类风湿性关节炎病人颌关节直接冠状CT扫描

为研究类风湿性关节炎(RA)病人颞颌关节(TMJ)受累的机率、特征和严重程度,以及病变的特异性,作者对26例RA病人和26例无关节疾病的对照组病人进行了TMJ直接冠状CT扫描。病人取仰卧位颈极度后伸,扫描机架调至20°,使X线束经TMJ达头端,用侧位定位扫描象制订扫描计划,层厚1.5mm连续扫描,扫描后行局部放大,TMJ的直接冠状CT扫描可用骨窗和软组织窗进行诊断。观察下颌髁状突的形状(凸、凹或变扁)和高度(正常、变短或增生),评价下列征象:关节突变扁、骨矿质脱失、下颌髁状突和关节窝的侵蚀和骨囊肿(无、1个、2个或更多),髁状突头部骨吸收(无、轻度、严重)、下颌骨骨折、关节腔变窄(<0.5 mm)、骨性强直、颞骨或下颌骨软骨下骨硬化、骨质增生及关节盘钙化。结果见到,对照组仅5例无骨改变,绝大多数(20例)有关节突     

人颞下颌关节关节盘、软骨及下颌骨的纳米弹性性能

为探讨人颞下颌关节（TMJ）各结构及下颌骨骨组织在纳米量级的材料力学性能的分布特点，采用原子力显微镜及毫微压痕测量法，对3位正常成的男性6个TMJ的关节盘、髁突软骨、关节窝软骨和下颌骨皮质骨、松质骨不同部位的纳米弹性模量进行测量和分析。结果显示：人TMJ内关节盘、髁突软骨和关节窝软骨的不同部位具有不同的弹性模量，而各结构的弹性模量以前、内侧较高，中、后部及外侧较小。下颌骨皮质骨的弹性模量是松质骨的2倍多，而下颌骨颊侧骨组织的弹性模量则明显低于舌侧。提示在纳米范围测量，TMJ内各结构以及下颌骨骨组织为非均质性材料，其不同结构或同一结构不同区域在纳米量级所承受的局部力学载荷不同。     

磁共振WATS技术在颞下颌关节三维有限元建模中的应用价值

目的　探讨磁共振WATS技术在颞下颌关节三维有限元建模中的应用价值。方法　利用超薄层磁共振T1W 3DWATS成像技术对模型进行数据采样 ,采用Matlab大型科学计算软件及Ansys三维有限元专用软件建立颞下颌关节模型。结果　建立出的模型形态理想 ,髁突、关节盘及关节结节等与活体解剖TMJ具有良好的相似性 ,尤其对关节盘的位置形态模拟较精确。结论　磁共振WATS技术在显示关节软骨上有独特优势 ,利用该成像技术建立TMJ三维有限元模型比以往其它成像技术更精确 ,为进行TMJ生物力学分析奠定了良好基础     

MRI在TMJ损伤中诊断价值研究

目的　研究MRI对观察损伤性颞颌关节结构的诊断价值。方法　对山羊颞颌关节损伤分别于 3h、7d及 1月行MRI检查 ,采用斜矢状闭、开口位梯度回波T1W / 3D/WATS、自旋回波PDW /TSE、T1W /SE和T2 W /TSE序列及冠状闭口位T1W / 3D/WATS、PDW /TSE扫描观察TMJ结构变化 ,并进行组织学观察。结果　MRI观察到TMJ损伤早期髁状突表面软骨碎裂 ,关节盘挫裂和移位 ,关节间隙减小及关节腔内有出血 ,损伤后期可见髁状突表面软骨破坏 ,关节盘畸形 ,关节间隙减小。结论　MRI能全面地观察TMJ损伤后骨性结构及附件结构和形态的变化 ,对颞颌关节损伤的诊治有重要价值     

MRI在诊断无髁突骨折的间接颞下颌关节损伤中的应用

颞下颌关节（temporo mandibular joint，TMJ）间接损伤是发生TMJ关节功能紊乱的主要原因之一。对于髁突骨折的患者，可通过常规的X线片、CT检查进行诊断。但对于无髁突骨折的间接TMJ损伤的患者，X线片、CT不能显示TMJ的非骨性结构（关节盘、关节囊、关节韧带及软组织）损伤，给TMJ损伤的临床早期诊断治疗造成困难。     

Ⅵ型髁突骨折致颞下颌关节损伤的MRI表现

目的 探讨MRI在Ⅵ型髁突骨折致颞下颌关节损伤中的应用价值. 方法 对18例Ⅵ型髁突骨折患者于伤后3～14 d内行颞下颌关节MRI检查,分析MRI表现. 结果 在18例19侧Ⅵ型髁突骨折中有15侧发生关节盘移位,9侧关节囊撕裂,16侧关节盘后区组织撕裂(双板区),19侧关节腔内关节液改变. 结论 MRI能很好地显示Ⅵ型髁突骨折引起的颞下颌关节损伤情况,是颞下颌关节损伤的重要检查与评价手段,有利于指导临床上对治疗方案的选择.     

