颞下颌关节损伤的实验动物模型

颞下颌关节损伤可以导致颞下颌关节内紊乱，颞下颌关节骨关节病及病关节强直等后遗症，动物模型是研究颞下颌关节损务后病理变化及发生的机理的重要手段，本文目前关于颞下颌关节损伤的实验动物选择及损伤方法和优，缺点作一系统综述。     

颞下颌关节紊乱病的治疗

关于 因素是否颞下颌关节紊乱病（ＴＭＤ）病因之一,以及ＴＭＤ的 治疗,现存在着各种争议。本文回顾了有关研究及观点。目前,无论是动物实验研究,还是临床实验研究,都不足以作出 因素是ＴＭＤ病因之一的结论。但是, 治疗在ＴＭＤ临床治疗中占有重要地位,且发挥重要作用：调 能有效地缓解慢性头痛,颈痛及肩部痛; 治疗对减轻ＴＭＤ患者的肌肉疼痛也显示理想效果：调位咬合板能消除一部分关节弹响。进一步探索ＴＭＤ的 因素,正确掌握ＴＭＤ 治疗的适应证及客观科学地评价 治疗的临床效果是我们今后研究的课题。     

程序性坏死在颞下颌关节骨关节炎软骨退变中的研究进展

颞下颌关节骨关节炎(temporomandibular joint osteoarthritis,TMJOA)是颞下颌关节紊乱病(tem-poromandibular diseases,TMD)的重症形式.关节软骨退变是TMJOA早期最典型的病理学特征之一,软骨细胞死亡是软骨退变中的核心事件.相比较于凋亡和自噬,新型细...     

错畸形与颞下颌关节紊乱病

颞下颌关节紊乱病(TMD)是由多因素引起的疾病,其中因素是重要的病因。关系异常可以引起TMD的症状,而错畸形矫正以后TMD症状明显减轻。亦有认为TMD与关系错乱没有直接关系,即所说的没有影响或仅有轻微影响。本文对TMD的临床表现,病因、治疗及预后等方面进展进行综述。     

调治疗颞下颌关节疼痛的临床分析

目的　了解颞下颌关节疼痛患者的牙合状况 ,解除牙合干扰。方法　通过面弓转移 ,记录正中关系 ,上牙合架 ,对 18例颞下颌关节疼痛的患者进行了牙合干扰分析。结果　调牙合对颞下颌关节疼痛与牙合干扰改善明显 ,牙合干扰的解除可以明显地减轻疼痛。结论　调牙合是改善颞下颌关节疼痛的一个可行方法。     

颞下颌关节骨关节炎与关节内紊乱关系的研究

目的 :探讨颞颌关节骨关节炎 (TMJOA)与颞颌关节内紊乱 (TMJID)的关系。方法 :利用MRI金标准 ,对 44例颞颌关节紊乱病患者 88侧关节完成开闭口T1加权成像 ,观察盘突关系和骨改变。结果 :88个关节中40 .9% ( 3 6/88)表现为TMJID ,13 .6% ( 12 /88)表现为TMJOA ,骨改变的分布情况 :正常盘突关系 (NDCR)关节中 2个 ,破坏和骨赘各 1个 ;可复性关节盘前移位 (ADDR)关节中 3个全部表现为骨破坏 ;不可复性关节盘前移位 (AD DWR)关节中 7个 ,表现为髁状突变平 3个 ;表现为破坏、骨赘、硬化和短小各 1个 ,统计学分析发现TMJOA与TMJID具有显著相关性。结论 :TMJOA的发生与关节结构紊乱显著相关。由于TMJOA可独立于TMJID之外而单独存在 ,目前将TMJOA看作是与TMJID密切相关的另一类疾病较为合适。     

颞下颌关节骨关节炎治疗的临床疗效比较

目的:探讨比较关节腔注射治疗、超短波物理治疗、药物口服治疗对颞下颌关节骨关节炎的临床疗效。方法 :选取初期骨关节炎患者60例,随机分为3组,分别采用透明质酸钠(Sodium hyaluronate,SH)关节上腔注射法、超短波物理治疗法、双氯芬酸钠(diclofenac sodium)联合盐酸氨基葡萄糖(glucosamine hydrochloride)口服法进行治疗。利用颞下颌关节功能障碍指数(dysfunction index,DI)及疼痛直观模拟标尺(visual analog variables,VAS)对比各组治疗后1周、1个月、3个月及6个月的疗效。结果:治疗后1周各组疗效无差异(P>0.05);治疗后1个月注射组及超短波组疗效优于药物组(P<0.05);治疗后3个月及6个月注射组疗效显著优于短波组及药物组(P<0.05)。结论:药物口服及超短波物理治疗疗效稳定性较差。透明质酸钠关节腔内注射法的疗效稳定性值得肯定。     

