Mini suture anchor: An effective device for reduction and fixation of displaced temporomandibular joint disc with intracapsular condylar fracture

PurposeThe main aim is to provide clinical reference for the application of mini suture anchor in the reduction and fixation of displaced temporomandibular joint (TMJ) disc with intracapsular condylar fracture.MethodsFrom October 2018 to October 2019, 21 patients (31 sides) with intracapsular condylar fractures and articular disc displacement from West China Hospital of Stomatology, Sichuan University were included. The selection criteria were: (1) mandibular condylar fractures accompanied by displacement of the TMJ disc, confirmed by clinical examination, CT scan and other auxiliary examinations; (2) indication for surgical treatment; (3) no surgical contraindications; (4) no previous history of surgery in the operative area; (5) no facial nerve injury before the surgery; (6) informed consent to participate in the research program and (7) complete data. Patients without surgical treatment were excluded. The employed patients were followed up at 1, 3, 6 and 12 months after operation. Outcomes were assessed by success rate of operation, TMJ function and radiological examination results at 3 months after operation. Data were expressed as number and percent and analyzed using SPSS 19.0.ResultsAll the surgical procedures were completed successfully and all the articular discs were firmly attached to the condyles. The articular disc sufficiently covered the condylar head after the fixation. The fixation remained stable when the mandible was moved in each direction by the surgeons. No complications occurred. The functions of the TMJ were well-recovered postoperatively in most cases. CT scan revealed that the screws were completely embedded in the bone without loosening or displacement.ConclusionMini suture anchor can provide satisfactory stabilization for the reduced articular disc and also promote the recovery of TMJ functions.     

Ultrasonography of the temporomandibular joint: comparison of findings in patients with rheumatic diseases and temporomandibular disorders. A preliminary report.

OBJECTIVE: The objective of the study was to compare findings from ultrasonography (US) of the temporomandibular joint (TMJ) in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and temporomandibular disorders (TMD). STUDY DESIGN: US assessment of the temporomandibular joints was bilaterally performed in 68 patients (22 with RA, 11 with PsA, and 35 with TMD). All the TMJs were assessed for the presence of disc displacement, effusion, and changes of the condylar profile, and the prevalence of such abnormalities was compared across the 3 groups of patients. To confirm generalizability of results, US findings were also compared with those of magnetic resonance (MR), taken as the standard of reference. RESULTS: Prevalence of disc displacement and changes in condylar profile were similar between patients with rheumatic diseases and temporomandibular disorders, while effusion was significantly more present in TMJs of TMD patients. Sensitivity of US to detect TMJ abnormalities was acceptable, while specificity was low for condylar alterations. CONCLUSIONS: Temporomandibular joint involvement in patients with rheumatic diseases seems to be similar to that described in subjects with temporomandibular disorders. Ultrasonography confirmed to be an accurate technique to detect disc displacement and effusion within the temporomandibular joint, but not to detect condylar abnormalities.     

Visualization of anterior disc displacement in temporomandibular disorders on contrast-enhanced magnetic resonance imaging: comparison with T2-weighted, proton density-weighted, and precontrast T1-weighted imaging.

OBJECTIVE: To compare postcontrast T1-weighted imaging (T1WI+) with precontrast T1-weighted (T1WI-), T2-weighted (T2WI), and proton density-weighted imaging (ProWI) in depiction of the anterior disc displacement (ADD) in temporomandibular disorders (TMDs). STUDY DESIGN: A total of 120 joints with TMD were included in this study. Qualitatively, Receiver operating characteristic analysis was performed. Quantitatively, the ratio of the intensity in the retrodiscal tissue to intensity in the disc (intensity ratio) was measured. RESULTS: One reader achieved superior performance in visualization of ADD with T1WI+ than with the other sequences. The other reader showed superiority with T1WI+ rather than T2WI or T1WI-. The intensity ratio on T1WI+ was significantly higher than the intensity ratio on other sequences. On T1WI,+ the intensity ratio in the joints with ADD was significantly higher than that in the joints without ADD. CONCLUSION: Postcontrast T1-weighted imaging can improve the visualization of ADD in TMDs.     