下颌髁突脱位骨折后颞下颌关节软组织改变的MRI表现

目的 分析下颌髁突脱位骨折后颞下颌关节(TMJ)软组织改变的MRI表现.方法 应用矢状面和冠状面质子密度加权成像(PDWI)和T2WI连续检查103侧(77例)患有下颌髁突脱位骨折的颞下颌关节(TMJ).结果 MRI上,103侧髁突脱位骨折后的TMJ异常表现有:(1)髁突骨折断片向前下(102侧,99.0%)和前(1侧,10%)脱位;(2)关节盘移位(100侧,97.1%),其中矢状面MRI显示关节盘随脱位的髁突向前下移位者99侧,向前移位者1侧;(3)关节腔积液(103侧,100%);(4)关节盘后区信号异常(91侧,88.3%);(5)关节盘下后附着异常(89侧,86.4%);(6)关节囊异常(89侧,86.4%);(7)关节盘上后附着异常(37侧,35.9%);(8)关节盘变形(8侧,7.8%);(9)关节盘撕裂(8侧,7.8%);(10)颞骨关节窝骨折(4侧,3.9%).结论矢状面MRI上,多数下颌髁突脱位骨折以TMJ关节盘随脱位的髁突向前下移位,并伴有关节腔积液为特点.     

颞下颌关节损伤的MRI表现

目的 研究颞下颌关节(temporomandibular joint, TMJ)损伤的MRI表现,重点观察关节盘的移位及损伤情况.方法 13例TMJ损伤的初诊患者,使用3英寸(1 英寸=2.54 cm)双颞下颌Dual表面线圈,分别行斜矢状面和斜冠状面T1WI和T2WI的闭口位及张口位扫描.结果 13例患者26个TMJ中有20个(20/26, 76.9%)发生髁突骨折,其中12例患者的19个(19/20, 95%)关节盘随着碎裂的髁突骨折片向前内侧移位,6个(6/20, 30%)关节盘可见扭曲、变形.另1例患者为单侧髁突骨折并关节盘断裂(1/20, 5%),向外侧移位,其对侧关节盘轻度向前移位.12个TMJ可见关节积液,均见于髁突骨折的关节(12/20, 60%).开口位关节盘的位置较闭口位未见明显变化.结论 MRI是TMJ损伤的有效检查方法,有助于判断关节盘形态和位置的改变.     

改良关节成形术治疗外伤性Ⅱ、Ⅲ型颞下颌关节强直

颞下颌关节（tempormandibular joint,TMJ）强直是指髁突、关节窝以及关节结节发生纤维性和骨性粘连，融合，外伤是导致TMJ强直的最主要原因。笔者对我院1998-2003年收治的TMJ强直进行回顾性研究，探讨改良关节成形术对外伤性Ⅱ、Ⅲ到TMJ强直的疗效。     

颞下颌关节滑膜软骨瘤病的MRI表现

目的:探讨和描述颞下颌关节(TMJ)滑膜软骨瘤病的MRI表现特点。材料和方法:回顾性观察和分析13例经手术病理证实的TMJ区滑膜软骨瘤病的MRI表现。所有病例均在术前行闭口矢状面和冠状面PDWI、开口矢状面T_2WI检查。结果:所有滑膜软骨瘤病均发生于TMJ上腔。病变的MRI表现:关节上腔异常积液(13例,100%);关节囊明显扩张(11例,84.6%);关节腔内有多发软骨样小体的形成(11例,84.6%);关节囊或滑膜组织增厚(8例,61.5%)和颞骨关节面骨质破坏(4例,30.8%)。MRI未显示病变有下颌髁突侵蚀、关节囊外软组织侵犯、大脑颞叶脑膜和脑实质侵犯。结论:颞下颌关节滑膜软骨瘤病的MRI表现具有一定特点,主要表现为关节上腔异常积液,伴关节囊扩张、多发软骨样结节小体形成和滑膜组织增厚。     

Changes in condylar mobility and radiographic alterations after treatment in patients with non-reducing disc displacement of the temporomandibular joint