颞下颌关节骨关节炎动物模型的建立方法

骨关节炎是颞下颌关节紊乱病的重要类型之一,建立动物模型是颞下颌关节骨关节炎研究中的一个重要方面.日前常用的建模方法主要有外科手术、化学试剂注射、被动过度大张口、基因敲除和制造咬合紊乱等。本文对骨关节炎的主要病理变化及以上几种建模方法的优缺点进行综述。     

医用臭氧对颞下颌关节骨关节炎大鼠髁突软骨作用研究

目的    分析于颞下颌关节腔内注射医用臭氧对颞下颌关节骨关节炎（temporomandibular joint osteoarthritis,TMJOA）大鼠髁突软骨的作用。方法    选取8 ~ 10周龄雄性SD大鼠22只,随机分为对照组6只、模型组6只、实验组10只。模型组和实验组大鼠建立TMJOA模型3周后,实验组大鼠颞下颌关节腔内注射质量浓度为30 μg/mL的医用臭氧,其他2组注射生理盐水,每周1次,共3次。行锥形束CT（cone beam computed tomography,CBCT）扫描后处死各组大鼠并进行取材,观察髁突和关节盘的变化;采用HE、甲苯胺蓝染色并分别通过改良Mankin′s评分和平均光密度值分析髁突软骨细胞和基质的变化情况;采用抗酒石酸酸性磷酸酶（tartrate-resistant acid phosphatase,TRAP）染色观察破骨细胞数量及分布。结果    经CBCT检查和肉眼观察发现,模型组和实验组颞下颌关节髁突及关节盘呈现出不同程度的缺损,模型组缺损程度重于实验组。3组改良Mankin′s评分、平均光密度值和TRAP染色阳性细胞数比较,差异均有统计学意义（F值分别为93.462、44.498、113.918,均P < 0.05）。其中,模型组和实验组的改良Mankin′s评分、TRAP染色阳性细胞数均大于对照组,模型组这2个指标还高于实验组,差异均有统计学意义（均P < 0.05）;模型组和实验组的平均光密度值低于对照组,模型组的平均光密度值低于实验组,差异均有统计学意义（均P < 0.05）。结论    于颞下颌关节腔内注射质量浓度为30 μg/mL的医用臭氧,可减轻TMJOA大鼠髁突软骨及软骨下骨的损伤。     

前牙深覆者的颞下颌关节振动分析

目的比较前牙深覆者与个别正常者开闭口运动中颞下颌关节(TMJ)的振动参数,探讨前牙深覆对TMJ振动的影响。方法运用关节振动分析仪记录22例前牙深覆者与33例个别正常者的TMJ振动参数,收集关节振动信号并进行提取处理及统计分析。结果前牙深覆组两侧TMJ的振动总能量(TI)、小于300Hz振动能量(I<300)、峰振幅(PA)与对照组相比均差异有统计学意义(P<0.05),且TI、I<300Hz、PA较个别正常组大;深覆组关节振动发生在开口中、末期及闭口中、末期。结论前牙深覆者TMJ振动总能量大于个别正常者;前牙深覆者关节振动多发生在开口中、末期及闭口中、末期。     

颞下颌关节髁突囊样变的锥形束CT影像特点

目的 利用口腔颌面锥形束CT观察髁突囊样变的影像学表现,探讨囊样变的影像特点并加以分类。方法 收集颞下颌关节锥形束CT影像学表现有囊样变的194例患者,观察并记录囊样变的部位、大小、数量、边缘骨白线、周围骨小梁结构、髁突整体骨质情况。根据髁突整体骨质情况,将髁突囊样变分为Ⅰ型和Ⅱ型,比较其发生的部位、数量、边缘骨白线以及周围骨小梁结构情况。结果 194例患者的198侧关节发现囊样变表现,94例位于左侧关节,96例位于右侧关节,4例位于双侧关节。50.0%（99侧）的囊样变位于髁突前外侧皮质骨下方;囊样变直径最小1.2 mm,最大13.5 mm,平均（3.4±1.5）mm;75.3%（149侧）为单发囊样变;62.6%（124侧）存在完整的骨白线包绕;80.8%（160侧）周围骨小梁结构有骨质硬化。66.7%（132侧）囊样变髁突表现有晚期骨关节病征象,5.1%（10侧）囊样变髁突表现有早期骨关节病征象,28.3%（56侧）髁突除囊样变外无其他明显骨质改变。Ⅰ型和Ⅱ型髁突囊样变在发生部位、数量和周围骨小梁结构方面存在差异,Ⅰ型髁突囊样变较多发和骨质硬化,Ⅱ型髁突囊样变发生于髁突内部或髁突颈部较多。结论 Ⅰ型和Ⅱ型髁突囊样变在发生部位、数量和周围骨小梁结构存在不同,这可能与其病因及形成机制不同有关。     

