颞下颌关节骨关节炎的诊治方案:基于上海交通大学医学院附属第九人民医院颞下颌关节中心的经验  

Protocols for diagnosis and treatment of temporomandibular joint osteoarthritis:experience from the TMJ Center of Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine

作　　者：张善勇[1] 杨驰[1] ZHANG Shanyong;YANG Chi(Department of Oral Surgery,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine/College of Stomatology,Shanghai Jiao Tong University/National Center for Stomatology/National Clinical Research Center for Oral Diseases/Shanghai Key Laboratory of Stomatology,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院口腔外科,上海交通大学口腔医学院,国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,上海200011

出　　处：《上海交通大学学报（医学版）》2022年第6期709-716,共8页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海市科学技术委员会优秀技术带头人项目(21XD1431500);上海申康医院发展中心临床三年行动计划(SHDC2020CR3060B);上海市黄浦区产业扶持基金(XK2020013)。

摘　　要：颞下颌关节骨关节炎(temporomandibular joint osteoarthritis,TMJOA)是最常见的颞下颌关节退行性疾病,其临床表现包括关节及周围肌肉疼痛、关节绞索、摩擦/破碎音以及张口受限等,可对患者的生活质量造成严重影响。TMJOA主要病理特征包括慢性滑膜炎、进行性关节软骨退变和软骨下骨异常改建。目前其发病机制尚未明确,异常机械负荷、创伤、遗传、代谢、性别和年龄等都可成为致病因素。TMJOA常用诊断方法包括磁共振成像(MRI)和计算机断层扫描[CT/锥形束CT(cone beam CT,CBCT)]等。TMJOA的分期标准主要有Wilkes分期和杨氏分期。TMJOA的临床治疗主要包括非手术治疗和手术治疗。其中非手术治疗包括健康教育、心理咨询、药物治疗、咬合治疗等;手术治疗包括关节穿刺术、关节镜手术、关节盘锚固术、自体组织移植修复术和关节置换术等。该文在文献综述的基础上对TMJOA疾病诊断、分期与手术治疗和术后评价等方面进行总结,并结合上海交通大学医学院附属第九人民医院口腔外科关节专科团队的诊治经验提出诊治方案的建议,从而为同行提供参考。Temporomandibular joint osteoarthritis(TMJOA)is the most common degenerative disease in the temporomandibular joint,mainly manifesting with pain in the joints and the muscles,joint locking,popping,crepitus,and limited mouth opening,which may undermine the quality of patients'life.The main pathological features of TMJOA include chronic synovitis,progressive articular cartilage degeneration,and abnormal subchondral bone remodeling.At present,its pathogenesis is still unclear,and abnormal mechanical load,trauma,heredity,metabolism,gender and age can all be regarded as pathogenic factors.Commonly used diagnostic methods for TMJOA include magnetic resonance imaging(MRI)and computed tomography[CT/cone beam CT(CBCT)].The staging standards of TMJOA mainly include Wilkes staging system and Yang's staging system.The clinical treatment of TMJOA mainly includes two categories:non-surgical treatment and surgical treatment.Non-surgical treatment includes health education,psychological consultation,medication,occlusion treatment,etc.Surgical treatment includes arthrocentesis,arthroscopic surgery,disc anchoring,autogenous tissue graft,and total joint replacement.This paper summarizes the diagnosis,staging,surgical treatment and postoperative evaluation of TMJOA on the basis of literature review,and proposes diagnosis and treatment protocols based on the experience of the TMJ Center of Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,so as to provide reference for clinicians.

关 键 词：颞下颌关节 骨关节炎 诊断 治疗 

分 类 号：R782.2[医药卫生—口腔医学]