MRI在诊断颞下颌关节紊乱病及评价RW咬合板治疗效果中的应用

The value of MRI in diagnosing temporomandibular disorders and evaluating treatment effect of RW-splint

目的研究颞下颌关节紊乱病(TMD)患者的磁共振成像(MRI)特征,探讨MRI在评价RW咬合板(RW-splint)治疗效果中的应用价值。方法收集经临床确诊并行MRI检查的TMD患者32例,回顾性分析32例患者共64侧颞下颌关节的MRI图像,总结TMD的MRI特征;其中21例患者进行RW咬合板治疗,治疗前、后均行MRI扫描,测量关节盘-髁突角度及关节盘长度并进行统计学分析。结果 64侧颞下颌关节中,46侧关节盘形态异常,其中可复性前移位21侧、不可复性前移位25侧;46侧髁突均可见不同程度骨质增生、骨皮质缺损,其中13侧髁突运动过度、5侧髁突运动受限;10侧关节腔内可见积液。21例患者RW-splint治疗后,可复性前移位患侧关节盘-髁突角度由(25.7±2.6)°减小至(19.1±1.6)°;关节盘长度(11.1±1.3)mm缩短至(9.1±0.7)mm,治疗前、后患侧关节盘-髁突角度及关节盘长度变化差异均具有统计学意义(t_(角度)=2.889,P_(角度)=0.014;t_(长度)=2.354,P_(长度)=0.023);不可复性前移位患侧盘突角度由(26.4±2.3)°减小至(24.1±2.1)°,关节盘长度(12.0±1.3)mm缩短至(11.9±1.2)mm,治疗前后患侧关节盘-髁突角度、关节盘长度变化差异均无统计学意义(t_(角度)=1.897,P_(角度)=0.082;t_(长度)=1.076,P_(长度)=0.124)。结论 MRI不仅能够无创、准确诊断TMD,而且能够客观评价RW-splint治疗效果。

Objective To analyze the MRI features of temporomandibular disorders（TMD）patients and the value of MRI in evaluating the treatment effect of RW-splint. Methods Thirty-two patients diagnosed with TMD underwent MRI examination,and the MRI features of sixty-four sides of temporomandibular joint were analyzed retrospectively. Twenty-one patients received RW-splint treatment and underwent MRI examination after treatment,the change of angle of disc-condyle and disc length were analyzed after RW-splint treatment. Results In sixty-four sides joints,forty-six discs were found morphogenetic changes,twenty-one joints showed anterior disk with reduction and twenty-five joints showed anterior disk without reduction. Forty-six mandibular condyles showed osteoproliferaion and cortical bone deficiency in varying degrees,thirteen mandibular condyles showed hyperkinesia and five mandibular condyles showed movement restriction. Ten sides showed arthoedema. After the treatment,the angle of disc-condyle in patients with reversible anterior disc displacement decreased from（25.7 ± 2.6）°to（19.1 ± 1.6）°,the disc length decreased from（11.1 ± 1.3）mm to（9.1 ± 0.7）mm,the change of angle of disc-condyle and disc length were statistically significant（t（angle） = 2.889,P（angle） = 0.014;t（length） = 2.354,P（length）= 0.023）. After the treatment,the angle of disc-condyle in patients with irreversible anterior discdisplacement changed from（26.4 ± 2.3）° to（24.1 ± 2.1）°,the disc length decreased from（12.0 ± 1.3）mmto（11.9 ± 1.2）mm,and the change of angle of disc-condyle and disc length were not statistically significant（t（angle） = 1.897,P（angle） = 0.082;t（length） = 1.076,P（length） = 0.124）. Conclusion MRI can not only beused to diagnose TMD,but also can evaluate the treatment effect of RW-splint objectively.