颞下颌关节盘不可复性前移位关节内压测量与分析

Measurement and Analysis of the Intra-articular Pressure in Temporomandibular Joint with Anterior Disc Displacement without Reduction

【目的】了解关节盘不可复性前移位患者关节上腔中压力变化的规律 ,初步探讨其对颞下颌关节紊乱病的分类的指导意义。【方法】收集颞下颌关节盘不可复性前移位患者 16例 2 2侧 ,用关节内压测量仪通过穿刺针进入关节上腔 ,分别测量患者关节张闭口位的关节上腔内压 ,并记录波形和平均值 ,测压后进行颞下颌关节镜手术。【结果】关节盘不可复性前移位关节上腔内压可分 3种类型。高压型 :压力普遍升高且波动幅度增大 ,开口位平均压力为 (- 948± 2 382 )Pa ,闭口位压力为 (12 86± 937)Pa;反压型 :压力变化规律反常 ,开口位 (997± 1132 )Pa ,闭口位 (- 5 2 1± 833)Pa ;低压型 :关节上腔异常负压 ,开口位 (- 15 2 6 1± 12 2 11)Pa ,闭口位 (- 816 3± 3 2 0 3)Pa。【结论】本实验测量了不可复性盘前移位关节开闭口位腔内压 ,并根据关节内压变化规律将关节盘不可复性盘前移位初步分为 3种类型 ,结合关节镜所见从病理学角度提出了各种类型的成因。

The study aims to find out the fluctuating curve of the intra articular pressure in temporomandibular joint (TMJ) with anterior disc displacement without reduction and discuss the mechanism of formation. 22 affected sides were collected in 16 patients. A No.8 syringe needle was used to pierce into the upper compartment of TMJ. The pre arthroscopy intra articular pressure was measured by the pressure transducer via the flexural rigid tubing in open and closed position. The curve and mean value were documented. The pressure values were classified into 3 types: high pressure, reverse pressure and low pressure. The first type manifested general increase and wide amplitude in the pressure, with average pressure of (-948±2 382) Pa in open position and (1 286±937) Pa in closed position. Contradictory to the former type, the second type showed extraordinary variation in the pressure, with pressure of (997±1 132) Pa in open position and (-521±833) Pa in closed position. The third type patients had significantly low negative intra articular pressure, which averaged (-15 261±12 211) Pa in open position and (-8 163±3 203) Pa in closed position. [Conclusion] The TMJ with anterior disc displacement without reduction can be classified into 3 types: high pressure, reversed pressure and low pressure. Every type has its own characteristic.