37例颞下颌关节盘不可复性前移位患者自然转归的临床及磁共振成像特征分析

doi:10.7518/hxkq.2024.2023219

华西口腔医学杂志 ›› 2024, Vol. 42 ›› Issue (1): 82-88.doi: 10.7518/hxkq.2024.2023219

37例颞下颌关节盘不可复性前移位患者自然转归的临床及磁共振成像特征分析

闫森¹(), 乔永明²(), 段亮伟³

^1.郑州大学第一附属医院口腔正畸科，郑州 450052
^2.郑州大学第一附属医院口腔颌面外科，郑州 450052
^3.郑州大学第一附属医院口腔修复科，郑州 450052

收稿日期:2023-09-04 修回日期:2023-11-19 出版日期:2024-02-01 发布日期:2024-01-12
通讯作者: 乔永明 E-mail:1037298251@qq.com;349876434@qq.com
作者简介:闫森，主治医师，硕士，E-mail：1037298251@qq.com
基金资助:
河南省高等学校重点科研项目计划(17A320054)

Analysis of clinical changes and magnetic resonance imaging features of 37 patients with temporomandibular joint disc condylar complex with anterior disc displacement without reduction

Yan Sen¹(), Qiao Yongming²(), Duan Liangwei³

^1.Dept. of Orthodontics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
^2.Dept. of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
^3.Dept. of Prosthodontics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China

Received:2023-09-04 Revised:2023-11-19 Online:2024-02-01 Published:2024-01-12
Contact: Qiao Yongming E-mail:1037298251@qq.com;349876434@qq.com
Supported by:
Key Scientific Research Project of Henan Provincial Universities(17A320054)

摘要/Abstract

摘要：

目的了解颞下颌关节盘不可复性前移位患者自然病程的临床、影像学变化及不同年龄段的差异性。方法选择2016年1月—2023年6月在郑州大学第一附属医院口腔颌面外科就诊的颞下颌关节盘不可复性前移位患者37例（45侧），男性4例，女性33例，平均年龄23.5岁，平均病程14.4个月。收集初诊及复诊时临床及磁共振成像（MRI）资料，测量关节盘的长度和厚度、关节盘前移角度、髁突高度，使用SPSS 25.0进行统计分析，比较临床及影像学的变化。结果 37例（45侧）患者复诊与初诊相比较：3例3侧自愈为可复性盘前移位；48.4%患者自觉张口受限未缓解或加重；58.3%患者张口疼痛无改善；54.5%咀嚼疼痛无改善；33.3%患者面部偏斜呈现加重趋势，仅1例缓解。关节盘前移角度从初诊时61.63°增长至67.81°，关节盘长度从8.20 mm缩短至7.27 mm，髁突高度从23.17 mm降为22.76 mm，以上差异有统计学意义（P<0.05），髁突吸收比例上升。青少年组与成人组颞下颌关节盘不可复性前移位患者关节软硬组织变化的差异无统计学意义（P>0.05）。结论在颞下颌关节盘不可复性前移位自然病程中，部分患者的临床症状不能完全缓解；不同年龄段患者都会出现关节盘前移程度逐渐增大，关节盘长度逐渐缩短，发生折叠变形，髁突出现吸收，继发面部偏斜、下颌后缩等继发畸形。

关键词: 颞下颌关节, 不可复性盘前移位, 磁共振成像

Abstract:

