颞下颌关节计算机曲面断层与胶片摄影技术对比研究

Comparative study on computed orthopantomography and film radiographic techniques in the radiography of temporomandibular joint

目的对颞下颌关节(TMJ)开闭口位计算机曲面断层摄影(COPT)与薛氏位(SR)、胶片曲面断层摄影(FOPT)进行对比研究,探讨 COPT 的优势。方法对98例患者分组并分别采用双侧 TMJ 开闭口位 COPT、FOPT、SR 等3种摄影技术进行摄影检查,对图像所显示的各解剖结构满意率采用 Pearson 卡方检验,对各组满意率两两比较采用 q 检验进行统计学分析。结果 144幅 COPT、128幅 FOPT 和120幅 SR 摄取的 TMJ 开闭口位图像显示的下颌支满意幅数分别为144、128、6,满意率分别为100%、100%、5%(P<0.01);冠突显示满意幅数分别为144、128、12,满意率分别为100%、100%、10%(P<0.01);切迹显示满意幅数分别为144、128、66,满意率分别为100%、100%、55%(P<0.01);关节间隙显示满意幅数分别为96、89、120,满意率分别为75%、62%、100%(P<0.01);对髁突、关节结节显示满意幅数分别为144、128、120,满意率均为100%。下颌支、冠突、切迹、关节间隙显示满意率3种摄影方法两两比较,SR与FOPT间比较,差异有统计学意义(P 值均<0.01);SR 与COPT 间比较(P 值均<0.01),差异有统计学意义;FOPT 与 COPT 间比较,差异无统计学意义(P 值均>0.05)。双侧 TMJ 开闭口位3种摄影技术曝光量分别为 COPT 99～113 mAs、FOPT 210～225 mAs、SR 210～500 mAs。因此,COPT、FOPT 对下颌支、冠突、切迹的显示质量优于 SR,对关节间隙的显示不及 SR,对髁突、关节结节显示三者相同,SR 曝光量大于 COPT 和 FOPT,FOPT 大于 COPT。结论COPT 检查颞下颌关节开闭口位,优于 FOPT 及 SR 摄影技术,应该在临床中推广应用。

Objective To compare the computed orthopantomography （COPT） with Shriller radiography（SR）, film orthopantomography （FOPT） and other traditional radiographic techniques in the radiography of temporomandibular joint （TMJ）. Methods Ninty-eight cases were randomly divided into 3 groups, and the open and close positions of TMJs of both sides were examined with SR, FOPT, and COPT, respectively. The satisfactory rates of the X-ray pictures were statistically analyzed with Pearson chi-square in SPSSI0. 0, and the satisfactory rates were analyzed with q test between the groups. Results One hundred and forty-four of the open and close positions of 144 TMJ pictures of the COPT group, 128 of 128 of the FOPT group, and 6 of 120 of the SR group were satisfactory in the mandible ramus of the TMJ, with satisfactory rate being 100%, 100%, and 5%, respectively（ P 〈 0. 01 ）. Coronoid process was satisfactorily shown in 144, 128, and 12 pictures, with satisfactory rate being 100%, 100% , and 10% respectively in the 3 groups（P 〈0. 01 ）. Incisure was satisfactorily shown in 144, 128, and 66 pictures respectively, with satisfactory rate being 100%, 100%, and 55% （P 〈0. 01 ）. The joint space was satisfactorily shown in 96, 89,and 120 pictures respectively, with satisfactory rate being 75%, 62%, and 100% （P 〈 0.05）. The condylar process and articular tubercle were satisfactorily shown in 144, 128 and 120 pictures respectively, with satisfactory rate being 100% in all the 3 groups. The satisfactory rates of the mandible ramus, coronoid process, incisure, and joint space were compared between the groups. （average P 〉 0. 01 ）, respectively between FOPT and COPT groups. The difference was not statistically significant. The exposure was as follows： COPT, 99--113 mAs; FOPT, 210--225 mAs; and SR, 48--75 mAs. Therefore, COPT and FOPT were superior to SR in the pictures of the mandible ramus, coronoid process, and incisure, but inferior in the joint space pictures. The satisfactory rates of the condylar process and articular tubercle were same in the 3 groups. The exposure of the FOPT group was greater than that of the COPT and SR groups. Conclusion COPT is superior to SR and FOPT in TMJ radiography, and should be applied widely in the clinic.