基于磁共振成像探究颞下颌紊乱综合征的影像解剖初步研究

Preliminary Study on Imaging Anatomy of Temporomandibular Disorder Syndrome: Magnetic Resonance Imaging

目的通过磁共振成像测量多项定量指标探讨颞下颌关节紊乱(TMD)综合征和正常人颞下颌关节(TMJ)影像解剖结构的差异性及临床意义。方法将60例单侧TMD患者纳入病例组并分为可复性组(ADDR组)和不可复性组(ADDWR组),30名双侧颞颌关节正常者纳入对照组。使用Siemens 3.0 T磁共振8通道头颅线圈,采用自旋回波T_(1)WI、T_(2)WI对受试者TMJ行闭口位、开口位斜矢状面及冠状面扫描,测量以下指标:闭口位斜矢状面关节前、上、后间隙及前、后间隙面积,冠状面关节内、上、外间隙及内、外间隙面积,髁状突前后径、内外径,关节窝深度、宽度,关节结节斜度,并对三组测量数据进行统计学检验。结果与健康对照组相比,ADDR组和ADDWR组的斜矢状面关节前间隙与后间隙比值(自然对数值)显著升高(P<0.05),在髁窝位置关系中表现为髁状突偏中、后位;ADDWR组的关节窝宽度及冠状面内、外侧间隙面积比的自然对数值升高(P<0.05),在髁窝位置关系中表现为髁状突偏外侧位;ADDR组与ADDWR组间各项数据均无明显统计学差异(P>0.05)。结论TMD的颞下颌关节解剖结构与正常人存在显著差异,主要体现在髁状突位置与关节窝形态上。

Objective To investigate the difference and clinical significance of temporomandibular joint(TMJ)bony structure between normal people and TMD by measuring multiple index data.Methods 60 patients with unilateral TMD were included in the case group and divided into ADDR group(repeatable)and ADDWR group(unrepeatable),and 30 patients with bilateral TMJ normal were included in the control group.SIEMENS 3.0T magnetic resonance 8-channel head coil was used to scan the TMJ in the oblique sagittal plane and coronal plane at closed and open positions using spin echo T_(1)WI and T_(2)WI.The following indexes were measured.The area of the anterior,upper and posterior space and the anterior and posterior space in the oblique sagittal plane at the closed mouth,the area of the internal,upper and external space and the internal and external space in the coronal plane,the anteroposterior diameter and the internal and external diameter of the condyles,the depth and width of the fossa,and the oblique degree of the joint nodules.Statistical tests were performed.Results Compared with healthy controls,the ADDR and ADDWR group of oblique sagittal joint clearance before and after the clearance ratio(natural)increased significantly(P<0.05),the condyle position in DCS of condyle,partial during and after ADDWR group of acetabulum width and coronary surface area ratio of inner and outer clearance nature of numerical increased(P<0.05),in the condylar fossa position of condyle DCS partial lateral.There was no significant statistical difference between ADDR group and ADDWR group(P>0.05).Conclusion The TMJ bone structure of TMD is significantly different from that of normal people,which is mainly reflected in the position of the condylar process and the morphology of the articular fossa.