46名青少年原发性关节炎患者颞下颌关节病的临床及影像学表现

Clinical and imaging performance of temporomandibular joint disease in 46 young patients with juvenile idiopathic arthritis

目的研究包含各型青少年原发性关节炎(JIA)亚型的一组患者颞下颌关节病发病情况、临床和影像学表现。方法对46名JIA患者进行临床风湿病学和正畸学评估。所有患者进行曲面断层和头颅侧位检查。研究颞下颌关节病的发病率与JIA亚型和疾病特点的相关性;头颅侧位片的测量结果与年龄和性别匹配的健康对照组进行比较。结果 65%的JIA患者具有至少一个颞下颌关节炎的症状,78.3%的患者显示出髁突的病损。髁突损伤的发病率与正畸学治疗以及JIA亚型、疾病的活动期、JIA的严重程度及病程没有相关性(P>0.05)。JIA患者的下颌平面角以及ANB角角度大,前面高,上下中切牙角及SNB角比较小。颅面部的改变与髁突病损直接相关(P<0.05)。结论 JIA患者的髁突损伤非常常见,髁突病损出现较早,轻微病损也能导致严重的颅面部形态的改变。通过本研究建议JIA患者应该进行早期和定期的正畸学及TMJ影像学检查。

Objective To study the incidence, clinical and radiographic manifestations of temporomandibular joint dis- ease in a group of patients with subtypes of juvenile idiopathic arthritis （JIA）. Methods 46 patients with JIA were evalu- ated for clinical rheumatism and orthodontics. All patients underwent surface faults and head lateral examination. The relationship between the incidence of temporomandibular joint disease and JIA subtype and the characteristics of dis- ease was analyzed. The measurement results between the contralateral lateral radiograph in the observation group and the age and sex matched healthy control group were compared. Results 65% of the patients with JIA had at least one symptom of temporomandibular arthritis,and 78.3% of patients showed condylar lesions. The incidence of condylar in- jury was not correlated with orthodontic treatment and JIA subtype, disease activity, severity of JIA and course of dis- ease（P〉0.05）. The angle of mandibular plane and ANB was big and the front is high in JIA patienls, And also the angle of incision and SNB was small in JIA patients. Craniofacial changes were directly related to condylar lesions （P〈 0.05）. Conclusion Condylar injury in patients with JIA is very common, and condylar lesions occur at early stage and mild lesions can lead to severe changes in craniofacial morphology. JIA patients should be recommended for early and regular orthodontics and TMJ imaging examinations.