颞下颌关节盘可复性前移与不可复性前移自然转归的MRI评价

doi:10.19438/j.cjoms.2017.06.006

摘要/Abstract

摘要： 目的利用磁共振（MRI）比较未经治疗的颞下颌关节可复性盘前移位与不可复性盘前移患者的关节盘长度、盘-髁距离及关节盘形态的变化,为制订治疗计划提供参考。方法收集165例（217侧关节）在随访期间未经有创或不可逆治疗的颞下颌关节盘移位患者,分为可复组与不可复组,在初诊及随访结束时拍摄MRI,分别对关节盘长度和盘-髁距离进行定量测量,对关节盘形态变化和Wilkes分期变化进行半定量分析。采用SPSS17.0软件包对数据进行t检验和Wilcoxon符号秩和检验,比较关节盘状态的改变。结果可复组86侧关节,平均随访9.38个月（3.17~25.47个月）;不可复组131侧关节,平均随访8.03个月（3.40~47.43个月）。可复组关节盘的平均长度从9.19 mm缩短至8.54 mm,盘-髁平均距离从3.77 mm增加至4.59 mm;不可复组关节盘平均长度从7.70 mm缩短至6.34 mm,盘-髁距离从6.29 mm增加至7.58 mm。可复组初诊及随访后关节盘形态均以Ⅰ型为主,关节盘仍有复位价值;不可复组初诊时以Ⅱ型为主,随访后以Ⅳ型为主,关节盘复位价值下降。以上结果组内、组间变化均存在显著差异（P<0.01）。结论在颞下颌关节盘前移位的自然转归过程中,关节盘前移距离逐渐增大,关节盘长度逐渐缩短。可复组经过半年余随访,关节盘形态仍较好,而不可复性组则出现明显的关节盘折叠变形。因此,对于不可复性关节盘前移,应尽早进行盘复位手术。

关键词: 颞下颌关节, 关节盘前移位, 磁共振

Abstract: PURPOSE: The aim of the study was to evaluate disc status changes of anterior disc displacement with reduction (ADDWR) and without reduction (ADDWoR),in order to get a better understanding of the disease progress without intervention. METHODS: This longitudinal retrospective study included 217 joints in 165 patients, which were divided into ADDWR group and ADDWoR group based on magnetic resonance imaging (MRI). The joints were assessed quantitatively for disc length and displacement distance at initial and follow-up visits. Disc morphology, which was classified into 5 types, as well as Wilkes stages were also evaluated. Paired t test and Wilcoxon signed rank test were used to assess intra-group differences and independent t test for inter-group differences using SPSS 17.0 software package. RESULTS: There were 86 joints in ADDWR group and 131 joints in ADDwoR group. The follow-up interval was 9.38 months in ADDWR group, compared to 8.54 months in ADDWoR group. Discs tended to become shorter, move further forward and distort more seriously in ADDWoR group than in ADDWR group during follow-up period. Type I disc morphology dominated in ADDwR group both at first and follow-up visits, demonstrating great value of disc repositioning. However, major disc morphology changed from type II to type IV in ADDWoR group, indicating decrease of the value of disc repositioning. CONCLUSIONS: Discs tended to become shorter, move further forward and distort more seriously, especially in ADDWoR group, which reminds TMJ surgeons to perform disc repositioning surgery as soon for ADDWoR patients with risk factors, instead of nonsurgical surgery for 6 months that may lead to serious deterioration in disc status.

Key words: Temporomandibular joint, Anterior disc displacement, MRI

中图分类号:

R739.8

胡颖恺, 杨驰, 蔡协艺, 谢千阳. 颞下颌关节盘可复性前移与不可复性前移自然转归的MRI评价[J]. 中国口腔颌面外科杂志, 2017, 15(6): 508-514.

HU Ying-kai, YANG Chi, CAI Xie-yi, XIE Qian-yang. MRI evaluation of disc status changes of anterior displacement with reduction and without reduction[J]. China J Oral Maxillofac Surg, 2017, 15(6): 508-514.

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