OBJECTIVES: The purpose of this study was to examine changes in condylar mobility and morphological changes in the affected condyles after treatment in patients with non-reducing disc displacement of the temporomandibular joint (TMJ). METHODS: Changes in condylar mobility and morphological changes of the condyle were examined radiographically in 55 patients who were diagnosed as having non-reducing disc displacement of the unilateral TMJ and had received pumping with injection of sodium hyaluronate. In all patients, standardized lateral oblique transcranial radiographs and panoramic jaw tomograms were taken both at initial visit and at 12 months or more follow-up (mean 28.1 months after treatment; range 12-104 months). 42 joints in 21 persons with no current or previous TMJ symptoms served as a control. RESULTS: Clinical signs and symptoms improved after treatment in the patients. Condylar mobility significantly increased after treatment in patients (P<0.001), although it did not reach levels of the control group. Frequency of radiographic changes of the condyle significantly increased after treatment (P<0.005). In most of the patients, no or only mild changes were observed. Frequency of changes of the condyle in patients at follow-up was significantly greater than that in controls (P<0.001). CONCLUSIONS: In the patients, condylar mobility increased in the subsequent course after treatment. However, bony changes of the condyle appeared more frequently. Long term-follow-up after treatment on bony changes of the condyle seems to be necessary in patients with non-reducing disc displacement of the TMJ.     

MR of osteochondritis dissecans and avascular necrosis of the mandibular condyle

We studied 40 patients exhibiting radiologic changes of either osteochondritis dissecans (OCD) or avascular necrosis (AVN) involving the mandibular condyle to evaluate the structural changes associated with these lesions when using high-field-strength MR imaging. Various clinical indications for imaging each patient with routine radiography, tomography, and surface-coil MR included headache, temporomandibular joint (TMJ) and/or ilsilateral facial pain, joint crepitus, clicking, locking, and either recently acquired or changing (unstable) occlusal disorder. Radiologic findings included alterations in condyle morphology and MR signal characteristics compatible with either OCD or AVN or, in some cases, both. Previous nonsurgical mandibular trauma was temporally related to the onset of symptoms in eight patients. Five patients exhibiting either unilateral or bilateral AVN involving the condyles and condylar necks had undergone previous orthognathic surgery, including sagittal split mandibular osteotomies followed by intermaxillary fixation. One patient exhibiting condylar AVN with articular surface collapse and osseous destruction had undergone previous TMJ meniscectomy followed by insertion of a permanent Proplast implant. Thirty-one of 34 patients with no prior surgery and MR changes of condylar OCD/AVN had associated internal derangement of the TMJ meniscus. There was surgical confirmation of findings in 10 joints. We assert that OCD and AVN are relatively common, clinically significant lesions of the mandibular condyle often associated with preexisting internal derangement of the temporomandibular joint.     

Unilateral medial dislocation of the temporomandibular joint

We present our experience of the rare condition of unilateral medial dislocation of the temporomandibular joint (TMJ) in 11 patients with head trauma who had received a direct lateral blow on the chin. The diagnosis was made by direct coronal CT of the TMJ performed from 6h to 7 days following the injury. In 6 patients, subcondylar fracture of the ipsilateral mandibular ramus was also demonstrated. A second CT performed 11–16 months following the first one demonstrated pseudoarthrosis of the fractured ramus in these 6 patients. The second CT was identical to the first in the remaining 5 patients with pure dislocation of the condyle. All patients suffered from severe disability of the TMJ. The maximal vertical distance between the upper and lower incisors in patients with uncomplicated dislocation ranged between 8 and 12 mm. In cases with complicated medial condylar dislocation with fracture and pseudoarthrosis of the mandibular ramus, this distance ranged between 16 and 25 mm, probably because of additional movement in the area of the pseudoarthrosis. The maximal vertical distance between the incisors was compared with a control group of 20 normal adults who had values from 40 to 52 mm. Medial unilateral dislocation of the TMJ can appear in two forms: uncomplicated or complicated, with pseudoarthrosis of the ipsilateral mandibular ramus. Received: 8 July 1996 Accepted: 22 July 1996     

Normal and abnormal temporomandibular joints as demonstrated by magnetic resonance imaging

Magnetic resonance imaging of the temporomandibular joint (TMJ) was performed on two normal volunteer subjects and two symptomatic subjects using a 0.15 T resistive magnet. A spin echo pulse sequence with a TE of 38 ms and a TR of 500 ms was employed. The TMJ meniscus is a low signal structure, and the bilaminar zone behind it is a relatively high signal structure. In normal closed mouths, the demarcation between meniscus and bilaminar zone is located at the vertex position above the mandibular condyle. When the condyle translates, the posterior portion of the meniscus bulges into the joint space. Dislocated meniscus can be identified by a gray mass anterior to the condylar head. The joint space is filled with the higher signal of the bilaminar zone. In non-reducible dislocations, the meniscus remains anterior to the condylar head with opening of the mouth. Reduced dislocations appear similar to normal joints in the open mouth.     