颈椎闭合复位对椎间盘和脊髓损伤的影响

目的探讨下颈椎小关节脱位闭合复位的临床疗效。方法46例颈椎小关节脱位患者,24例单侧小关节脱位,22例双侧小关节脱位,在透视下行颅骨牵引闭合复位,并于复位前后进行神经功能和颈椎MRI检查,借以比较复位前后椎间盘损伤和脊髓实质性损伤的变化情况。结果46例中39例在透视下行颅骨牵引闭合复位,其中34例复位成功,5例未成功,成功率87％。34例中复位前MRI显示存在明显椎间盘突出者7例,椎间盘撕裂4例,复位后有6例椎间盘脱出仍存在,大小无明显变化;1例原脱出椎间盘明显缩小,无新椎间盘脱出发生。33例在复位前后脊髓信号无明显改变,1例复位前脊髓无明显改变者,复位后出现T2加权高信号。结论1、透视下颅骨牵引闭合复位是一种安全有效的治疗方法,通常情况下不会诱发或加重椎间盘脱出,进而造成继发性脊髓功能损伤。2、MRI对颈椎小关节脱位合并椎间盘和脊髓损伤的诊断、预后的参考价值高,但不应因行MRI检查而耽误闭合复位。     

髌股关节发育不良对髌骨脱位磁共振成像表现的影响

背景：当存在髌股关节发育不良时,髌骨脱位的损伤程度较轻,因此更加依赖影像学诊断。 目的：比较髌股关节发育不良患者和髌股关节发育正常患者髌骨脱位时磁共振成像（MRI）表现的异同。 方法：回顾性分析54例经临床证实的髌骨脱位患者的MRI影像学资料。髌股关节发育不良患者32例,髌股关节发育正常患者22例。记录患者MRI中髌骨内侧骨挫伤或撕脱骨折、髌骨关节面骨软骨骨折、股骨外侧髁外侧部骨挫伤、髌股内侧支持带撕裂等情况。 结果：髌股关节发育不良组的32例患者中,髌骨内缘骨折12例,内侧支持带损伤10例,髌骨软骨损伤7例,股骨外髁骨挫伤18例;髌股关节发育正常组的22例患者中,髌骨内缘骨折8例,内侧支持带损伤14例,髌骨软骨损伤14例,股骨外髁骨挫伤14例。两组在内侧支持带损伤和髌骨内缘骨折上有显著统计学差异（P＜0.05）。 结论：MRI可以较好地诊断髌骨脱位。当髌股关节发育不良时,内侧支持带损伤和髌骨内缘骨折的发生率降低。     

创伤性无骨折脱位型椎管内硬膜外血肿的MRI表现

目的探讨创伤性无骨折脱位型脊髓硬膜外血肿（TSEH）的MRI表现特点及其鉴别诊断。方法对12例TSEH常规行T1WI矢状位,T2WI矢状位及横轴位MRI扫描。结果12例TSEH中,9例位于椎管腹侧,3例位于椎管背侧,呈新月状或长条带状,分别累及2～6个脊髓节段,平均3．5个脊髓节段。血肿位于颈段4例,颈胸段3例,胸段3例,胸腰段2例。7例血肿T1WI上为等信号,T2wI低信号;2例血肿T1WI为稍高信号,T2WI呈不均质性高信号,3例于T1WI及T2WI均为高信号。血肿于T1WI及T2WI与脊髓之间有一低信号带相隔,尤以T2WI显示最佳。结论MRI是诊断TSEH的最佳检查方法,不仅可以清楚地显示血肿的部位及范围,而且可以清楚地显示血肿新旧程度及脊髓受损的情况。     

Spinal injury at the level of the third and fourth cervical vertebrae from football

Acute traumatic lesions of the spine at the third and fourth cervical levels without associated fracture are not common. The eight lesions in this report occurred as a result of injuries sustained during tackle football. They included acute intervertebral disc herniation, anterior subluxation of the third cervical vertebra on the fourth, unilateral dislocation of the joint between the articular processes, and bilateral dislocation of the joints between the articular processes. The mechanism of injury was the use of the top or crown of the helmet as the primary point of contact in a high-impact collision when blocking, tackling, or head-butting. To avoid a seemingly inevitable increase in the incidence of these lesions occurring from tackle football, coaches and officials will have to modify the current techniques of blocking tackling, and head-butting.     

