«上一篇/Previous Article|本期目录/Table of Contents|下一篇/Next Article»

《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

29卷

期数:

2023年04期

页码:

422-426

栏目:

临床医学

出版日期:

2023-07-10

文章信息/Info

Title:

CBCT analysis of patients with temporomandibular joint osteoarthritis

文章编号:

1006-8147（2023）04-0422-05

作者:

高思文¹; 4; 李泽奎²; 李欣³; 张娟¹

天津医科大学口腔医院1.口腔修复科；2.放射科；3.牙周科，天津300070；4.中国人民武装警察部队特色医学中心口腔修复科，天津300162

Author(s):

GAO Si-wen¹; 4; LI Ze-kui²; LI Xin³; ZHANG Juan¹

1.Department of Prosthodontics；2.Department of Radiology；3.Department of Periodontics，Stomatological Hospital，Tianjin Medical University，Tianjin 300070，China；4.Department of Prosthodontics，Characteristic Medical Center of the Chinese People′s Armed Police Forces，Tianjin 300162，China

关键词:

颞下颌关节; 骨关节病; 弹响; 疼痛; 锥形束CT

Keywords:

temporomandibular joint; osteoarthritis; clicking; pain; cone beam computed tomography

分类号:

R617

DOI:

-

文献标志码:

A

摘要:

目的：对有颞下颌关节（TMJ）弹响和疼痛的骨关节病患者的锥形束CT（CBCT）进行测量分析，比较影像学上髁突位置和骨关节病征象的特点。方法：选取2015年9月—2018年9月天津医科大学口腔医院CBCT诊断有TMJ骨关节病（TMJOA）的患者120例为试验组：根据临床症状分组，关节弹响组40例，关节疼痛组40例，弹响和疼痛组40例；同期健康无症状对照组40名。利用Invivo5软件对CBCT数据测量分析，包括髁突形态、关节窝高度、关节间隙，髁突骨关节病征象诊断，分析伴弹响和疼痛的骨关节病患者CBCT的影像学特征。结果：与对照组相比，试验组髁突内外径、前后径、后间隙、上间隙以及髁突头部高度均减小（均P<0.05）。前间隙、关节窝深度测量比较差异无统计学意义（均P>0.05）。经析因设计方差分析结果显示，弹响与左、右侧内外径和左、右侧髁突头高度显著相关（均P<0.05）。疼痛与左侧前后径和左、右侧髁突头显著相关（均P<0.05）。弹响和疼痛同时存在与左、右侧内外径，左、右侧前后径，左侧后间隙，左、右侧髁突头高度和左侧关节窝深度显著相关（均P<0.05）。对照组髁突位置以中位48/80（60%）居多，试验组以后位111/240（46.25%）居多。TMJOA征象中试验组吸收破坏型占43.58%（78/179），增生硬化型占56.42%（101/179）。弹响组吸收破坏型占26.32%（15/57），增生硬化型占73.68%（42/57）。疼痛组吸收破坏型占62.71%（37/59），增生硬化型占37.29%（22/59）。弹响并疼痛组吸收破坏型占41.27%（26/63），增生硬化型占58.73%（37/63）。关节弹响患者髁突增生硬化型居多，关节疼痛患者髁突吸收破坏型居多（P<0.05）。结论：伴TMJ弹响和疼痛症状的骨关节病患者CBCT多表现为髁突变小，髁突后移位，关节弹响患者髁突增生硬化型居多，关节疼痛患者髁突吸收破坏型居多。

Abstract:

