颞下颌关节盘复位缝合术后髁突骨再生的MRI表现及影响骨再生相关因素分析  

MRI evaluation of condylar bone regeneration after temporomandibular joint disc reduction and suture and analysis of factors affecting bone regeneration

作　　者：章智宇 杨娇艳 邢一鸣 周薇娜[2] 张平[1] 江宏兵[1] Zhang Zhiyu;Yang Jiaoyan;Xing Yiming;Zhou Weina;Zhang Ping;Jiang Hongbing(Department of Oral and Maxillofacial Surgery,The Affiliated Stomatological Hospital of Nanjing Medical University&Jiangsu Province Key Laboratory of Oral Diseases&Jiangsu Province Engineering Research Center of Stomatological Translational Medicine,Nanjing 210029,China;Department of TMD and Orofacial Pain,The Affiliated Stomatological Hospital of Nanjing Medical University&Jiangsu Province Key Laboratory of Oral Diseases&Jiangsu Province Engineering Research Center of Stomatological Translational Medicine,Nanjing 210029,China)

机构地区：[1]南京医科大学附属口腔医院口腔颌面外科,江苏省口腔疾病研究重点实验室,江苏省口腔转化医学工程研究中心,南京210029 [2]南京医科大学附属口腔医院颞颌关节与颌面疼痛科,江苏省口腔疾病研究重点实验室,江苏省口腔转化医学工程研究中心,南京210029

出　　处：《中华口腔医学杂志》2023年第10期1004-1009,共6页Chinese Journal of Stomatology

基　　金：江苏省自然科学基金(BK20201350,BK20190648);江苏省科教能力提升工程-江苏省研究型医院建设单位(YJXYYJSDW4);江苏省医学创新中心(CXZX202227)。

摘　　要：目的:观察颞下颌关节不可复性盘前移位患者行关节盘复位缝合术后髁突骨再生的MRI表现,分析影响骨再生的相关因素。方法:回顾性纳入2020年4月至2021年12月于南京医科大学附属口腔医院口腔颌面外科就诊的61例(共75侧)颞下颌关节不可复性盘前移位患者,分析其术前、术后(随访6个月及以上)MRI的髁突骨再生特点,并对骨再生的影响因素进行Logistic回归分析。结果:61例患者中有骨再生28例,年龄(20.2±4.9)岁;无骨再生33例,年龄(41.9±17.5)岁。髁突有骨再生的关节35侧,其中新骨位于髁突后斜面占45.7%(16/35),新骨位于髁突周围占28.6%(10/35),新骨位于髁突前斜面占17.1%(6/35),新骨位于髁突顶部占8.6%(3/35)。多因素Logistic回归分析显示,患者年龄、术前关节盘长度和髁突骨质吸收程度均与术后髁突骨再生相关(P<0.05),患者年龄小于30岁,术前关节盘长度未变短,髁突骨质吸收程度轻,髁突新骨再生的可能性高。结论:恢复正常盘-髁关系后髁突具有骨再生能力,患者年轻,术前关节盘长度未变短,髁突骨质吸收程度轻有利于术后髁突骨再生。Objective To evaluate the MRI manifestations of condylar bone regeneration after disc reduction and suture for anterior disc displacement without reduction(ADDWoR)patients and to analyze the relevant factors affecting bone regeneration.Methods A total of 61 patients of 75 joints with ADDWoR who attended the Department of Maxillofacial Surgery of the Affiliated Hospital of Stomatology of Nanjing Medical University from April 2020 to December 2021 were enrolled in the study.The characteristics of MRI condylar bone regeneration were analyzed before and after surgery(follow-up for 6 months or more),and logistic regression analysis was performed on the influencing factors of bone regeneration.Results The new bone formation of the condyle was found in 28 patients,with age of(20.2±4.9)years.However,there were 33 patients that had no condylar bone regeneration,with age of(41.9±17.5)years.A total of 35 joints in this study were found new bone formation.There were 16 joints(45.7%)had new bone formation on the posterior slope of the condyle,10 joints(28.6%)around the condyle,6 joints(17.1%)on the anterior slope of the condyle,and only 3 joints(8.6%)on the top of the condyle.Multivariate logistic regression analysis showed that age,preoperative disc length and degree of condylar bone resorption correlated with postoperative condylar bone regeneration(P<0.05).Patients younger than 30 years with non-shortened preoperative disc length and less condylar bone resorption have a higher probability of new bone formation.Conclusions The condyle has bone regeneration capacity after correcting the abnormal relationship between disc and condyle,and young age,non-shortened preoperative disc length and less condylar bone resorption are conducive to postoperative condylar bone regeneration.

关 键 词：下颌骨髁状突 骨再生 磁共振成像 颞下颌关节紊乱病 关节盘复位缝合术 

分 类 号：R782.6[医药卫生—口腔医学]