关节盘前移位患者的关节音分析

目的比较关节盘前移位（ADD）患者和正常人开闭口运动中颞下颌关节（TMJ关节音的振动参数,探讨关节音频谱图的临床诊断价值。方法运用关节音分析仪记录43例ADD患者和15例正常人的TMJ表面振动参数,收集关节振动信号并进行提取处理和统计学分析。结果（1）病例组两侧TMJ的振动总能量、小于300Hz的振动能量、大于300Hz的振动能量、峰振幅均明显大于对照组（P〈0.01）;（2）不可复性盘前移位者关节振动能量及峰振幅明显低于可复性盘前移位者（P〈0.05）;（3）关节音频谱图对ADD的诊断灵敏度、特异性较高（分别为87.5%和86.7%）。结论ADD患者关节音振动的各个参数明显高于正常人,不同病变阶段的关节音亦不同,通过分析TMJ音频谱图,可能有助于鉴定异常关节音所属的病变阶段,有望成为ADD的无创辅助诊断和早期筛查方法。

Joint sounds analysis of patients with temporomandibular joint anterior disk displacement

Objectives To compare the difference of temporomandibular joint （TMJ） sounds between disk displacement （ADD） and the normal TMJs, investigate the clinical value of sounds analysis for the diagnosis of ADD. Methods 43 ADD subjects （7 male, 36 female） were included from the TMJ disease out-patient clinic of the hospital of Stomatology, Sun Yat-sen University from March, 2006 to May, 2007, with an average age of 28.5 ± 4.4 years. Chief complains were TMJ clicking or opening restriction, TMJ region pain. According to the clinical and radiological examinations, the subjects were divided in 27 anterior disc displacement with reduction （ADDWR） and 16 anterior disk displacement without reduction （ADDWoR）. 15 subjects, with an average age of 23.9 ±2.0 years full dentition, and fundamental normal occlusion, without signs and symptoms of tempolomandibular disorders （TMD） or nervous system diseases, had never received any correlated treatments, were chosen to be the control group. The BioPAK system was employed to record and analyze the joint vibration. Results The total integral, 〈 300 hertz integral, 〉 300 integral and peak amplitude of bilateral TMJs were significant higher in case group than that in control group （P 〈 0.01 ）. Affected TMJs in case group showed increasing vibration integral and amplitude accompanied with the aggravation of clinic signs and symptoms. ADDWoR subjects demonstrated lower vibration integral and peak amplitude than ADDWR subjects （P 〈 0.05）. Frequency spectrogram of TMJ sounds showed a high sensitivity and specificity （87.5% and 86.7%, respectively） in the diagnosis of ADD. Conclusions All the parameters of TMJ sounds in ADD patients are higher than that in normal subjects. Different stages of ADD have different TMJ sounds. Analysis of the frequency spectrogram of TMJ sounds may be of help to identity the process of abnormal TMJ sounds, and used as a noninvasive technique for auxiliary diagnosis and screening of TMD.