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中华口腔医学研究杂志(电子版) ›› 2016, Vol. 10 ›› Issue (05) : 347 -351. doi: 10.3877/cma.j.issn.1674-1366.2016.05.009

所属专题: 文献

临床研究

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
许跃1, 林秋平1, 林韩1, 张志光1, 郑有华1,()   
  1. 1. 510055 广州,中山大学光华口腔医学院·附属口腔医院,广东省口腔医学重点实验室
  • 收稿日期:2016-08-10 出版日期:2016-10-01
  • 通信作者: 郑有华
  • 基金资助:
    国家自然科学基金(81271115)

Exploration of temporomandibular disc perforation with cone beam computed tomography arthrography diagnosis

Yue Xu1, Qiuping Lin1, Han Lin1, Zhiguang Zhang1, Youhua Zheng1,()   

  1. 1. Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
  • Received:2016-08-10 Published:2016-10-01
  • Corresponding author: Youhua Zheng
  • About author:
    Corresponding author: Zheng Youhua, Email:
引用本文:

许跃, 林秋平, 林韩, 张志光, 郑有华. 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[J]. 中华口腔医学研究杂志(电子版), 2016, 10(05): 347-351.

Yue Xu, Qiuping Lin, Han Lin, Zhiguang Zhang, Youhua Zheng. Exploration of temporomandibular disc perforation with cone beam computed tomography arthrography diagnosis[J]. Chinese Journal of Stomatological Research(Electronic Edition), 2016, 10(05): 347-351.

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。

Objectives

To explore the relationship of anterior disc displacement, disc perforation and condyle bone defect.

Methods

A total of 96 cases of osteoarthrosis (145 sides of temporomandibular joint) from Hospital of Stomatology, Sun Yat-sen University, were included and undertook cone beam computed tomography arthrography (CBCT) . They are classified into Perforation Group and Non-perforation Group. The disc displacement and types of perforation were analyzed with Pearson χ2 method, and the bone defect types between two groups were compared with χ2 analyses using SPSS 18.0 software.

Results

Anterior disc displacement was shown in all the joints, among which 123 cases were anterior disc displacement without reduction, and 22 cases were anterior disc displacement with reduction. Disc perforation was confirmed by arthrography in 86 cases. Significant correlation (χ2= 6.866, P= 0.015) was found between the types of the anterior disc displacement and the groups of Perforation or Non-perforation. In the Perforation Group, the incidence of anterior disc displacement without reduction (91.86%) was greater than that in the Non-perforation Group (76.3%) .

Conclusions

The disc displacement can happen in the disc perforation cases. And the types of disc displacement are correlated with the perforation, while the type of condyle bone defect show no significance correlation with the perforation.

