颞下颌关节紊乱病关节腔注射糖皮质激素后关节液病理分析

Pathologic study on synovial fluid after intra articular corticosteroid therapy in temporomandibular joint disorders

目的研究颞下颌关节腔内注射糖皮质激素后的变化。方法对１８例颞下颌关节紊乱病（ｔｅｍｐｏｒｏｍａｎｄｉｂｕｂａｒｊｏｉｎｔｄｉｓｏｒｄｅｒｓ，ＴＭＤ）关节腔内注射醋酸泼尼松封闭治疗，于注射后第４天或第７天，抽取关节冲洗液作涂片镜下观察。结果冲洗液内含脱落的滑膜组织块，散在或团状分布的滑膜细胞、吞噬细胞、炎症细胞、大量的软骨基质以及脱落的软骨碎屑。①糖皮质激素通过药物性的滑膜切除是治疗ＴＭＤ关节源性疼痛的一个可能的作用机制；②一次性的关节腔内注射治疗剂量的糖皮质激素可以导致软骨基质的丢失和软骨的破坏。结论糖皮质激素关节腔注射治疗ＴＭＤ，一般仅应注射一次，且注射后３～５天应加压冲洗。

Objective To study what happens after intra articular injection of corticosteroid. Methods Synovial fluid after intra articular corticosteroid therapy in temporomandibular joint disorders (TMD) was studied by hematoxylin eosin, PAS, and Atcian blue staining. Results The results were that broken synovial membrane and articular cartilage , lots of synovial lining cells, macrophagocytes, inflammatory cells and free cartilage matrix could be found in the lavage fluid. Conclusion The results suggest that drug synovectomy may be one mechanism about intra articular corticosteroid therapy in TMD, and this therapy could lead to progressive degradation and destruction of the articular cartilage. Arthrocentesis and lavage are needed three to five days after this therapy.