颞下颌关节盘不可复性前移位患者骨关节病表现的锥形束CT观察

The images of osteoarthrosis associated with anterior disc displacement without reduction detected by cone-beam CT

目的：利用锥形束CT分析颞下颌关节盘不可复性前移位患者髁突骨改变的影像学特点，以期为临床提供参考。方法选取2010年1月至2012年12月于北京大学口腔医学院·口腔医院颞下颌关节病口颌面疼痛诊治中心就诊的≤30岁临床诊断为单侧颞下颌关节盘不可复性前移位、且患病时间在1年以内的患者，共204例。由两名评价者分别根据锥形束CT，判断患者双侧髁突骨质的骨关节病表现：骨皮质模糊、表面粗糙不平（Ⅰ型）、表面缺损破坏（Ⅱ型）、形态改变（磨平、短小畸形）（Ⅲ型）、骨质硬化（Ⅳ型）、骨质增生（Ⅴ型）、囊样变（Ⅵ型）；其中Ⅰ、Ⅱ型为早期骨关节病表现。分析颞下颌关节盘不可复性移位患者骨关节病锥形束CT表现与性别、年龄、患病时间及开口度的关系。结果204例患者的症状侧关节中124侧（60.8%）有骨关节病表现，其中早期骨关节病表现的检出率为47.1%（96/204），显著高于对侧[10.8%（22/204）]（P〈0.05）。Logistics回归分析显示，患病时间（P＝0.000）和开口度（P＝0.002）与早期骨关节病表现显著相关，患病时间越长，开口度越大，越可能出现骨质改变。患病时间＞1个月的患者，其早期骨关节病表现的检出率从患病时间≤1个月的25%快速上升到70%以上。结论颞下颌关节盘不可复性前移位与髁突骨关节病表现密切相关；患病时间＞1个月后，早期骨关节病的检出率显著增大；开口度越大，早期骨关节病的可能性也越大。

Objective To analyze the radiological characteristics of the condylar bone in patients with anterior disc displacement without reduction of temporomandibular joint using cone-beam CT （CBCT）, and to further investigate the clinical factors possibly associated with the early-stage osteoarthritic changes. Methods Two hundred and four individuals （≤30 years old） diagnosed as unilateral anterior disc displacement without reduction （disease duration≤1 year） were recruited. CBCT images of bilateral condyles were independently evaluated by two assessors and documented. Correlation between the early-stage osteoarthritic （OA） changes and gender, age, disease duration and mouth opening were analyzed using SPSS 21.0 software. Results About sixty percent were presented with OA changes in the symptomatic joints, and most of them （47.1%） （96/204） were early-stage OA changes characterized by loss of continuity of articular cortex （Ⅰ） and/or surface erosion （Ⅱ）. Logistics regression analyses indicated that disease duration （P=0.000） and mouth opening （P=0.002） were correlated significantly with early-stage OA changes. Conclusions Disc displacement without reduction was closely related to OA occurrence. OA changes occurred in more than half of the patients after one month of the joint locked and more possibly in patients with increased mouth opening.