髁状突髓腔信号异常与关节液TNFα、IL-1β含量关系的研究

目的 :探讨核磁共振 (MRI)图像上髁状突髓腔信号异常与TNFα、IL -1β含量的关系。 方法 :对 40例单侧TMJ疼痛患者 ,利用MRI进行闭口斜矢状位T1W和T2 W扫描 ,将T1W和T2 W成像相结合诊断水肿、硬化及混合型髓腔信号异常 ,同时利用T1W成像判定是否伴有骨关节炎 (OA )。在关节上腔冲洗治疗时收集关节液标本 ,采用双抗体夹心酶联免疫法 (ABC -ELASA)检测其关节液标本中TNFα、IL -1β的含量。 结果 :40侧疼痛关节中MRI上表现为髁状突髓腔信号异常的关节 11侧 ,均为水肿型 ,4例伴有OA。髓腔信号异常的关节液中IL -1β、TNFα含量较髓腔信号正常的关节液高 ,经统计学检验两者无显著性差异 ,但髓腔信号异常的关节液中TNFα、IL -1β的检出率显著高于髓腔信号正常的关节。 结论 :髁状突髓腔信号异常的形成可能有IL -1β、TNFα的参与。     

髁状突髓腔信号异常与关节液TNFa、IL-1β含量关系的研究

目的：探讨核磁共振(MRI)图像上髁状突髓腔信号异常与TNFa、IL-1β含量的关系。方法：对40例单侧TMI疼痛患者，利用MRI进行闭口斜矢状位T1W和T2W扫描，将T1W和T2W成像相结合诊断水肿、硬化及混合型髓腔信号异常，同时利用T1W成像判定是否伴有骨关节炎(OA)。在关节上腔冲洗治疗时收集关节液标本，采用双抗体夹心酶联免疫法(ABC-ELASA)检测其关节液标本中TNFa、IL-1β的含量。结果：40侧疼痛关节中MRI上表现为髁状突髓腔信号异常的关节11侧，均为水肿型，4例伴有OA。髓腔信号异常的关节液中IL-1β、TNFa含量较髓腔信号正常的关节液高，经统计学检验两者无显著性差异，但髓腔信号异常的关节液中TNFa、IL-1β的检出率显著高于髓腔信号正常的关节。结论：髁状突髓腔信号异常的形成可能有IL-1β、TNFa的参与。     

颞下颌关节渗出液与关节疼痛关系的研究

目的:评价关节疼痛与渗出液的关系。方法:对44例单侧关节疼痛TMD患者88侧关节,完成闭口矢状位T2加权成像,以非疼痛侧作为自身对照,观察关节渗出液发生率;利用VAS进行疼痛程度的判定,比较疼痛侧渗出液组与无渗出液组有无差异。结果:44个疼痛关节中,26个关节(59.1%)存在渗出液;而44个非疼痛关节中,仅7个关节(15.9%)存在渗出液,经统计学分析,TMJ疼痛与渗出液有显著相关性(P<0.005),将少量渗出液视为无渗液,进一步统计分析发现疼痛与渗出液仍有相关性;在44个疼痛关节中,渗出液组患者及无渗出液组患者VAS平均值分别为46.5±25.1和39.7±22.8,经t检验两组间差别无统计学意义。结论:渗出液为关节疼痛原因之一,但其与关节疼痛程度无关。     

颞下颌关节疾病

咬合紊乱对颞下颌关节盘厚度的影响；颞下颌关节病髁突组织细胞凋亡的研究；髁突髓腔信号异常与颞下颌关节内紊乱关系的研究；髁突骨髓腔MRI信号异常与颞下颌关节疼痛的关系；颞下颌关节强直的手术方法与复法。     

髁突髓腔信号异常与颞下颌关节内紊乱关系的研究

目的探讨裸突髓腔信号异常与颗下领关节内紊乱(In印D)的关系。方法利用核磁共振成像(MRI ),对 44例颜下领关节紊乱病(TMD)患者88侧关节完成开闭口T1、闭口位T2加权成像,判定TMD患者的盘突关系及髓腔信号变化。结果TMD患者14.8%(13/88)表现髓腔信号异常,水肿型为II个关节,硬化型及混合型各1个关节,84.6%(11/13)存在TMJID;而75个髓腔信号正常关节中,33.3%(25/75)存在TMJID;髓腔信号异常与TMAD有显著相关性(P < 0.05)。结论关节盘移位是导致髓腔信号异常的原因之一。     

