颞下颌关节骨关节炎关节上下腔内改变的临床研究

Clinical Analysis of Changes in the Superior and Inferior Cavities of Temporomandibular Joint Osteoarthritis

目的 探讨颞下颌关节骨关节炎(TMJOA)关节上、下腔软硬组织的改变。方法 选取2019年1月至2022年3月于西安交通大学口腔医院口腔颌面外科行颞下颌关节成形术治疗的TMJOA患者19例(20侧)为研究对象。先行关节上腔内窥镜检查并清理上腔部分病变,根据关节盘完整性,处理关节下腔病变;并对关节上、下腔内的改变情况进行分析和讨论。结果 20侧上腔内至少存在骨赘、松散小骨体和关节结节踝突骨质硬化3种不同程度病变;20侧髁突骨质病变均符合影像学检查,髁突和关节结节表面软骨出现退变;但影像学检查无法观察到髁突病变与关节盘粘连情况。结论 TMJOA患者关节上腔内普遍存在急、慢性滑膜炎,上腔内其他病理改变符合骨关节炎表现。TMJOA患者反复疼痛不适可能与髁突骨质病变(侵蚀破坏、骨刺、骨赘等)逐渐与关节盘粘连引起刺激相关。

Objective To investigate the changes of soft and hard tissues in the superior and inferior articular cavities of patients with temporomandibular joint osteoarthritis(TMJOA).Methods A total of 19 TMJOA patients(20 sides)who underwent condyloplasty in the oral and maxillofacial surgery department of Stomatology Hospital of Xi'an Jiaotong University from January 2019 to March 2022 were selected as the study objects.Minimally invasive surgery was performed by endoscopy in the superior cavity of the joint first to clean the lesions and check the condition of the articular disc.And condyloplasty was performed by open surgery in the inferior cavity without opening the superior cavity as much as possible according to the condition of the disc.The changes in the superior and inferior articular cavities were analyzed and discussed.Results There were at least 3 kinds of lesions(osteophytes,loose nodules,and articular tubercle condylar sclerosis)of different degrees in the 20 sides of supra-articular cavity.Bone lesions in the 20 sides of condyles were consistent with imaging features.Degeneration was found in the cartilage on the surface of condyles and joint nodes.However,the adhesion of condylar lesions to articular disc could not be observed by imaging examination.Conclusion The supra-articular cavity of TMJOA patients is mostly dominated by acute or chronic synovitis.Other pathological changes in the supra-articular cavity are consistent with osteoarthritis.Repeated pain and discomfort in TMJOA patients may be related to the stimulation caused by adhesion of condylar bone lesions(bone erosion and destruction,spurs,osteophytes,etc.)to articular disc.