中国组织工程研究

中国组织工程研究 ›› 2022, Vol. 26 ›› Issue (29): 4593-4597.doi: 10.12307/2022.848

• 口腔组织构建 oral tissue construction •    下一篇

青少年颞下颌关节骨关节病患者髁突在关节窝内间隙变化与骨质破坏位置的相关性

张  宁1，2，高思文1，郭  隽1，李泽奎1，张  娟1   

  1. 1天津医科大学口腔医院，天津市  300070；2天津市滨海新区妇女儿童保健和计划生育服务中心，天津市  300450
  • 收稿日期:2021-09-30 接受日期:2021-11-13 出版日期:2022-10-18 发布日期:2022-03-27
  • 通讯作者: 张娟，博士，副主任医师，天津医科大学口腔医院，天津市 300070
  • 作者简介:张宁，女，1989年生，天津市人，天津医科大学口腔医院在读硕士，医师，主要从事口腔修复学研究。
  • 基金资助:
    天津市卫生健康科技项目(KJ20081)，项目参与人：张宁

Correlation between articular fossa space and bone destruction location of the condyle in adolescents with temporomandibular joint osteoarthrosis

Zhang Ning1, 2, Gao Siwen1, Guo Jun1, Li Zekui1, Zhang Juan1   

  1. 1Stomatological Hospital of Tianjin Medical University, Tianjin 300070, China; 2Women and Children’s Health Care and Family Planning Service Center of Binhai New Area, Tianjin 300450, China
  • Received:2021-09-30 Accepted:2021-11-13 Online:2022-10-18 Published:2022-03-27
  • Contact: Zhang Juan, MD, Associate chief physician, Stomatological Hospital of Tianjin Medical University, Tianjin 300070, China
  • About author:Zhang Ning, Master candidate, Physician, Stomatological Hospital of Tianjin Medical University, Tianjin 300070, China; Women and Children’s Health Care and Family Planning Service Center of Binhai New Area, Tianjin 300450, China
  • Supported by:
    the Tianjin Health Science and Technology Project, No. KJ20081 (to ZN [project participant])

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摘要：

文题释义：
髁突特发性吸收：发病位置和发病特点具有特定性，且无明显的症状，但其病因机制是不解之谜，是诸多学者研究的内容。
口腔锥形束CT：简称CBCT，是精准、低辐射环形数字式投照并重组获得的三维图像。

背景：国内外对于青少年颞下颌关节骨关节病患者的相关研究甚少，以往采用传统X射线平片检查方法，近年来通过口腔锥形束CT手段获取图像资料分析优势显著，不仅可以了解髁突影像学变化特征，而且可为青少年颞下颌关节骨关节病患者在临床诊断及治疗中提供参考。
目的：对青少年颞下颌关节骨关节病患者进行锥形束CT测量分析，评价在影像学成像方面的异常形态及影响因素。
方法：选择80例颞下颌关节骨关节病的青少年(试验组)和80例无症状青少年(对照组)，均于牙尖交错位进行锥形束CT扫描，使用Invivo 5.2软件对两组患者进行颞下颌关节三维重建影像测量研究：①矢状位测量：包括颞下颌关节上间隙、前间隙、后间隙；②轴位测量：包括颞下颌关节髁突前后径、内外径；③三维立体成像：下颌升支的高度；④试验组颞下颌关节骨关节病各病理改变类型的百分比。
结果与结论：①据统计试验组中男27例，女53例，男、女比例约为1∶2；②组内比较：试验组双侧颞下颌关节关节上间隙、后间隙差异有显著性意义(P < 0.05)；对照组双侧颞下颌关节的关节测量值相比差异均无显著性意义(P > 0.05)；③组间比较：试验组与对照组双侧比较，关节上间隙、后间隙、髁突前后径、髁突内外径均减小，差异有显著性意义(P < 0.05)，其余测量值差异均无显著性意义(P > 0.05)；④试验组髁突局限性骨质溶解、缺损或较大范围骨质侵蚀或破坏病变发生率最高(约27%)，其次依次为髁突磨平变短(约24%)，髁突骨皮质模糊不清、消失(约21%)，髁突在关节窝中移位(约16%)，髁突骨质增生、骨赘形成(约8%)，发生率最低为髁突局部发生囊样变(约4%)；⑤提示青少年颞下颌关节骨关节病患者髁突在关节窝内位置发生变化，髁突趋于变小，下颌升支高度有变短的趋势，髁突骨质破坏；髁突在关节窝内间隙的变化与骨质破坏位置具有相关性。
缩略语：颞下颌关节骨关节病：temporomandibular joint osteoarthrosis，TMJOA

https://orcid.org/0000-0001-5732-3466 (张宁) 

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

关键词: 锥形束CT, 颞下颌关节骨关节病, 青少年, 髁突特发性吸收, 关节窝

Abstract: BACKGROUND: Research on adolescent patients with temporomandibular joint osteoarthritis is less reported. In the past, traditional X-ray examination was used. In recent years, cone-beam CT analysis shows marked advantages in image data analysis, which can not only be used to understand the changing characteristics of the condyle but also provide reference for the clinical diagnosis and treatment of temporomandibular joint osteoarthrosis in adolescents.
OBJECTIVE: To evaluate the abnormal morphology and influential factors based on cone-beam CT images of adolescent patients with temporomandibular joint osteoarthrosis. 
METHODS: Eighty adolescents with temporomandibular joint osteoarthrosis (experimental group) and 80 healthy adolescents (control group) were subjected to the cone-beam CT scan in the intercuspal position. The three-dimensional reconstruction images of the temporomandibular joint were measured by Invivo 5.2 software in both groups. (1) Sagittal measurements: upper, anterior and posterior joint spaces; (2) axis measurements: anterior and posterior diameters, internal and external diameters of the condyle; (3) three-dimensional imaging: the height of the mandibular ramus; and (4) the percentage of different pathological change types due to temporomandibular joint osteoarthrosis in the experimental group. 
RESULTS AND CONCLUSION: According to statistics, there were 27 males and 53 females in the experimental group, and the ratio of male to female was about 1:2. Intra-group comparison: there were significant differences between the supra-articular and posterior spaces of the bilateral temporomandibular joints in the experimental group (P < 0.05). There was no significant difference between the measurements of the bilateral temporomandibular joints (P > 0.05). Inter-group comparison: Compared with the control group, the supra-articular space, posterior space, anterior and posterior diameters of the condyle, internal and external diameters were significantly reduced in the experimental group (P < 0.05), while the other measurements showed no significant difference (P > 0.05). The experimental group had the highest incidence of local osteolysis, defect or extensive erosion or destruction of the condyle (about 27%), followed by flattened and shortened condyle (about 24%), blurred and disappeared condylar cortical bone (about 21%), displaced condyle in the articular fossa (about 16%), hyperosteogeny and formation of osteophytes (about 8%), and micro-cystoid degeneration of the condyle (about 4%) in order. To conclude, the condyle in the articular fossa is displaced in adolescent patients with temporomandibular joint osteoarthrosis. The condylar process tends to become small, the height of the mandibular ramus tends to become short, and condylar bone destruction appears. The changes of the condylar process in the intraarticular fossa space are correlated with the location of bone destruction. 

Key words: cone-beam CT, temporomandibular joint osteoarthrosis, adolescent, idiopathic condylar resorption, articular fossa

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