MRI在颞下颌关节紊乱病的盘-突结构及移位角度分析中的应用

Application of MRI in the Analysis of Structure of Disc-Condyle and Displacement Angle of Temporomandibular Joint Disorders

目的探讨MRI在颞下颌关节紊乱病(TMD)盘-突结构及移位角度分析中的作用,为临床早期诊断提供帮助。方法对33例TMD患者的66侧颞下颌关节行MRI扫描,根据颞下颌关节盘是否移位分为正常组及移位组。观察各组关节盘及髁突形态,关节腔积液、髓腔水肿等情况,通过Logistic回归进行影响因素分析。根据张口位移位关节盘是否可复将移位组分为可复组和不可复组,观察可复组及不可复组关节盘移位角度的情况。结果66侧颞下颌关节中,关节盘正常组为29侧,移位组为37侧。正常组及移位组间关节盘变形、髁突形态、髓腔水肿及关节渗出液差异具有统计学意义(P<0.05),且关节盘变形、髓腔水肿及关节渗出液为关节盘移位的独立危险因素。可复组与不可复组组间关节盘移位角度差异具有统计学意义(P<0.05),且不可复组关节盘移位角度大于可复组(P<0.05)。结论MRI可协助临床更好地了解TMD患者颞下颌关节的临床演变进程,对其早期诊断及临床治疗方式的选择具有一定价值。

Objective To evaluate the structure of the articular disc and the condylar head and the angle of disc displacement in the temporomandibular joint disorders by MRI,providing help for early clinical diagnosis.Methods MRI scans were performed on 66 temporomandibular joints in 33 patients with TMD,and the patients were classified into 2 groups:disc without displacement,disc displacement.The morphology of the articular disc and the condylar head,joint effusion,marrow edema were evaluated in each group.The associations between the influencing factors were analyzed using Logistic regression analysis.The group with disc displacement were classified into 2 groups according the disc displacement:disc displacement with reduction(DDWR)and disc displacement without reduction(DDWoR).Results The group of disc without displacement accounted for 43.9%and the group of disc displaced accounted for 56.1%.There was significant difference for the articular disc deformity、the condylar morphology、marrow edema and joint effusion between the group of disc without displacement and the group of disc displacement(P<0.05).The articular disc deformity,marrow edema and joint effusion were independent risk factors for disc displacement.There was significant difference for the angle of disc displacement between DDWR and DDWoR group(P<0.05),and the angle of DDWoR group was higher than that of DDWR group(P<0.05).Conclusion MRI can help clinicians observe the clinical evolution of temporomandibular joint,providing a basis for early clinical diagnosis and choosing the best clinical treatment.