可复性关节盘前移位患者关节振动的特征性研究

Characteristics of joint vibration of patients with anterior disc displacement with reduction in TMJ

目的本实验旨在研究正常人与可复性关节盘前移位患者的关节振动发生的时间及相应的特征,为临床定量诊断提供依据。方法用BioPAK下颌运动功能分析系统采集24名可复性关节盘前移位患者与24名正常对照者进行最大张闭口运动时的双侧颞下颌关节振动的图像,采集振动的能量与频率,计算关节振动发生的时间,分析其关节振动特征。结果可复性关节盘前移位患者关节振动的振动总能量(P<0.001)、峰振幅(P<0.001)、峰频率(P=0.002)、频率大于300 Hz振动总能量(P=0.001)以及频率小于300 Hz振动总能量(P<0.001)均高于对照组,关节振动分析对可复性关节盘移位诊断的灵敏度、特异性、准确性分别为87.5%、79.5%及83.3%。ADDR组关节振动大多发生于开口初期及开口末期,而对照组关节振动大多发生于开口末及闭口初期。结论可复性关节盘移位患者关节振动与正常组有特征性变化,可应用于临床作为辅助检查,关节振动分析无创、简便且灵敏度高,有一定的临床应用价值。

Objective To study the occurrence time and the characteristics of the joint vibration from TMJs in both of the patients with anterior disc displacement with reduction（ADDR） and controls, thus to provide the basis for quantitative clinical diagnosis. Meth- ods The joint vibration pictures from TMJ were recorded bilaterally from 24 patients with ADDR and 24 healthy controls by electrovi- bratography. The total integral of the vibration energy（TI） , the ratio of the integral between frequencies above 300 Hz and below 300 Hz （ratio of 〉300 Hz/〈300 Hz）, peak frequency（ FP）, median frequency（MF） , peak amplitude（PA） and distance to centric occlu- sion position（D） were calculated. Data were analyzed with Mann-Kendall nonparametric test to assess the joint vibration characteristics. Results The values of total integral （P〈0.001）, integral〈300 Hz（P〈0.001）, integral〉300 Hz（P〈0.001）, peak amplitude（P〈 0.001 ） and peak frequency （P= 0.002）were significantly higher than those of the control group. The vibration analysis showed that the sensitivity, specificity and accuracy of the disc displacement with reduction were respectively 87.5%, 79.5% and 83.3%. The joint vibration of the ADDR subjects occurred mostly at the beginning of the opening phase and the end of the opening phase, while in normal subjects, the vibration often occurred at the end of the opening phase and the beginning of the closing phase. Conclusion The joint vibration of the ADDR subjects shows higher energy and frequency, which can be used as auxiliary examination. JVA can provide a fast, non-invasive, and repeatable method to record the status of TMJ. Further studies are needed to identify the characteristic waveforms of different subgroups of TMD and to evaluate the possibility of diagnostic value.