颞下颌关节疼痛冲洗疗效及关节液中TNFα含量变化

目的　探讨关节上腔冲洗术对颞下颌关节疼痛的影响及疼痛变化与关节液中TNFα含量的关系。方法　在关节上腔冲洗治疗前 ,抽取 4 0名关节源性疼痛TMD患者 4 6侧关节液标本 ,4名患者 6侧关节液标本因血污染被舍弃 ,记录治疗前关节疼痛的VAS值 ;治疗一周后 4 0名患者复诊 36人 ,再次抽取关节液标本 38例 ,并记录VAS值 ;采用双抗体夹心酶联免疫法 (ABC ELASA)检测治疗前后关节液中TNFα的水平。结果　治疗前患者关节液中TNFα检出率为 6 7 5 % (2 7/40 ) ,含量为 (6 4 7 5 6± 4 6 8 75 )pg/mgprotein ,VAS值 :(46 .0 3± 19.6 9)mm ;治疗后患者关节液中TNFα均未检出 ,VAS值 :(17 75± 7 33)mm ,与治疗前相比显著降低。结论　关节疼痛与关节液内TNFα水平密切相关 ;关节上腔冲洗术对缓解患者关节疼痛疗效肯定。     

颞下颌关节内紊乱与关节疼痛关系的研究

目的 :探讨TMJ疼痛与TMJID的关系。方法 :对 4 4例单侧关节疼痛TMD患者 88侧关节完成开闭口斜矢状位PDW成像 ,以非疼痛侧盘突关系做自身对照 ,评价关节疼痛与TMJID的关系。结果 :4 4个疼痛关节中 ,30个关节 (6 8.2 % )表现为TMJID ,其中ADDR为 11个关节 (2 5 % ) ,ADDWR为 19个关节 (4 3.2 % ) ;而 4 4个非疼痛关节中 6个关节 (13.6 % )表现为ADDR。经统计学分析 ,TMJ疼痛与TMJID及TMJID的类型有显著相关性 (P <0 .0 0 5 )。结论 :TMJID是颞下颌关节疼痛的原因之一     

下颌髁突重建的研究进展

颞下颌关节(TMJ)是颌面部唯一的活动关节,手术重建下颌髁突,是恢复TMJ功能的基本要求。 一、髁突重建的适应症 任何原因造成髁突骨性部分或完全丧失、髁突与关节凹、关节结节之间骨性粘着并有临床症状,如关节疼痛、杂音和功能丧失以及颌面部和牙颌畸形等,均需行髁突重建。髁突重建主要见于以下几种情况:     

安Ⅱ^1青少年颞下颌关节盘-突-窝位置关系的MRI研究

目的研究安Ⅱ1错合青少年颞下颌关节(TMJ)髁突在关节凹内的位置和盘突关系以及髁突位置和盘突关系之间的相关关系,探讨安Ⅱ1是否存在一定的TMJ病理结构.方法29例安Ⅱ1错合青少年(男14例,女15例),平均年龄10.8+1.1岁(8.1-13.0岁);摄取58侧TMJ的磁共振(MRI)片,测量分析突)窝、盘-突关系,与正常值相比较,并对髁突位置与盘突关系进行相关分析.结果反映髁突位置的JSI,Ca-Ti值与正常值之间有显著差异(P＜0.05),显示髁突处于前移位;反映盘突关系的各测量值稍比正常值前位,但差异无显著性;髁突位置与盘突关系相关系数多在0.013～0.213之间;盘前移位组与盘正常组的髁突位置差异无显著性.结论安Ⅱ1错合青少年髁突位置呈前移位,关节盘相对髁突偏前位但在正常生理范围内;未发现髁突位置与盘突关系之间存在相关关系.     

人颞下颌关节软骨弹性模量的测定

目的:测试人颞下颌关节(Temporomandibular Joint,TMJ)软骨不同解剖区域的弹性模量,分析颢下颌关节病的力学致病机理。方法:通过生物力学的研究手段,测量了8个TMJ软骨的弹性模量(E)及厚度(H),用SPCC/PC 软件进行统计分析。结果:关节软骨各区域中关节窝前斜面弹性模量最大、厚度最薄(E=23.94±9.95Mpa,H=0.543±0.140mm);而髁突后斜面弹性模量最小、软骨最厚(E=16.90±9.86Mpa,H=0.936±0.325mm)。未发现弹性模量与厚度之间有明显的相关关系。结论:认为TMJ软骨各区弹性模量的差异足后天功能刺激所致,其抗力能力不仅依赖厚度因素。     

The relationship of bone marrow edema pattern in the mandibular condyle with joint pain in patients with temporomandibular joint disorders: longitudinal study with MR imaging

