颞下颌关节紊乱病患者髁突位置和形态的MRI观察

MRI observation of condylar location and morphology in the patients with temporomandibular disc displacement

目的通过MRI评估颞下颌关节紊乱病患者髁突位置及形态的变化,为临床提供参考。方法对2011年11月至2019年4月解放军总医院放射科及解放军总医院海南医院放射科门诊就诊的137例临床诊断为颞下颌关节紊乱病的患者[年龄(37.5±16.1)岁,男性39例,女性98例]进行颞下颌关节MRI扫描,根据关节盘移位情况分为关节盘位置正常组(disc without displacement,DWoD)(185侧关节),关节盘可复性前移位组(anterior disc displacement with reduction,DDWR)(17侧关节)及关节盘不可复性前移位组(disc displacement without reduction,DDWoR)(72侧关节),观察颞下颌关节髁突位置(前位、中立位及后位)和形态(卵圆形、扁平形及鸟嘴形),并在横轴位T2WI图像上测量髁突长轴和短轴长度。根据双侧关节盘移位情况分为正常组(74例)、单侧移位组(40例)及双侧移位组(23例),并在横断面T2WI上测量并比较3组髁间角。结果DWoD组、DDWR组和DDWoR组髁突位置差异无统计学意义(χ^2=7.435,P=0.115)。DWoD组扁平形髁突发生率[83.9%(115/137)]显著高于DDWoR组[50.7%(34/67)](P<0.05),DWoD组鸟嘴形髁突发生率[16.1%(22/137)]显著低于DDWoR组[49.3%(33/67)](P<0.05)。DWoD组髁突长轴长度[(17.2±2.4)mm]显著大于DDWR组[(15.4±2.0)mm]和DDWoR组[(14.7±2.7)mm](P<0.05)。DWoD组髁突短轴长度[(7.3±1.2)mm]显著大于DDWR组[(6.5±1.3)mm]和DDWoR组[(6.1±1.4)mm](P<0.05)。正常组、单侧移位组髁间角(分别为136°±13°和132°±14°)均显著大于双侧移位组(124°±17°)(P<0.05)。结论颞下颌关节紊乱病患者群中颞下颌关节盘移位患者可见髁突形态显著改变。

Objective To evaluate the mandibular condylar location and morphology in the temporomandibular joint disorders.Methods One hundred thirty-seven TMD patients (age 37.5±16.1 years,male/female=39/98) were performed with MRI scan for temporomandibular joint (TMJ) from November,2011 to April,2019 in Department of Radiology,Hainan Hospital of General Hospital of Chinese PLA and General Hospital of Chinese PLA.The patients were classified into 3 groups according the disc displacement: disc without displacement (DWoD)(185 TMJ),disc displacement with reduction (DDWR)(17 TMJ) and disc displacement without reduction (DDWoR)(72 TMJ).The location (anterior position,central position and posterior position) and morphology (oval shape,flat shape and beaklike shape) of the condylar head were observed on the sagittal PDWI,and the long and short axes were measured on the axial T2WI.Another groups were classified into 3 subgroups according to the disc displacement of bilateral TMJ: bilateral normal disc location (biND)(74 cases),unilateral disc displacement (uniDD)(40 cases) and bilateral disc displacement (23 cases).The inter-condyle angle was measured on the axial T2WI.Results There was no significant difference for the location of condylar head among DWoD,DDWR and DDwoR groups (χ^2=7.435,P=0.115).The rate for flat condylar shape was significantly higher in DWoD group [83.9%(115/137)] than that in DDWoR group [50.7%(34/67)],and the rate for beaklike condylar shape was significantly lower in DWoD group [16.1%(22/137)] than that in DDWoR group [49.3%(33/67)](χ^2=23.521,P<0.001).The length of long axis presented significantly longer in DWoD group [(17.2±2.4) mm] than that in DDWR group [(15.4±2.0) mm] and that in DDWoR group [(14.7±2.7) mm](P<0.05).The length of short axis presented significantly longer in DWoD group [(7.3±1.2) mm] than that in DDWR group [(6.5±1.3) mm] and that in DDWoR group [(6.1±1.4) mm](P<0.05).The inter-condyle angle presented significantly larger in biND group (136°±13°) and uniDD group (132°±14°) than that inbiDD group (124°±17°)(P<0.05).Conclusions The mandibular condylar morphology changes significantly presented in the patients with temporomandibular disc displacement for the temporomandibular disorders.