无骨折脱位型急性颈脊髓损伤的MRI特点及意义

目的探讨无骨折脱位型急性颈脊髓损伤的MRI改变特点及其在脊髓损伤程度、预后及治疗中的作用。方法回顾性分析26例无骨折脱位型急性颈脊髓损伤的MRI和临床资料。结果无骨折脱位型急性颈脊髓损伤MRI绝大多数表现为脊髓水肿，急性期T1加权像等信号，T2加权像高信号。慢性期部分T1加权像局限性低信号，T2加权像局限性高信号。MRI T2加权像单节段脊髓水肿预后较双节段以上者好。结论无骨折脱位型急性颈脊髓损伤MRI信号改变及其范围能反映脊髓损伤程度，提示预后，指导治疗。     

Temporo-mandibular joint. Morpho-functional considerations

The temporo-mandibular joint is distinguished from most other synovial joints of the body by two features: 1. the two jointed components carry teeth whose position and occlusion introduce a very strong influence on the movements of the temporo-mandibular joint and 2. its articular surfaces are not covered by hyaline cartilage, but by a dense, fibrous tissue. This paper describes the parts of the temporo-mandibular joint: the articular surfaces (the condylar process of the mandible and the glenoid part of the temporal bone), the fibrocartilaginous disc which is interposed between the mandibular and the temporal surface, the fibrous capsule of the temporo-mandibular joint and the ligaments of this joint. All these parts present a very strong adaptation at the important functions of the temporo-mandibular joint.     

Transient epiphyseal lesion of the femoral head after traumatic hip dislocation: A case report

IntroductionWe experienced a rare case in which magnetic resonance imaging (MRI) showed a transient epiphyseal lesion of the femoral head four months after traumatic hip dislocation. To our knowledge, there have been no previously published reports on the development of such transient lesions after traumatic hip dislocation involving no abnormalities just after dislocation.Presentation of caseWe report a 22-year-old man who showed a transient epiphyseal lesion of the femoral head after traumatic hip dislocation. On MRI performed two days after dislocation, no bony injuries were observed around the hip joint. Four months after dislocation, the patient suddenly experienced right hip pain without any new trauma or injury. A low-intensity band convex to the articular surface was apparent above the epiphyseal scar on T1-weighted imaging, and bone marrow edema was observed around the band lesion on short-tau inversion recovery imaging. Following a two-month period of non-surgical conservative therapy, the patient’s hip pain resolved and the low-intensity band was no longer observed on follow-up MRI.DiscussionAlthough the detailed pathogenesis of this transient changes was unclear, we speculate that prolonged rest after traumatic hip dislocation may contribute to bone insufficiency, resulting in an insufficiency fracture of the femoral head.ConclusionThis study suggests that transient epiphyseal lesions of the femoral head may occur in patients with a history of traumatic hip dislocation associated with an adapted long-term rest.     