Objective：The cone-beam computer tomography（CBCT）imaging performance of osteoarthritis patients withtemporomandibular joint（ TMJ） clicking and pain were measured and analyzed，and the characteristics of condyle position and osteoarthritis symptoms were compared. Methods:A total of 120 patients with TMJ osteoarthritis （ TMJOA） diagnosed by CBCT in the Stomatological Hospital of Tianjin Medical University from September 2015 to September 2018 were included in the experimental group. According to the clinical symptoms，40 patients were divided into joint clicking group，40 patients were joint pain group，40 patients were coexisting joint clicking and pain group. Another 40 asymptomatic patients were included in control group in the same period. Invivo5 software was used to measure and analyze CBCT data，including the morphplogy of condyle，the height of articular fossa，the joint space，and the diagnosis of condylar osteoarthropathy，and analysis of the CBCT imaging manifestations of patients with TMJOA. Results: Compared with the control group，the internal，external，anterior and posterior diameter，posterior space of the condyle，upper space and the height of the condyle head of the experimental group were all decreased （ all P<0.05）. There was no statistical significance in the measurement of anterior space and fossa depth （ all P>0.05）.The results of factorial design variance analysis showed that the bounce was significantly correlated with the left and right inner and outer diameter and the left and right condyle head （ all P<0.05）. Pain was significantly correlated with left and right anterior and posterior diameter and left and right condylar head （ all P<0.05）. The simultaneous presence of clicking and pain was significantly correlated with left and right internal and external diameters，left and right anterior and posterior diameters，left posterior space，left and right condyle head height and left articular fossa depth （ all P<0.05）. In the asymptomatic group，the median condylar position took the largest proportion with 48/80 （ 60%），while posterior position took the largest proportion with 111/240（ 46.25%） in experimental group. In the TMJOA signs，the constituent ratio of the absorption destruction type accounted for 43.58% （ 78/179），the hyperplastic sclerosing type accounted for 56.42%（ 101/179） in the test group. Clicking group: the absorption destruction type accounted for 26.32%（ 15/57），the hyperplastic sclerosing type accounted for 73.68%（ 15/57）. Pain group: the absorption destruction type accounted for 62.71%（ 15/57），the hyperplastic sclerosing type accounted for 37.29%（ 22/59）.Clicking and pain group：the absorption destruction type accounted for 41.26%（ 22/59），the hyperplastic sclerosing type accounted for 58.73%（ 37/63）. Most of the patients with joint clicking had the hyperplastic sclerosing type，while most of the patients with joint pain had the destructive type of condylar absorption （ P<0.05）. Conclusion：In the CBCT findings of osteoarthritis patients with TMJ clicking and pain，the condylar mutates in smaller，and the condylar displaces backward. In patients with clicking，the sclerosis of condylar hyperplasia takes the most part，while the absorption destruction type takes the most part in patients with joint pain.

参考文献/References:

