颞下颌关节钝挫伤急性期损伤程度的磁共振成像分析

Magnetic resonance imaging analysis of injury degree of temporomandibular joint blunt trauma in acute stage

目的应用磁共振成像(magnetic resonance imaging,MRI)分析颞下颌关节钝挫伤急性期的损伤程度。方法收集2021年2月至2022年10月于山西医科大学第二医院口腔科就诊的22例颞下颌关节钝挫伤急性期患者的临床和影像学资料进行回顾性分析,包括下颌骨未骨折和非髁突骨折患者各11例,分别记为下颌骨未骨折组和下颌骨非髁突骨折组。通过MRI检查结果分析22例患者44侧颞下颌关节的状态,并对损伤程度进行分级。结果MRI检查显示,22例患者的44侧颞下颌关节均发生损伤,主要表现为关节盘移位(占84.1%)、关节腔积液或积血(占79.5%)及关节盘后区损伤(占72.7%);此外,还有31.8%的颞下颌关节发生关节盘穿孔。对损伤程度进行分级发现,Ⅰ、Ⅱ、Ⅲ级损伤构成比依次为9.1%(4/44)、59.1%(26/44)和31.8%(14/44)。下颌骨未骨折组Ⅰ、Ⅱ、Ⅲ级损伤构成比依次为4.6%(1/22)、36.3%(8/22)和59.1%(13/22),下颌骨非髁突骨折组Ⅰ、Ⅱ、Ⅲ级损伤构成比依次为13.6%(3/22)、81.8%(18/22)和4.6%(1/22);2组损伤程度分级比较,差异有统计学意义(Z=-3.632,P<0.001)。结论颞下颌关节钝挫伤急性期患者的颞下颌关节损伤程度大多较重,尤其是下颌骨未骨折患者,建议行MRI检查以全面评估颞下颌关节状态。

Objective To analyze the degree of temporomandibular joint blunt trauma in acute stage based on magnetic resonance imaging(MRI).Methods The clinical and imaging data of 22 patients with temporomandibular joint blunt trauma in the acute stage who were treated in the Department of Stomatology of the Second Hospital of Shanxi Medical University from February 2021 to October 2022 were collected and analyzed retrospectively,including 11 patients with no mandibular fracture and 11 patients with non-condylar fracture,which were respectively recorded as the mandibular non-fracture group and the mandibular non-condylar fracture group.The status of 44 temporomandibular joints in 22 patients was analyzed by MRI examination,and the degree of injury was graded.Results MRI examination showed that 44 sides of temporomandibular joints in 22 patients were injured,the main manifestations of which were disc displacement(84.1%),joint cavity effusion or hematocele(79.5%)and retrodiscal injury(72.7%).In addition,31.8%of the temporomandibular joint had disc perforation.According to the grading of the degree of injury,the constituent ratios of gradeⅠ,ⅡandⅢinjuries were 9.1%(4/44),59.1%(26/44)and 31.8%(14/44)respectively.The constituent ratios of gradeⅠ,ⅡandⅢinjuries in the mandibular non-fracture group were 4.6%(1/22),36.3%(8/22)and 59.1%(13/22)respectively,and the constituent ratios of gradeⅠ,ⅡandⅢinjuries in the mandibular non-condylar fracture group were 13.6%(3/22),81.8%(18/22)and 4.6%(1/22)respectively;there was statistically significant difference in the grading of injury degree between the two groups(Z=-3.632,P<0.001).Conclusion In the acute stage of temporomandibular joint blunt trauma,the degree of temporomandibular joint injury is mostly serious,especially in patients with mandibular non-fracture.It is suggested that MRI should be performed to comprehensively evaluate the status of temporomandibular joint.