人工髁突假体在颞下颌关节重建中的临床应用

目的探讨人工髁突假体应用于颞下颌关节重建的可行性及临床治疗效果。方法 2005年1月-2010年1月,对10例(11侧)患者应用人工髁突假体行颞下颌关节重建手术。男7例,女3例;年龄40～68岁,平均50岁。左侧7侧,右侧4侧。下颌骨肿瘤7例,病程9～24个月,平均15个月。双侧髁突囊内骨折3例,其中交通事故伤2例,高处坠落伤1例;伤后至入院时间分别为2、3、2 d;骨折按照Neff等的分类法:M型及A型1例,M型及B型1例,余1例一侧为M型,一侧为髁突下骨折。结果术后切口均Ⅰ期愈合,无相关并发症发生。患者均获随访,随访时间1～4年,面部对称,咬关系良好;张口度22～38 mm,平均30 mm。双侧颞下颌关节无弹响及疼痛,肿瘤无复发。一侧人工髁突假体就位角度稍差,其余人工髁突假体位置良好,与关节窝和关节结节的关系正常,能正常饮食。结论人工髁突假体应用于肿瘤术后颞下颌关节重建,效果良好;应用于髁突囊内骨折的治疗,其临床效果待进一步验证。     

Fracture and dislocation fracture of the os pisiforme

Four cases of pisiform fracture are presented. In one case the largest fragment of the pisiform bone with the articular surface was dislocated. After open reduction, osteosynthesis with K-wires was performed. Two patients had an isolated fracture without fragment dislocation. They had their lower arms immobilized with a plaster of Paris cast for 4 weeks. In the fourth case the fracture of the pisiform bone was associated with an intraarticular distal radial fracture and wrist dislocation. The typical traumatic cause of pisiform fracture is a fall onto the outstretched hand. Immobilization for 4 weeks results in functional recovery. In cases with dislocation of the pisotriquetral joint open reduction and osteosynthesis are necessary. Excision of the pisiform bone is not indicated in a fresh injury.     

非手术治疗无骨折脱位型颈脊髓损伤预后的多因素分析

目的 :探讨影响非手术治疗无骨折脱位型颈脊髓损伤预后的因素。方法 :回顾性分析2009年1月至2012年12月接受非手术治疗的122例无骨折脱位型颈脊髓损伤患者的临床资料,其中男84例,女38例;平均年龄(52.37±13.27)岁(18~83岁)。选择年龄、性别、受伤原因、受伤至治疗时间、脊髓损伤ASIA分级、MRI脊髓损伤类型、脊髓损伤范围、有效颈椎管率、椎间盘突出Pfirrmann分级、椎间盘突出节段、椎间盘韧带复合体损伤、大剂量甲基强的松龙冲击治疗12个可能对非手术治疗预后产生影响的因素,应用单因素和多因素Logistic回归分析,研究其对预后的影响。结果:单因素分析显示MRI脊髓损伤类型、脊髓损伤范围、有效颈椎管率、椎间盘突出Pfirrmann分级、椎间盘突出节段及脊髓损伤ASIA分级均对预后有显著影响(P均0.05)。进一步行多因素分析,按照其作用强度,影响预后的主要因素依次为:MRI脊髓损伤类型、脊髓损伤范围、有效颈椎管率、椎间盘突出Pfirrmann分级、脊髓损伤ASIA分级(P均0.05)。结论 :影响非手术治疗无骨折脱位型颈脊髓损伤预后的主要因素是MRI脊髓损伤类型及范围,同时与有效椎管率、椎间盘突出程度及脊髓损伤ASIA分级相关。对于选择非手术治疗需谨慎,仅适用MRI检查提示脊髓信号无改变或水肿程度轻且范围局限者,其余则建议积极手术治疗。     

The role of mandibular condylar cartilage in articular cartilage repair.

