磁共振成像在无髁突骨折的颞颌关节即刻损伤中的诊断价值

Diagnostic Value of Magnetic Resonance Imaging in Immediate Injury of Temporomandibular Joint Without Condylar Fracture

目的探讨磁共振成像(magnetic resonance imaging,MRI)在无髁突骨折的颞颌关节即刻损伤后的潜在诊断价值。方法选取云南大学附属医院口腔颌面外科2018年6月至2021年3月收治的无髁突骨折的颞下颌关节损伤患者36例,共72侧关节纳入研究。所有的患者锥形束CT结果均显示髁突及关节窝无骨折且伤后髁突表面骨质“完整”。患者伤前均无关节疾患,伤后均出现不同程度的关节区疼痛和张口受限及弹响,其中24例合并有面部及其他部位的骨折。通过MRI对纳入患者进行影像检查,并对结果进行分析。结果MRI检查显示有关节48侧关节发生不同程度损伤,发生率为66.7%。损伤类型为骨髓水肿12侧(25%),关节盘后区损伤撕裂27侧(56.25%),关节盘移位33侧(68.75%)以及关节腔积血、积液36侧(75%)。关节盘后区损伤撕裂,关节盘移位,关节腔积血(积液)与骨髓水肿的发生率相比较,前3者发病率明显高于骨髓水肿,差异有统计学意义(P<0.05)。结论MRI在无髁突骨折的颞颌关节即刻损伤后,能清楚的显示出关节软组织的损伤部位和类型。此外,在这些损伤中关节盘后区损伤撕裂,关节盘移位,关节腔积血(积液)与骨髓水肿的发生率相比较,前三者发生率明显高于骨髓水肿。MRI是无髁突骨折的颞颌关节即刻损伤后重要检查和评价手段。

Objective To investigate the diagnostic value of MRI in immediate injury of temporomandibular joint without condylar fracture.Methods 36 patients with temporomandibular joint injury without condylar fracture treated in the Department of Oral and Maxillofacial Surgery of the Affiliated Hospital of Yunnan University from June 2018 to March 2021 were selected,with a total of 72 joints included in the study.Cone beam CT results of all patients showed that there was no fracture of condyle and articular fossa,and the bone on the surface of condyle was“complete”after injury.All patients had no history of joint diseases.After injury,they had varying degrees of joint pain,limited opening and popping.Among them,24 cases were complicated with fractures of face and other parts.The included patients were examined by MRI,and the results were statistically analyzed.Results MRI showed that 48 joints had different degrees of injury,and the incidence was 66.7%.The injury types included 12 joints with bone marrow edema(25%),27 joints with posterior disc tear(56.25%),33 joints with disc displacement(68.75%),and 36 joints with joint cavity hematocele and effusion(75%).The incidence of posterior disc disruption,disc displacement,and intraarticular blood accumulation(bone effusion)were significantly higher than those of bone marrow edema(P<0.05).Conclusion MRI can clearly show the location and type of injury of joint soft tissue after immediate injury of temporomandibular joint without condylar fracture.In addition,in these injuries,the incidence of posterior disc tear,disc displacement,joint cavity hematocele(effusion)was significantly higher than that of bone marrow edema.MRI is an important examination and evaluation method after immediate injury of temporomandibular joint without condylar fracture.