The purpose of this study was to investigate the course of bone marrow edema pattern (decreased signal intensity on T1- or proton-density-weighted images and increased signal intensity on T2-weighted fat-suppressed images) in the mandibular condyle after improvement in clinical symptoms, and to clarify its relationship with temporomandibular joint (TMJ) pain. This study was based on 14 joints of 11 patients (all female, mean age 37.5 years) with TMJ disorders showing condylar bone marrow edema pattern on initial magnetic resonance (MR) images. All joints were re-evaluated clinically and using MR images after relief of joint pain following arthrocentesis combined with non-surgical treatment. The time interval between the initial and follow-up MR images ranged from 14 to 27 months (mean 17 months). Of the 14 joints, 4 joints (28.6%) showed a normal bone marrow signal, whereas 10 joints (71.4%) showed persistent bone marrow edema pattern on follow-up MR images (P = 0.125). Therefore, the reduction in TMJ pain did not correlate with resolution of bone marrow edema pattern in most joints. The results of this study suggest that the bone marrow edema pattern in the mandibular condyle does not always contribute to the occurrence of joint pain in patients with TMJ disorders.     

Medical Managed Care for Temporomandibular Disorders and Orofacial Pain

Abstract

This study investigated the differences of age distribution and temporomandibular joint (TMJ) pain between marrow edema and osteonecrosis in the mandibular condyle. Subjects consisted of 35 TMJs in 35 patients with abnormal bone marrow on MR images who were selected from a consecutive series of 527 patients with TMJ disorders. Proton density and T2-weighted MR images taken in the oblique sagittal and coronal planes were used to diagnose condylar marrow abnormalities and divide them into either edema or osteonecrosis. The differences in TMJ pain and age distribution for these two abnormalities were assessed with the one-sided Wilcoxon rank sum test with 0.05 alpha level.The degree of pain was higher in joints with marrow edema than in joints with osteonecrosis (p=0.033). The mean age was higher in joints with osteonecrosis (p<0.001). Our results suggest that there is more severe pain in TMJs with marrow edema of the mandibular condyle than in those with osteonecrosis. Since the patients with marrow edema have lower age, it also appears that marrow edema may be a precursor condition for osteonecrosis of the TMJ.     

Differences in temporomandibular joint pain and age distribution between marrow edema and osteonecrosis in the mandibular condyle

This study investigated the differences of age distribution and temporomandibular joint (TMJ) pain between marrow edema and osteonecrosis in the mandibular condyle. Subjects consisted of 35 TMJs in 35 patients with abnormal bone marrow on MR images who were selected from a consecutive series of 527 patients with TMJ disorders. Proton density and T2-weighted MR images taken in the oblique sagittal and coronal planes were used to diagnose condylar marrow abnormalities and divide them into either edema or osteonecrosis. The differences in TMJ pain and age distribution for these two abnormalities were assessed with the one-sided Wilcoxon rank sum test with 0.05 alpha level. The degree of pain was higher in joints with marrow edema than in joints with osteonecrosis (p = 0.033). The mean age was higher in joints with osteonecrosis (p < 0.001). Our results suggest that there is more severe pain in TMJs with marrow edema of the mandibular condyle than in those with osteonecrosis. Since the patients with marrow edema have lower age, it also appears that marrow edema may be a precursor condition for osteonecrosis of the TMJ.     

Relationship between temporomandibular joint pain and magnetic resonance imaging findings in patients with temporomandibular joint disorders

The purpose of this study was to evaluate abnormal magnetic resonance imaging (MRI) findings related to temporomandibular joint (TMJ) pain. This study included 245 joints of 152 patients with temporomandibular disorders with anterior disc displacement; of these, 129 joints had joint pain whereas 116 joints had no joint pain. MRI was used to evaluate the reduction of anterior disc displacement, joint effusion, mandible condylar morphology, bone marrow oedema of the mandibular condyle, and signal intensity of the posterior disc attachment (PDA) on fat-suppressed T2-weighted images. The odds ratio (OR) for each MRI variable for the pain group versus the no pain group was computed using logistic regression analysis. Univariate logistic regression analysis showed significant correlations between TMJ pain and all MRI findings. Multivariate logistic regression analysis showed significant correlations with joint effusion (P = 0.03, OR 2.21), bone marrow oedema (P < 0.001, OR 11.75), and signal intensity of the PDA (P < 0.001, OR 6.21). These results suggest that bone marrow oedema, high signal intensity of the PDA on fat-suppressed T2-weighted images, and joint effusion, in descending order of influence, are factors related to TMJ pain.     