The articular hyaline cartilage of synovial joints has a very limited capacity for repair after injury. In contrast, the mandibular condylar cartilage of the temporomandibular joint possesses as intrinsic potential for regeneration. This study aimed to test the hypothesis that cultured allografts of mandibular condylar cartilage could be used to promote biological repair of injured orthotopic joint surfaces. Using a primate animal model, cultures of mandibular condylar cartilage cells were grafted into surgically created defects in a recipient hyaline cartilage joint surface. Articular wound healing was assessed macroscopically and histologically over a postoperative period of 52 weeks. Mandibular condylar cartilage cells scheduled for allogenous transplantation were initially characterised in vitro. Expansion of primary colonies in organ culture provided the allogenic cellular material for in vivo grafting. Grafting of osteochondral articular wounds with 5-week cultures of mandibular cartilage cells led to wound regeneration with complete reconstitution of articular surface continuity by 52 weeks. There was novel synthesis of cartilage collagens and sulphated glycosaminoglycans within the repair tissue and no evidence of immunological rejection. Healing of grafted defects was thought to occur by a combination of donor cell proliferation and ingress of host mesenchymal cells. In contrast, grafted control wounds underwent largely fibrous repair with incomplete articular regeneration. In conclusion, transplanted allografts of cultured mandibular condylar cartilage appeared to have the ability, in this primate model, to promote cartilaginous repair and regeneration of orthotopic articular wounds.     

Schatzker Ⅳ型胫骨平台骨折的分型及治疗

目的　探讨SchatzkerⅣ型胫骨平台骨折的损伤特点、疗效差的原因和改进的方法。方法　根据SchatzkerⅣ型胫骨平台骨折的骨折特点 ,将 1993～ 2 0 0 2年间诊治的 5 1例患者分为劈裂型、整髁型和塌陷型。对劈裂型和整髁型骨折 ,无关节面塌陷者 ,采用内侧切口 ;CT检查示有关节面塌陷者 ,采用正中切口纠正塌陷并植骨 ;劈裂型支撑钢板在内后侧固定 ,整髁型支撑钢板在内侧固定 ,或双侧支撑钢板固定。对塌陷型骨折 ,采用内侧切口 ,行复位、植骨、支撑钢板内侧固定。 33例患者术后平均随访 4 1个月 ,对影响骨折预后的因素进行分析。结果　随诊的 33例患者膝关节活动度为30°～ 14 7°(平均 110°) ;Lysholm评分平均为 83 2分 ,优 8例、良 9例、中 14例、差 2例。平台非解剖复位、平台增宽 >4mm、平台向外侧移位 >8mm是预后较差的相关因素 (χ2 值分别为 5 10、6 0 8、8 0 2 ,P<0 0 5、<0 0 5、<0 0 1) ,也易导致骨性关节炎的发生。结论　应根据分型和CT检查结果选择手术入路和固定方法 ,膝内翻畸形、平台增宽 >4mm或向外侧移位 >8mm是影响预后的因素。     

Role of endochondral ossification of articular cartilage and functional adaptation of the subchondral plate in the development of fatigue microcracking of joints

The mechanisms that regulate functional adaptation of the articular ends of long bones are poorly understood. However, endochondral ossification of articular cartilage and modeling/remodeling of the subchondral plate and epiphyseal trabeculae are important components of the adaptive response. We performed a histologic study of the distal end of the third metacarpal/metatarsal bone of Thoroughbreds after bones were bulk-stained in basic fuchsin and calcified sections were prepared. The Thoroughbred racehorse is a model of an extreme athlete which experiences particularly high cyclic strains in distal limb bones. The following variables were quantified: microcrack boundary density in calcified cartilage (N.Cr/B.Bd); blood vessel boundary density in calcified cartilage (N.Ve/B.Bd); calcified cartilage width (Cl.Cg.Wi); duplication of the tidemark; and bone volume fraction of the subchondral plate (B.Ar/T.Ar). Measurements were made in five joint regions (lateral condyle and condylar groove; sagittal ridge; medial condylar and condylar groove). N.Cr/B.Bd was site-specific and was increased in the condylar groove region; this is the joint region from which parasagittal articular fatigue (condylar) fractures are typically propagated. Formation of resorption spaces in the subchondral plate was co-localized with microcracking. N.Ve/B.Bd was also site-specific. In the sagittal ridge region, N.Ve/B.Bd was increased, Cl.Cg.Wi was decreased, and B.Ar/T.Ar was decreased, when compared with the other joint regions. Multiple tidemarks were seen in all joint regions. Cumulative athletic activity was associated with a significant decrease in B.Ar/T.Ar in the condylar groove regions. N.Cr/B.Bd was positively correlated with B.Ar/T.Ar (P < 0.05, r(s) = 0.29) and N.Ve/B.Bd was negatively correlated with B.Ar/T.Ar (P < 0.005, r2 = 0.14) and Cl.Cg.Wi (P < 0.05, r2 = 0.07). We conclude that endochondral ossification of articular cartilage and modeling/remodeling of the subchondral plate promote initiation and propagation of site-specific fatigue microcracking of the joint surface, respectively, in this model. Microcracking of articular calcified cartilage likely represents mechanical failure of the joint surface. Propagation of microcracks into the subchondral plate is a critical factor in the pathogenesis of articular condylar fatigue (stress) fracture. Functional adaptation of the joint likely protects hyaline cartilage from injury in the short-term but may promote joint degeneration and osteoarthritis with ongoing athleticism.     