Objective This study aims to investigate clinical outcomes, imaging changes, and age differences with regard to temporomandibular joint disc condylar complex with anterior disc displacement without reduction (ADDWoR). Methods A total of 37 patients (45 lateral joints) with ADDWoR who were admitted to The First Affiliated Hospital of Zheng Zhou University from January 2016 to June 2023 were selected. The patients were composed of 4 males and 33 females and had an average age of 23.5 years. The average course of the disease was 14.4 months. Clinical and magnetic resonance imaging (MRI) data were collected at the end of initial diagnosis and follow-up, and the length and thickness of the articular disc, the angle of the disc condyle, and the height of the condyle were measured. The statistical significance of the changes was assessed using SPSS 25.0 software package. Results At the end of follow-up, disc displacement in three patients (three lateral joints) was healed. Approximately 48.4% of the patients felt that limitation of mandibular movement was not alleviated; 58.3% of patients reported that pain during mouth opening was not reduced; 54.5% reported pain while chewing; 33.3% of the patients showed facial deviation, and only one showed remission. The mean disk-condyle angle increased from 61.63° to 67.81°. The average length of articular disc shortened from 8.20 mm to 7.27 mm, and the height of the condyle significantly decreased from 23.17 mm to 22.76 mm (P<0.05). The absorption ratio of the condyle increased, and no significant differences in the changes of joint soft and hard tissues between the adolescent and adult groups (P>0.05). Conclusion In different age groups of patients with ADDWoR, clinical symptoms cannot be completely relieved. The disc is anteriorly displaced and shortens, condylar height decreases, and secondary facial asymmetry and mandibular retraction occur.

Key words: temporomandibular joint, anterior disc displacement without reduction, magnetic resonance imaging

中图分类号:

R782.6

闫森, 乔永明, 段亮伟. 37例颞下颌关节盘不可复性前移位患者自然转归的临床及磁共振成像特征分析[J]. 华西口腔医学杂志, 2024, 42(1): 82-88.

Yan Sen, Qiao Yongming, Duan Liangwei. Analysis of clinical changes and magnetic resonance imaging features of 37 patients with temporomandibular joint disc condylar complex with anterior disc displacement without reduction[J]. West China Journal of Stomatology, 2024, 42(1): 82-88.

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参考文献 17

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关节软硬组织	初诊	复诊	t值	P值
关节盘长度/mm	8.20±2.34	7.27±2.79	4.676	<0.001
关节盘厚度/mm	2.91±0.76	2.83±0.85	0.748	0.458
关节盘前移角度/°	61.63±12.73	67.81±10.71	-5.618	<0.001
髁突高度/mm	23.17±3.30	22.76±3.15	3.328	0.002

组别	数量	关节盘长度/mm			关节盘厚度/mm			关节盘前移角度/°			髁突高度/mm
组别	数量	初诊	复诊	差值	初诊	复诊	差值	初诊	复诊	差值	初诊	复诊	差值
青少年组	30侧	8.03（6.79，11.04）	6.89（5.72，10.02）	0.70（0.09，1.65）	2.69（2.33，3.22）	2.70（2.13，3.11）	0.11（-0.21，0.47）	58.57（49.12，69.38）	66.94（58.00，74.43）	-6.43（-13.84，-2.54）	22.83（20.95，26.03）	23.02（20.33，24.96）	0.23（-0.13，0.99）
成年组	15侧	7.66（6.11，8.25）	6.33（5.36，7.00）	1.00（0.31，2.47）	3.21（2.36，3.60）	3.37（1.88，3.96）	0.16（-0.33，0.48）	63.54（61.18，73.50）	67.13（62.78，81.09）	-2.80（-6.81，-0.59）	24.25（20.23，25.37）	23.49（20.20，25.17）	0.55（0.20，0.90）
Z值		-1.216	-1.493	-0.987	-1.625	-0.963	-0.157	-1.902	-0.939	-1.758	-0.289	-0.072	-0.939
P值		0.224	0.135	0.324	0.104	0.335	0.876	0.057	0.348	0.079	0.773	0.942	0.348

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37例颞下颌关节盘不可复性前移位患者自然转归的临床及磁共振成像特征分析

Analysis of clinical changes and magnetic resonance imaging features of 37 patients with temporomandibular joint disc condylar complex with anterior disc displacement without reduction

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临床症状	初诊	复诊
临床症状	初诊	加重	无变化	减轻	消失
关节杂音	22	1	10	3	8
张口疼痛	24	6	8	5	5
咀嚼疼痛	22	2	10	5	5
张口受限	31	7	8	10	6
面部偏斜/下颌后缩	18	6	11	1	0