关节盘前移位对颞下颌关节骨性结构关系影响的三维影像学测量研究  

A three-dimensional imaging study of the effect of anterior disc displacement on the bony structural relationship of the temporomandibular joint

作　　者：刘旭[1,2] 李晨曦 龚忠诚[1] 马优祎[1] 塞比努尔·吐尔孙 Liu Xu;Li Chenxi;Gong Zhongcheng;Ma Youyi;Saibinuer·Tuersun(Department of Oral and Maxillofacial Oncology&Surgery,the First Affiliated Hospital of Xinjiang Medical University,School and Hospital of Stomatology,Xinjiang Medical University,Stomatological Research Institute of Xinjiang Uygur Autonomous Region,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院(附属口腔医院)口腔颌面肿瘤外科、新疆维吾尔自治区口腔医学研究所,乌鲁木齐830054 [2]兰州大学口腔医学院·口腔医院口腔颌面外科,兰州730013

出　　处：《中华口腔医学杂志》2024年第2期157-164,共8页Chinese Journal of Stomatology

基　　金：国家自然科学基金(82160189);口腔颌面发育与再生湖北省重点实验室开放课题(2022kqhm008);新疆维吾尔自治区天山创新团队(2021D14001);自治区科研创新项目(XJ2023G174)。

摘　　要：目的本研究通过三维重建图像测量分析3种不同关节盘状态下,颞下颌关节(TMJ)相关骨性结构的改变情况,为临床诊断提供指导。方法对2018年3月至2021年12月就诊于新疆医科大学第一附属医院颞下颌关节专病门诊同时行MRI与锥形束CT检查的52例患者,其中女性46例,男性6例,年龄(27.8±8.3)岁。根据MRI检查结果将纳入研究对象分为关节盘位置正常(NADP)组、可复性关节盘前移位(ADDWR)组及不可复性关节盘前移位(ADDWoR)组,每组各28侧TMJ。对各组锥形束CT资料进行三维重建,根据重建模型分别记录髁突体积(CV)、髁突表面积(CSA)、关节窝体积(FV)、关节窝表面积(FSA)、髁突在关节窝中体积占比(CV%)、髁突在关节窝中表面积占比(CSA%)、关节腔上间隙(SJS)、关节腔前间隙(AJS)、关节腔后间隙(PJS)以及关节腔内侧间隙(MJS)。采用单因素方差分析、Kruskal-Wallis H检验及受试者操作特征曲线(ROC曲线)分析各参数的改变情况。结果CV和CSA在关节盘正常至不可复性前移位的病理进展中均发生显著变化(F=10.79,P<0.001;F=10.95,P<0.001)。NADP组和ADDWR组的CV、CSA和SJS[分别为(1834.90±667.67)和(1747.34±369.42)mm^(3),(859.27±216.01)和(838.23±118.82)mm^(2),(2.22±0.88)和(1.94±0.64)mm]均显著大于ADDWoR组[分别为(1256.29±418.27)mm^(3)、(669.14±150.26)mm^(2)、(1.45±0.57)mm](t=4.31,P<0.001;t=3.66,P<0.001;t=4.27,P<0.001;t=3.80,P<0.001;t=4.11,P<0.001;t=2.63,P=0.010)。NADP组MJS[(5.03±1.41)mm]显著高于ADDWR组[(3.86±1.32)mm](t=3.00,P=0.004),ADDWR组MJS显著高于ADDWoR组[(4.91±1.65)mm](t=2.63,P=0.009)。ROC曲线分析显示,CV、CSA、SJS对鉴别NADP与ADDWoR的曲线下面积(AUC)值分别为0.77、0.76、0.76,CV、CSA、SJS对鉴别ADDWR与ADDWoR效果的AUC值分别为0.80、0.80、0.72。MJS对鉴别NADP和ADDWR、ADDWR和ADDWoR的AUC值分别为0.73和0.69。结论颞下颌关节盘移位患者的髁突在三维层面上改变明显,CV、CSA、SJS和MJS的变化与�Objective To investigate the correlation between the osseous structure of temporomandibular joint(TMJ)and three different status of anterior disc location,so that it could guide the clinical diagnosis further.Methods Fifty-two patients[46 females and 6 males,with an age of(27.8±8.3)years]who treated with MRI and cone beam CT,were recruited from the Temporomandibular Joint Specialist Clinic,The First Affiliated Hospital of Xinjiang Medical University,between March 2018 to December 2021.According to the radiographic findings of the level of anterior disc displacement(ADD)in TMJ,patients were divided into three groups:normal articular disc position(NADP,n=28 TMJs),anterior disc displacement with reduction(ADDWR,n=28 TMJs),and anterior disc displacement without reduction(ADDWoR,n=28 TMJs).In the light of the reconstructed three-dimensional model,ten representative morphological parameters including condylar volume(CV),condylar superficial area(CSA),fossa volume(FV),fossa superficial area(FSA),the proportion of the condylar volume in the articular fossa(CV%),the proportion of the condylar superficial area in the articular fossa(CSA%),superior joint space(SJS),anterior joint space(AJS),posterior joint space(PJS),and medial joint space(MJS),were measured respectively under one-way analysis of variance(ANOVA),Kruskal-Wallis Htest and receiver operator characteristic curve(ROC curve)analyses.Results CV and CSA values varied significantly in the pathological progression from normal location to irreversible anterior displacement in TMJ.For CV value,NADP group[(1834.90±667.67)mm^(3)]>ADDWR group[(1747.34±369.42)mm^(3)]>ADDWoR group[(1256.29±418.27)mm^(3)][t=4.31,P(NADP-ADDWoR)<0.001;t=3.66,P(ADDWR-ADDWoR)<0.001],for CSA value,NADP group[(859.27±216.01)mm^(2)]>ADDWR group[(838.23±118.82)mm^(2)]>ADDWoR group[(669.14±150.26)mm^(2)][t=4.27,P(NADP-ADDWoR)<0.001;t=3.80,P(ADDWR-ADDWoR)<0.001].The difference of SJS value in NADP group[(2.22±0.88)mm],ADDWR group[(1.94±0.64)mm]and ADDWoR group[(1.45±0.57)mm],was statisticall

关 键 词：颞下颌关节 颞下颌关节紊乱病 关节盘移位 三维重建技术 诊断性试验 

分 类 号：R782.6[医药卫生—口腔医学]