颞下颌关节紊乱患者关节盘软骨形态学改变的MR定量研究

Quantitative MR Study of Morphological Changes in Articular Disc Cartilage in Patients with Temporomandibular Disorders

目的定量对比正常关节盘位置(ND)志愿者、可复性前移位(ADDWR)及不可复性前移位(ADDWOR)颞下颌关节紊乱(TMD)患者的关节盘形态学差异,探索关节盘在病变过程中的演化模式。方法纳入108例TMD患者和28名健康志愿者。根据临床表现及影像学诊断分为三组,其中ND组56侧,ADDWR组69侧,ADDWOR组91侧。应用Mimics Medical软件基于质子密度加权成像(PDWI)对关节盘进行三维重组,比较三组关节盘之间的体积、表面积、最大左右径、最大前后径及最大上下径差异,并分析ADDWR及ADDWOR患者的关节盘变化与病程之间的关系。结果ADDWR组关节盘的体积、表面积、最大前后径、最大上下径均大于ADDWOR组(P值均<0.0001),但与ND组没有明显差异;而ADDWR组关节盘的最大左右径小于ND组(P<0.05),与ADDWOR组没有明显差异。在所有诊断为ADDWR或ADDWOR患者的关节盘中,长病程组(>24个月)关节盘的体积、表面积明显小于短病程组(≤24个月)(P值均<0.05),而两组之间关节盘的最大左右径、最大前后径及最大上下径均没有明显差异。结论关节盘的体积、表面积、最大左右径、最大前后径以及最大上下径的变化能够反映TMD的进展情况。随着病程延长,关节盘的软骨改变持续进行。

Objective Quantitatively compare the morphological differences between normal disc position(ND),anterior disc displacement with reduction(ADDWR)and anterior disc displacement without reduction(ADDWOR),to explore the mechanism of disc changes during the course of the disease.Methods One hundred and eight patients with temporomandibular disorders(TMD)and 28 healthy volunteers were enrolled.According to clinical manifestation and imaging diagnosis,they were divided into three groups,including 56 sides in ND group,69 sides in ADDWR group and 91 sides in ADDWOR group.Three-dimensional reconstruction of the articular disc based on proton density-weighted imaging(PDWI)with the application of Mimics Medical software.Differences in volume,surface area,maximum left-right diameter,maximum anterior-posterior diameter and maximum upper-lower diameter were compared among the three groups of articular discs,and to analyze the relationship between the articular discs and the course of the disease in patients with ADDWR and ADDWOR.Results The volume,surface area,maximum anterior-posterior diameter,and maximum upper-lower diameter of the articulated discs in the ADDWR group were larger than those in the ADDWOR group(all P values<0.0001),but not significantly different from those of the ND group,whereas the maximum left-right diameter of the articular discs in the ADDWR group was smaller than that of the ND(P<0.05),and not significantly different from those of the ADDWOR.In all articular discs of patients diagnosed with ADDWR or ADDWOR,the volume and surface area of the articular discs in the long-duration group(>24 months)were significantly smaller than those in the short-duration group(≤24 months)(all P values<0.05),whereas there was no significant difference in the maximum left-right,maximum anterior-posterior and maximum upper-lower diameter of the articular discs between the two groups.Conclusion Changes in the volume,surface area,maximum left-right diameter,maximum anterior-posterior diameter,and maximum upper-lower diameter of the articular discs can reflect the progression of TMD.The cartilaginous changes in the articular disc continued with the prolongation of the disease.