Condylar luxation following bilateral intraoral vertical ramus osteotomy.

OBJECTIVE: The intraoral vertical ramus osteotomy (IVRO) is widely used to treat mandibular prognathism and some forms of temporomandibular joint disorder (TMD). This retrospective report evaluated the incidence of condylar luxation following bilateral IVRO. STUDY DESIGN: Clinical records and radiographs of 319 patients seen during a 13-year period between 1992 and 2005 were evaluated. The mean age of the patients (232 females, 87 males) at the time of surgical procedure was 26.1 years. All patients underwent a bilateral IVRO to treat mandibular prognathism or TMD. Postoperatively, the condylar position was evaluated from lateral and anteroposterior cephalograms and tomograms of the temporomandibular joint (TMJ). RESULTS: An IVRO was performed on 638 sides in 319 patients. In 8 sides in 8 patients, the proximal segments were dislocated, and the condylar heads were located beyond the articular eminence. One patient underwent a closed reduction under local anesthesia, and 4 patients underwent an open reduction under sedation or general anesthesia. The average follow-up period was 4.3 years (1.2-9 years). Six of the 8 patients did not complain of any TMJ dysfunction. The objective clinical evaluation also did not reveal any dysfunctional patterns. A TMJ click on the affected side was observed in 1 patient, and mandibular deviation to the affected side upon opening the mouth was observed in 1 patient. CONCLUSION: Although condylar sag is a consistent finding after IVRO, the mandibular condyles tend to return their preoperative positions. In this study, condylar luxation was observed in 1.3% (8/638) of the joints after bilateral IVRO. However, there were no severe clinical problems in these patients during a relatively long follow-up period.     

不同类型胫腓骨骨折对胫骨远侧关节面的影响

目的 通过对不同类型胫腓骨骨折及胫骨远侧关节面变化的分析,探讨不同类型小腿骨折对踝关节的影响.方法 对1997～2001年5年间住院病人中病历资料齐全的144例X线片做回顾性分析,测量胫骨远侧关节面与胫骨纵向中心线夹角.结果 小腿下段螺旋形及斜形骨折时胫骨远侧关节面与胫骨纵向中心线夹角变小,与正常对照比较明显变小（P＜0.01）,小腿中段螺旋形及斜形骨折时胫骨远侧关节面与胫骨纵向中心线夹角变小,与正常对照比较变小（P＜0.05）.结论 小腿中、下段螺旋形及斜形骨折时易引起胫骨远侧关节面外侧角压缩,致使踝关节的运动轴线发生改变,易出现踝关节损伤.     

四肢地震伤的影像诊断价值

目的探讨四肢地震伤的影像诊断价值。方法103例四肢地震伤患者均行X线平片检查,其中28例行CT检查,5例行MRI检查。结果经影像学检查明确四肢骨骨折81例,其中单发骨折34例,多发骨折47例;开放性骨折6例,闭合性骨折75例。关节脱位7例,软组织内异物5例,膝关节半月板损伤1例,气性坏疽1例。结论影像学检查有利于四肢地震伤的及时准确诊断和治疗方式的选择。