图1 颞下颌关节盘病变及造影锥形束CT矢状位图像
图2 髁突骨质改变7种分型的锥形束CT冠状位及矢状位图像
表1 颞下颌关节骨关节病患者关节盘穿孔与关节盘前移位类型的关联性分析
表2 髁突骨质分型在穿孔与非穿孔分组中的构成比[例(%)]
[1]
艾晓武,汤涛,陈璐.颞下颌关节盘穿孔的临床研究观察[J].口腔医学研究,2008,24(4):455-456.
[2]
Hagandora CK, Almarza AJ. TMJ disc removal:comparison between pre-clinical studies and clinical findings[J]. J Dent Res,2012,91(8):745-752.
[3]
Juran CM, Dolwick MF, McFetridge PS. Shear mechanics of the TMJ disc:relationship to common clinical observations[J]. J Dent Res,2013,92(2):193-198.
[4]
Kuo J, Zhang L, Bacro T,et al. The region-dependent biphasic viscoelastic properties of human temporomandibular joint discs under confined compression[J]. J Biomech,2010,43(7):1316-1321.
[5]
Shen P, Huo L, Zhang SY,et al. Magnetic resonance imaging applied to the diagnosis of perforation of the temporomandibular joint[J]. J Craniomaxillofac Surg,2014,42(6):874-878.
[6]
Muñoz-Guerra MF, Rodríguez-Campo FJ, Escorial Hernández V,et al. Temporomandibular joint disc perforation:long-term results after operative arthroscopy[J]. J Oral Maxillofac Surg,2013,71(4):667-676.
[7]
Brooks SL, Brand JW, Gibbs SJ,et al. Imaging of the temporomandibular joint:a position paper of the American Academy of Oral and Maxillofacial Radiology[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod,1997,83(5):609-618.
[8]
Truelove EL, Sommers EE, LeResche L,et al. Clinical diagnostic criteria for TMD. New classification permits multiple diagnoses[J]. J Am Dent Assoc,1992,123(4):47-54.
[9]
Xu Y, Zhan J, Zheng Y,et al. Synovial fluid dynamics with small disc perforation in temporomandibular joint[J]. J Oral Rehabil,2012,39(10):719-726.
[10]
Moncada G, Cortés D, Millas R,et al. Relationship between disk position and degenerative bone changes in temporomandibular joints of young subjects with TMD. An MRI study[J]. J Clin Pediatr Dent,2014,38(3):269-276.
[11]
Cortés D, Exss E, Marholz C,et al. Association between disk position and degenerative bone changes of the temporomandibular joints:an imaging study in subjects with TMD[J]. Cranio,2011,29(2):117-126.
[12]
Campos MI, Campos PS, Cangussu MC,et al. Analysis of magnetic resonance imaging characteristics and pain in temporomandibular joints with and without degenerative changes of the condyle[J]. Int J Oral Maxillofac Surg,2008,37(6):529-534.
[13]
Ribeiro-Rotta RF, Marques KD, Pacheco MJ,et al. Do computed tomography and magnetic resonance imaging add to temporomandibular joint disorder treatment?A systematic review of diagnostic efficacy[J]. J Oral Rehabil,2011,38(2):120-135.
[14]
Petersson A. What you can and cannot see in TMJ imaging—an overview related to the RDC/TMD diagnostic system[J]. J Oral Rehabil,2010,37(10):771-778.
[15]
Limchaichana N, Petersson A, Rohlin M. The efficacy of magnetic resonance imaging in the diagnosis of degenerative and inflammatory temporomandibular joint disorders:a systematic literature review[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2006,102(4):521-536.
[16]
Liu XM, Zhang SY, Yang C,et al. Correlation between disc displacements and locations of disc perforation in the temporomandibular joint[J]. Dentomaxillofac Radiol,2010,39(3):149-156.
[17]
龙星.颞下颌关节盘穿孔的外科治疗[J].中华口腔医学杂志,2005,40(5):423-424.
[18]
龙星,李金荣,汪传铎,等.颞下颌关节盘前移位和穿孔的关节内窥镜研究[J].口腔医学纵横杂志,1999,15(4):222-224.
[19]
de Farias JF, Melo SL, Bento PM,et al. Correlation between temporomandibular joint morphology and disc displacement by MRI[J]. Dentomaxillofac Radiol,2015,44(7):20150023.
[20]
Venetis G, Pilavaki M, Triantafyllidou K,et al. The value of magnetic resonance arthrography of the temporomandibular joint in imaging disc adhesions and perforations[J]. Dentomaxillofac Radiol,2011,40(2):84-90.
[21]
Embree MC, Iwaoka GM, Kong D,et al. Soft tissue ossification and condylar cartilage degeneration following TMJ disc perforation in a rabbit pilot study[J]. Osteoarthritis Cartilage,2015,23(4):629-639.
[22]
Hu YK, Yang C, Cai XY,et al. Does condylar height decrease more in temporomandibular joint nonreducing disc displacement than reducing disc displacement?:A magnetic resonance imaging retrospective study[J]. Medicine(Baltimore),2016,95(35):e4715.
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