Significance of frequency-selective fat saturation T2-weighted MR images for the detection of bone marrow edema in the mandibular condyle

The objective of this study was to evaluate the utility of frequency-selective fat saturation (FS) T2-weighted images (T2WI) for the detection of bone marrow edema in the mandibular condyle. MR evidence of bone marrow abnormalities was examined on the set of FS T2WI and conventional T1WI or of conventional T2WI and T1WI in 200 patients with temporomandibular joint (TMJ) related pain. Other parameters studied were TMJ effusion, disk displacement categories, and cortical bone abnormalities. The detection rate and area of bone marrow edema by FS T2WI and T1WI were significantly greater than those assessed by conventional T2WI and T1WI. The correlation between bone marrow abnormalities on FS T2WI and T1WI and pain was significantly stronger than with conventional T2WI and T1WI. This study confirms that FS T2WI is useful for the detection of the "edema pattern" in the mandibular condylar associated with TMJ-related pain.     

Long-term magnetic resonance imaging after temporomandibular joint discectomy without replacement.

PURPOSE: The intracapsular changes in patients who underwent discectomy without disc replacement were evaluated by magnetic resonance imaging (MRI) to determine the long-term outcome of this procedure. PATIENTS AND METHODS: Thirty-three patients observed for an average of 9 years 4 months (5 to 24 years) and 10 asymptomatic volunteers underwent MRI using T1- and T2-weighted images and 3-dimensional fast imaging with a steady precession sequence (FISP-3D) technique. The intracapsular changes, especially those in the joint space, were compared with the postoperative clinical findings. RESULTS: MRI examination of the temporomandibular joint in the 33 patients (35 joints) indicated the presence of tissue with an intermediate or high signal intensity in the joint space. This tissue covered the articular surface of the condyle and fossa. Thirty-two joints had no pain or only occasional, mild pain (3 joints). No patient had severe joint pain or a low signal intensity in the joint space on MRI examination. There was no correlation between joint noise and the presence of a tissue deformity in the joint space. MRI of 2 patients with limited mouth opening showed tissue with high signal intensity in the joint space as well as an exostosis on the eminence and hypertrophy of the condyle. CONCLUSION: Long-term success is possible with discectomy without replacement. This appears to be attributable to the formation of new tissue between the condyle and fossa that acts as a pseudodisc.     

Significance of Frequency-Selective Fat Saturation T2-Weighted MR Images for the Detection of Bone Marrow Edema in the Mandibular Condyle

Abstract

The objective of this study was to evaluate the utility of frequency-selective fat saturation (FS) T2-weighted images (T2WI) for the detection of bone marrow edema in the mandibular condyle. MR evidence of bone marrow abnormalities was examined on the set of FS T2WI and conventional T1WI or of conventional T2WI and T1WI in 200 patients with temporomandibular joint (TMJ) related pain. Other parameters studied were TMJ effusion, disk displacement categories, and cortical bone abnormalities. The detection rate and area of bone marrow edema by FS T2WI and T1WI were significantly greater than those assessed by conventional T2WI and T1WI. The correlation between bone marrow abnormalities on FS T2WI and T1WI and pain was significantly stronger than with conventional T2WI and T1WI. This study confirms that FS T2WI is useful for the detection of the “edema pattern” in the mandibular condylar associated with TMJ-related pain.     

Zonograms of temporomandibular joints in patients with anterior displacement of the disc without reduction

Zonogram investigations were made of 86 temporomandibular joints in 81 patients who were diagnosed by video-fluoroarthrogram as having anterior disc displacement without reduction. Comparisons between of condylar shape and movement, clinical phenomena, and disc perforation were made. Results 1. Condylar deformity on zonograms was classified into 3 types: flattening, osteophyte, and concavity. Condylar deformity was much higher in patients than in normal volunteer controls. 2. Condylar movement patterns were classified into 3 types: coordinated, uncoordinated, and limited. Coordinated movement was frequently observed in normal volunteers, and limited movement was common in the patients group. 3. In the patients group, condylar deformity was observed in both the displaced and the non-displaced sides, although it occurred with extremely high frequency in the displaced side. Condylar deformation was more common when the disc was perforated than when it was unperforated. A correlation between condyle deformity and pain on the non-displaced side was suggested; but no correlation existed between condylar deformity and such elements as age, joint sounds, mouth opening range, and locking term. 4. Limited condylar movement occurred more frequency in the displaced than in the non-displaced side. Consequently values for limited movement without joint sounds were high for the displaced side; and coordinated movement without joint sounds was frequent in the non-displaced side. There was no correlation between condylar movement and such elements as mouth opening range, locking term, and disc perforation. 5. Comparisons of condylar deformity and movement with clinical phenomena and disc perforation showed no instances of high (greater than or equal to 0.5) correlation. These results suggest that, in the temporomandibular joint, changes occur in both hard and soft tissues and that these changes take place on both the displaced and non-displaced sides.