Ultrastructural study of synovitis induced by trauma to the rat temporomandibular joint (TMJ)

BACKGROUND: Electron microscopy was used to examine the histologic effect of trauma on the rat temporomandibular joint synovial membrane. METHODS: Trauma to the TMJ in male Wister rats (100-200 g) was introduced through repeated forced condylar hypermobility. Ultrastructural observations were made 5 days and 6 weeks after the trauma. RESULTS: The early response of the synovial membrane was synovial hyperplasia, type A synovial cell loss, dilation of the r-ER in the type B synovial cells and fibrin deposition on the synovial surfaces. The late response included degeneration of synovial cells with swollen mitochondria and cell projections, and cell fragmentation. Large amount of fibrin deposition on opposing surface layers was also noticed. CONCLUSION: The type A cell loss and fibrin deposition followed by the occurrence of fibrinous materials at opposing surface layers of the synovial membrane suggest that traumatic synovitis causes synovial adhesions.     

Irrigation fluid volume requirement for conventional arthrocentesis of the temporomandibular joint: a cadaver study

Temporomandibular joint (TMJ) arthrocentesis is considered an effective and minimally invasive procedure for certain conditions related to temporomandibular disorders. The ideal irrigation volume for arthrocentesis lavage has not yet been defined. Therefore, the aim of this study was to evaluate the efficacy of different saline solution volumes in removing methylene blue from the TMJ space of fresh human cadavers. Nineteen cadavers were selected and 1 ml of 10 μM methylene blue solution was injected into the upper joint space unilaterally. Conventional arthrocentesis was then conducted by infusion of 300 ml of 0.9% saline solution, collecting a 1-ml sample from the drained quantity for every 25 ml injected. Finally, the samples were assayed by measuring photo absorbance of the methylene blue solution. There was a statistically significant difference between the irrigation volumes regarding the removal of methylene blue solution from the joint space (P < 0.001), specifically between the first 25 ml and 200 ml (P = 0.014), 225 ml (P = 0.001), 250 ml (P < 0.001), and 275 ml (P = 0.001). Based on this ex vivo study, a 25-ml perfusion volume appears to be sufficient for joint lavage in conventional arthrocentesis of the TMJ.     

下颌骨延期植骨对兔颞下颌关节影响的扫描电镜观察

目的：观察下颌骨延期植骨后颞下颌关节表面的超微结构变化。方法：通过扫描电镜观察下颌骨延期植骨对兔颞下颌关节的影响,并与同期植骨的家兔关节和相同月龄的正常家兔关节进行比较。结果：下颌骨延期植骨后髁突和关节盘表面的凝胶样物质被破坏,暴露出下面疏松的,排列紊乱的胶原纤维组织。结论：下颌骨延期植骨可导致颞下颌关节退行性改变。     

Development and histologic characteristics of synovitis induced by trauma in the rat temporomandibular joint

Histopathological changes caused by trauma to the rat temporomandibular joint synovium were examined by light microscopy. The trauma was induced by forced hypermobility of the condyle. Pathological changes of the synovium were found primarily in the anterior pouch of the upper joint compartment. The main findings included surface cell proliferation, increased capillary hyperemia, fibrin deposits on the surfaces of inflamed synovial membranes, and fibrinous adhesion between closely opposed synovial membranes. A gradual change from fibrinous adhesion to fibrous adhesion was also seen.     

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颞下颌关节强直是口腔颌面部一类严重的疾病,造成患者张口受限,语言、咀嚼功能障碍,口腔卫生状况下降,面部不对称以及小颌畸形等。本文简要介绍了颞下颌关节强直的病因、病理以及临床治疗的基础与临床研究。     

Histological evaluation of changes in the temporomandibular joint after direct and indirect trauma: an experimental study

Abstract – Direct or indirect trauma to the temporomandibular joint (TMJ) may cause several injuries such as fibrous adhesion, ankylosis and fracture. The aim of this study was to examine and compare the histological changes of TMJ and adjacent soft tissue after direct or indirect trauma to TMJ. In this study, a total of 35 healthy young adult guinea pigs were exposed to direct and indirect trauma to their TMJ, and histologic evaluation was done after 24 h, 7, 15 and 45 days. Hemorrhage was the most frequent complication, following that enlargement of the disc, adhesion of the disc to the condyle and fracture of the condyle were seen in both groups. There were regenerative changes in adjacent muscles of the TMJ in indirect trauma group when compared to direct trauma group. Regenerative changes were more obvious on days 15 and 45. As a result, it may be suggested that when a trauma comes to the maxillo-mandibular complex, even TMJ is indirectly affected, TMJ and its adjacent soft tissues should also be examined clinically and followed closely.