJ autopsy specimens were dissected and studied by light microscopy. Normal disc position was seen in eight joints, partial anterior displacement of the discs in eight joints, and complete anterior displacement of the discs in five joints; one joint had a perforated disc. Degenerative changes, such as horizontal splitting, clustering of chondrocytes, bone marrow fibrosis, sclerosis, erosion, cyst formation, and reduction in TMJ size, were found in 11 of the 14 joints with displacement or perforation of the disc and in four of the eight joints with normal disc position. Internal derangement appeared to be associated with osteoarthritis. The relations between remodeling, aging, internal derangement, and osteoarthritis are discussed.     

兔颞下颌关节盘移位与骨关节病关系的评价

目的评价颞下颌关节盘移位与骨关节病的关系。方法通过手术方法将２５只大耳白兔的颞下颌关节盘前移，术后１、２、４、８、１２周进行组织病理学检查。结果１１侧手术关节为部分关节盘前移位，８侧为完全性关节盘前移位，６侧为关节盘穿孔。部分关节盘前移位出现早期退行性改变和后期生理性改建，完全性关节盘前移位和关节盘穿孔出现退行性改变和严重的骨关节病。结论颞下颌关节盘前移位的程度与骨关节病有关，关节盘前移位越明显，越易出现骨关节病     

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.     

Correlation of arthroscopic findings with clinical–radiological signs and symptoms of temporomandibular joint dysfunction: retrospective study of 829 joints

Temporomandibular joint (TMJ) arthroscopic findings are difficult to predict based on clinical criteria. Few studies have attempted to correlate signs, symptoms, and characteristics of patients with the final arthroscopic findings. The aim of this study was to assess the correlation between clinical–radiological signs and symptoms and arthroscopic findings in patients with TMJ dysfunction undergoing arthroscopy. A retrospective study was performed involving 487 patients (829 joints) with TMJ dysfunction who underwent TMJ arthroscopy between 2000 and 2019. The clinical–radiological variables recorded were pain, maximum mouth opening, joint noises, Wilkes classification, and disc displacement. The arthroscopic findings evaluated were synovitis, chondromalacia, adhesions, disc perforation, disc displacement, and roofing. Pain symptoms were significantly associated with the intensity of synovitis (P = 0.005) and disc displacement evaluated arthroscopically (P < 0.001). A statistically significant relationship was observed between Wilkes stage and the level of synovitis (P < 0.001) and chondromalacia (P < 0.001). Mouth opening was negatively correlated with adhesions (P < 0.001). Based on this study, pain symptomatology was associated with the intensity of synovitis and disc displacement evaluated arthroscopically, the Wilkes stage was a good predictor of the severity of synovitis and chondromalacia, and mouth opening was negatively correlated with adhesions.