A study of the relationship between the position of the condylar head and displacement of the temporomandibular joint disk.

OBJECTIVES: To examine the possible relationship between condylar position and disk displacement in the TMJ. METHODS: Forty-eight joints with no disk displacement (NDD), 84 joints with a reducible displaced disk (RDD) and 99 joints with a permanently displaced disk (PDD) were selected. The positions of the condyle and TMJ disk were calculated from lateral MR images. RESULTS: There were significant differences in condylar position between the joints with NDD and RDD, while there was no difference between those with NDD and PDD (Kruskal-Wallis and post-hoc test, P<0.05). There was also a significant correlation between the position of the condylar and the displaced disk (Spearman's rank correlation, P<0.05). The condyle was located more anteriorly with advancing disk displacement. CONCLUSIONS: We suggest that if the disk displacement is slight, the condyle is displaced posteriorly: as the disk displacement becomes more severe (i.e. more anteriorly displaced), the condyle returns to the concentric position.     

保留髁突和关节盘治疗Ⅲ型颞下颌关节内强直的作用和疗效观察

目的 探讨保留髁突和颞下颌关节盘的术式对于治疗创伤性颞下颌关节内强直Ⅲ型的疗效.方法 创伤性颞下颌关节内强直Ⅲ型8例,男4例,女4例;年龄7～22岁,平均13.6岁.病程1～12年,开口度2～10 mm.手术方法为去除外侧髁突骨折断面形成的骨痂,将髁突磨改成形,在内侧寻找分离出移位的关节盘,松解后将关节盘的外侧端缝合固定至外侧关节囊或软组织.结果 术后随访6～38个月,患者开口度平均30 mm,无关节疼痛及弹响症状,随访期内无复发.结论 采用保留髁突和关节盘的方法治疗创伤性颞下颌关节内强直Ⅲ型,方法简单易行,创伤小,能有效防止复发.     

Temporomandibular joint and rheumatoid polyarthritis. X-ray computed tomographic aspects]

Direct coronal computed tomography (CT) examination of the temporomandibular joint (TMJ) was performed in 26 patients with rheumatoid arthritis (RA) and 26 control subjects. Changes in condylar shape, erosions and cysts of the mandibular condyle and condylar head resorption were more frequent among the RA group than the control group. Only the erosions and cysts of the mandibular condyle had a significantly higher frequency in the RA group than in the control group (p less than 0.05). Bone changes were bilateral in RA. Coronal view of the CT examination allow a clear visualization of the osseous elements of the TMJ but a control group is absolutely necessary to affirm with certainty the rheumatoid origin of the bone changes. The erosions and cysts of the mandibular condyle and their bilateral nature are the most specific features of RA on TMJ.     

髁状突脱位骨折坚固内固定术25例疗效观察

 目的评价髁状突脱位骨折开放复位并行坚固内固定(RIF)的长期治疗效果.方法25名患者术后接受了平均4.5 a的随访调查.根据( )关系、颞下颌关节功能恢复情况和术后X线片评价术后效果.结果临床术后效果令人满意.放射学上,尽管骨折段经准确对位,但32%患者髁状突骨质与升支高度仍有改变.一般完全暴露和无血供的髁状突较部分保留血供的髁状突术后改变大.结论坚固内固定对髁状突脱位骨折是有满意疗效的.     

Temporomandibular joint injuries

The clinical and radiologic findings in 30 patients who sustained injuries to the temporomandibular joint (TMJ) were retrospectively analyzed. Imaging consisted of variable combinations of radiography, tomography, two-compartment arthrography, computed tomography, and magnetic resonance imaging and was performed 2 days to 24 months after injury. Indications for imaging included acquired and/or unstable occlusal disturbances, cephalalgia, facial pain, otalgia, TMJ pain, tinnitus, dizziness, hearing disturbance, masticatory dysfunction, and muscle atrophy. Radiologic findings included internal derangement of the TMJ meniscus, swelling of retrodiskal tissues, joint effusion, mandibular condyle and condylar neck fractures, osteochondritis dissecans, avascular necrosis, degenerative condylar remodeling, osteoarthritis, musculotendinous injuries, and atrophy of masticatory muscles. After imaging studies, seven patients underwent surgery, at which time imaging findings were confirmed; one patient underwent successful aspiration of a painful hemarthrosis. TMJ injuries may result in joint derangement, radiologically demonstrable joint degeneration, masticatory muscle dysfunction, pain, and progressive clinical disability.