颞下颌关节弹响的临床体征与关节造影诊断的对比研究

Clinical vs arthrographic diagnosis of temporomandibular joint clicks

目的:探讨依据颞下的颌关节(TMJ)弹响的临床体征判断TMJ结构紊乱(TMJID)的发生与病程阶段的可靠性.方法:依据美国第三届TMJ研讨会提出的关节盘移位的特征性临床表现,对128例具有TMJ弹响或病史者共140侧TMJs(116例单侧,12例双侧)TMJID的存在与病程阶段进行判断,并与TMD上腔造影及X线摄片检查形成对照.结果:临床特征符合可复性盘前移位(ADDR)与不可复性盘前移位(ADDWR)者分别为79侧与61侧;上腔造影证实79侧ADDR中21侧为正常盘突关系(NA),61侧ADDWR中12侧为ADDR,临床诊断的误诊率分别为26%与19%.ADDWR组骨关节炎(OA)发病率(36%)显著高于ADDR组(2%),但ADDWR组与NA组OA发病率无明显差异.结论:依据TMJ弹响的临床体征判断TMJID的存在与病程阶段易误诊,仅供临床参考.TMJID与OA密切相关,本研究认为OA是与TMJID有关的另一种疾病较为合适,而不是TMJID不可避免的最后阶段.

ve: To evaluate the reliability of clinicans in predicting the arthrographic diagnosis of articular disk position in a typical patient population presenting for Temporomandibular Joint (TMJ) arthrographic evaluation. Method: We utilized a brief history, clinical examination, characteristic signs of TMJ clicks, and tomographic TMJ imaging in evaluating 128 patients. The radiographist subsequently performed the orthographic procedure on 140 TMJs (116 unilater and 12 bilateral). Result: In totally 140 TMJs, 79 and 61 had characteristic clinical findings of ADDR (anterior disk displacement with reduction )and ADDWR (anterior disk displacement without reduction) accordingly. Arthographic examination demonstrated that 21 TMJs showed normal Arthrography in 79 ADDR TMJsand 12 TMJs showed ADDR in 61 ADDWR TMJs. The misdiagnosis rate of clinical diagnosis of ADDR and ADDWR were 26% and 19%, respectively. The occurence of Osteoarthrosis (OA) in group ADDWR(36%)was significantly higher than that of OA in group ADDR(2%), but there was no difference between group ADDWR and group NA. Conlusion: The result indicated that not all TMJID has chracterisitic clinical findings, the clinical findings is only a reference. The relationship between OA and TMJID was also noticed. At present, it would seem appropriate to consider OA as an additional diagnosis assciated with TMJID, rather than an inevitable end-stage of TMJID.