伴偏侧咀嚼颞下颌关节骨关节炎患者的临床症状及锥形束CT影像分析  

Analysis of the characteristic of clinical symptoms and cone-beam CT imaging changes in temporomandibular joint osteoarthritis patients with chewing side preference

作　　者：翟孝庭 黄东宗 胡一帆 徐鑫宇 王家柱[2] 李鸿波[1] 胡敏[3] 刘洪臣[4] 姜华[1] Zhai Xiaoting;Huang Dongzong;Hu Yifan;Xu Xinyu;Wang Jiazhu;Li Hongbo;Hu Min;Liu Hongchen;Jiang Hua(Department of Prosthodontics,General Hospital of Chinese PLA,Beijing 100853,China;Department of Radiology,General Hospital of Chinese PLA,Beijing 100853,China;Department of Oral and Maxillofacial Surgery,General Hospital of Chinese PLA,Beijing 100853,China;Instutute of Stomatology,General Hospital of Chinese PLA,Beijing 100853,China)

机构地区：[1]解放军总医院口腔修复科,北京100853 [2]解放军总医院放射诊断科,北京100853 [3]解放军总医院口腔颌面外科,北京100853 [4]解放军总医院口腔医学研究所,北京100853

出　　处：《中华口腔医学杂志》2022年第7期688-693,共6页Chinese Journal of Stomatology

基　　金：国家自然科学基金(81970957);解放军总医院大数据与人工智能研发项目(2019MBD-013)。

摘　　要：目的探讨伴偏侧咀嚼的颞下颌关节骨关节炎(temporomandibular joint osteoarthritis,TMJOA)患者临床症状及锥形束CT的影像学特征。方法纳入2018年1月至2020年12月于解放军总医院口腔科就诊的TMJOA患者100例(200侧关节),其中男性32例,女性68例,中位年龄为27.5岁(16~71岁)。根据是否有偏侧咀嚼习惯分为TMJOA伴偏侧咀嚼组71例,TMJOA无偏侧咀嚼组29例。观察两组患者疼痛、关节杂音和张口受限的临床症状,以及髁突骨质的锥形束CT影像改变。在髁突骨质的影像分析中,排除有双侧颞下颌关节症状的病例,根据患者主诉症状分为伴偏侧咀嚼组和无偏侧咀嚼组的症状侧和非症状侧关节。采用SPSS 25.0进行统计学分析,K-S检验显示患者年龄不符合正态分布,使用"M(IQR)"描述并进行Mann-WhitneyU检验;患者性别、临床症状、髁突病变类型等定性资料使用构成比描述并进行χ^(2)检验。结果无偏侧咀嚼组和伴偏侧咀嚼组TMJOA患者的性别及年龄差异均无统计学意义(P>0.05)。TMJOA伴偏侧咀嚼组患者疼痛的比例[83.1%(59/71)]略高于无偏侧咀嚼组[65.5%(19/29)],但差异无统计学意义(χ^(2)=3.71,P=0.054),两组间关节杂音和下颌运动受限的比例差异均无统计学意义(χ^(2)=0.11,P=0.742;χ^(2)=0.48,P=0.489)。检测的200侧关节中,锥形束CT影像表现依次为髁突磨平变短[73.0%(146/200)]、表面骨质破坏[65.0%(130/200)]、骨质硬化[42.0%(84/200)]、骨质增生[30.5%(61/200)]及囊性变[15.5%(31/200)]。根据症状分组后,组内比较显示伴偏侧咀嚼组的症状侧关节出现骨质破坏的比例[80.0%(40/50)]显著高于同组的非症状侧关节[50.0%(25/50)](χ^(2)=9.89,P=0.002);组间比较显示伴偏侧咀嚼组的症状侧关节出现髁突磨平变短的比例[84.0%(42/50)]显著高于无偏侧咀嚼组患者的双侧关节[均为(8/15)](χ^(2)=8.81,P=0.032)。结论伴偏侧咀嚼的TMJOA患者可能更易出现疼痛的临床症状,以及髁突表�Objective To investigate the clinical symptoms and cone-beam CT(CBCT)imaging characteristics of temporomandibular joint osteoarthritis(TMJOA)with chewing side preference(CSP).Methods One hundred patients with TMJOA diagnosed in the Department of Stomatology,General Hospital of the Chinese PLA from January 2018 to December 2020 were enrolled,including 32 males and 68 females,with an median age of 27.5 years(16-71 years).According to the habit of CSP,100 cases were divided into 71 cases of TMJOA with CSP group and 29 cases of TMJOA without CSP group.The clinical symptoms were observed,including pain,TMJ sounds,limited mouth opening as well as the radiograph imaging changes of condylar bone.When analyzing the radiograph imaging changes of condylar,the cases with bilateral TMJ symptoms were excluded and the remaining cases were divided into symptomatic sides and asymptomatic sides with CSP or without CSP according to the symptoms of the chief complaint.SPSS 25.0 was used to analyze the statistical data.Age data did not conform to normal distribution so that median and quartile spacing were used for description,and Mann-Whitney U test was used for nonparametric test.Qualitative data such as gender,clinical symptoms and condylar lesion types were described by composition ratio and chi-square test was performed.Results There was no statistical significance in age and gender of TMJOA patients in the group with or without CSP(P>0.05).The incidence of pain in CSP group[83.1%(59/71)]was marginally higher than that in non-CSP group[65.5%(19/29)]but without statistical difference(χ^(2)=3.71,P=0.054).There was also no significant difference in TMJ sounds and limitation of mandibular movement between the two groups(χ^(2)=0.11,P=0.742;χ^(2)=0.48,P=0.489).Among all of joints,the most common types of TMJOA were articular flattening and shortening and erosion.CBCT showed that erosion[65.0%(130/200)],flattening and shortening[73.0%(146/200)],subcortical sclerosis[42.0%(84/200)],osteophyte[30.5%(61/200)]and subcortical cystic[15.5

关 键 词：颞下颌关节 骨关节炎 锥形束计算机体层摄影术 偏侧咀嚼 

分 类 号：R782.6[医药卫生—口腔医学]