[1] 马绪臣.对颞下颌关节紊乱病关节盘移位的认识及治疗策略[J].中华口腔医学杂志，2017，52（ 3）：139-142.
[2] MEYER R A.Treatment of temporomandibular disorders：symptoms versus cause [J]. J Oral Maxil Surg，2020，28（ 1）：11-15.
[3] SPERR M，KARTH A S.Experimental methods to inform diagnostic approaches for painful TMJ ostearthritis[J]. J Dent Res，2019，98（4）：388-397.
[4] 龙星. 正 确区分颞下颌关节骨退行性关节病中的骨关节病和关节炎[J].中华口腔医学杂志，2022，57（ 7）：674-681.
[5] 刘华蔚，毕文婷，李永峰，等.颞下颌关节骨关节病的螺旋CT和锥形束CT影像学比较观察[J].中华口腔医学杂志，2021，56（8）：745-752.
[6] 赵燕平，马绪臣.颞下颌关节紊乱病相关疼痛与年龄/性别及骨关节病影像学改变的关系[J].中华口腔医学杂志，2006，41（ 12）：757-758.
[7] MOHAMMED A Q，NOURA A，HIMAM S，et al. MRI and CBCT imge registration of temporomandibular joint a systematic review [J]. J Otolaryngol Head Neck Surg，2016，10；45（ 1）：30.
[8]王学侠. 颞下颌关节无症状成年人骨性Ⅲ类错 髁状突-关节窝的位置和形态特征[D].山东大学，2011.
[9] KAMELCHUK L S，GRACE M G，Major P W.Post-imaging temporo－mandibular joint space analysis[J].Cranio，1996，14（ 1）：23-29.
[10]王瑞永，马绪臣，张万林，等.健康成年人颞下颌关节间隙锥形束计算机体层摄影术测量分析[J].北京大学学报：医学报，2007，39（5）：503-506.
[11]傅开元，张万林，柳登高，等.应用锥形束CT诊断颞下颌关节骨关节病的探讨[J].中华口腔医学杂志，2007，42（ 7）：417-420.
[12]杨绍练，何秋敏，许彪，等.颞下颌关节骨关节病和喙突形态特征的锥形束CT测量分析[J].中华口腔医学杂志，2022，57（7）：694-700.
[13] COSTA E D，GOMES A F，ASSIS A，et al. Volumetric evaluation of temporomandibular joints in patients with a chewing-side prefer－ence：a CBCT study [J]. General Dentistry，2021，69（ 1）：38-43.
[14] SCHNABL D，ROTTLER A K. CBCT and MRI imaging in patients clinically diagnosed with temporomandibular joint arthralgia [J]. He－liyon，2018，4（ 6）：e00641.
[15] TSAI C M，WU F Y. The advantage of cone-beam computerized to－mography over panoramic radiography and temporomandibular joint quadruple radiography in assessing temporomandibular jiont osseous degenerative changes[J]. J Dent Sci，2020，15（ 2）：153-162.
[16]韩建辉，雷杰，刘木青，等.颞下颌关节不可复性前移位患者骨关节病理表现的锥形束CT观察[J].中华口腔医学杂志，2017，52（1）：22-26.
[17] PAKNAHAD M，SHAHIDI S. Association between mandibular condylar position and clinical dysfunction index [J]. J Cranio-Max－illofacial Surg，2015，43（ 4）：432-436.
[18]傅开元，马绪臣，张震康，等.颞下颌关节紊乱器质性改变X线分型 研究[J].现代口腔医学杂志，1997，11（ 3）：174-176.
[19] SHAHIDI S，SALEHI P. Comparison of the bony changes of TMJ in patients with and without TMD complaints using CBCT [J]. J Dent Shiraz，2018，19（ 2）：142-149.
[20] DERWICH M，MITUS_KENIG M. Morphology of the temporomandibu－lar joints regarding the presence of osteoarthritic changes[J]. Int J Environ Res Public Health，2020，17（ 8）：2923.
[21] CEVIDANES LHS，HAJATI A K. Quantification of condylar resorp－tion in temporomandibular joint osteoarthritis[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod，2010，110（ 1）：110-117.
[22] WIESE M，SVENSSON P. Association between temporomandibular joint symptoms，signs，and clinical diagnosis using the RDC/TMD and radiographic findings in temporomandibular joint tomograms[J]. Orofac Pain，2008，22：239-251 .
[23]雷杰，秦思思，傅开元，等.锥体束CT影像评估颞下颌关节重度骨关节病髁突骨改变的稳定性[J].中华口腔正 畸学杂志，2017（4）：212-216.
[24] TALAAT W，AL BAYATTI S. CBCT analysis of bony changes asso－ciated with temporomandibular disorders [J]. Cranio，2016，34（ 2）：88-94.
[25] COMERTKILIC S，KILIC N. Tempormandibular joint osteoarthritis：cone beam computed tomography findings，clincalfeatures，and cor－relations[J]. Int J Oral Maxillofac Surg，2015，44（ 10）：1268-1274.

相似文献/References:

[1]王超然,李洪发,李志勤,等.Forsus矫治器矫治下颌后缩患者牙颌及颞下颌关节变化的CBCT分析[J].天津医科大学学报,2016,22(03):241.
　WANG Chao-ran,LI Hong-fa,LI Zhi-qin,et al.CBCT analysis of maxillofacial and temporal-mandibular joint of mandibular retrusion with Forsus appliance[J].Journal of Tianjin Medical University,2016,22(04):241.

备注/Memo

备注/Memo:

基金项目: 天津市医学重点学科建设项目（TJYXZDXK-038A）；天津医科大学口腔医院科研基金（2020YKYQ02）
作者简介:高思文（1984-），女，主治医师，硕士在读，研究方向：口腔修复；
通信作者：张娟，E-mail：kqzhangjuan@126.com。

常用功能

更新日期/Last Update: 2023-07-10