安氏分类下颞下颌关节盘动态位置与形态变化的观察  

Observation of dynamic position and morphological changes of temporomandibular joint discs under Angle′s classification

作　　者：母晓丹 刘华蔚[2] 黄晓峰[1] 胡敏[2] Mu Xiaodan;Liu Huawei;Huang Xiaofeng;Hu Min(Department of Stomatology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Oral and Maxillofacial Surgery,General Hospital of Chinese PLA,Beijing 100853,China)

机构地区：[1]首都医科大学附属北京友谊医院口腔科,北京100050 [2]解放军总医院口腔颌面外科,北京100853

出　　处：《中华口腔医学杂志》2024年第10期1019-1026,共8页Chinese Journal of Stomatology

基　　金：国家重点研发计划(2017YFB1104103)。

摘　　要：目的了解不同安氏分类下颞下颌关节(TMJ)关节盘在关节运动中的动态变化,为了解关节功能运动提供参考,并为临床影像更准确诊断提供依据。方法纳入2022年1月至2024年4月期间就诊于首都医科大学附属北京友谊医院及解放军总医院的颞下颌关节紊乱病患者30例(男性13例,女性17例),年龄(34.4±8.5)岁,通过MRI对其TMJ从闭口位至最大开口位,再至闭口位进行多层面动态成像,观察关节盘的位置及形态变化。结果安氏错[牙合]畸形关节盘无移位患者在开闭口运动过程中,其关节盘形态不尽相同,但最大开口位时,关节盘均位于上颌结节正下方,其形态均呈双凹形。就不可复性关节盘前移位而言,安氏Ⅰ类错[牙合]中,由最大开口回至闭口前,关节盘后缘均与髁突前斜面接触;安氏Ⅱ类错[牙合]中,由开口初至最大开口位,关节盘后缘与髁突前斜面接触;安氏Ⅲ类错[牙合]中,整个运动过程中,关节盘后缘始终与髁突前斜面接触;其中,部分患者闭口位时,关节盘呈现前移位状态,其形态发生折叠现象;当其开口度为2.5 cm时,关节盘一定程度上移,距离髁突前斜面更近,其形态亦发生部分改变;当开口度为4.3 cm时,关节盘形态呈典型的双凹形,位于关节结节前斜面与髁突后斜面之间,因过大张口存在部分后移,但足以表明达到最大开口度时其关节盘是可复的。就可复性关节盘前移位而言,安氏Ⅰ类错[牙合]开口初和闭口末,关节盘后缘与髁突前斜面接触;安氏Ⅱ类错[牙合]中则未观察到关节盘后缘与髁突前斜面接触,且其关节盘仅在开口初及闭口末存在关节盘前移位。安氏Ⅲ类错[牙合]中,闭口末时,其关节盘后缘与髁突前斜面接触。结论通过颞下颌关节多层面动态MRI成像数据可动态观察TMJ运动,直观且准确地显示关节盘在运动中的位置和形态,可作为TMJ静态常规MR成像的有益补充。患者TMJ需达到最�Objective:To observe the dynamic changes of the temporomandibular joint(TMJ)disc in joint movement under different Angle′s classification,providing reference for understanding joint functional movement and providing a basis for more accurate clinical imaging diagnosis.Methods:A total of 30 patients(13 males and 17 females)with temporomandibular disorders who were admitted to Beijing Friendship Hospital,Capital Medical University and General Hospital of the People′s Liberation Army from January 2022 to April 2024 were enrolled.Thirty adults(13 males and 17 females)with different Angle′s classification,with an average age of(34.4±8.5)years,were subjected to dynamic imaging of their TMJ from the closed position to the maximum opening position,and then to the closed position using MRI.The position and morphological changes of the articular discs were observed.Results:The results showed that volunteers with no displacement of the articular disc in class Ⅰ,Ⅱ,and Ⅲ relationships had different shapes of the articular disc during open and closed mouth movements.However,in the maximum opening position,the articular disc were all located directly below the maxillary nodules,and their shape is double concave.In terms of irreversible anterior displacement of the articular disc,in class Ⅰ Angle,the posterior zone of the disc contacts the anterior inclined plane of condyle from the maximum opening position back to the front of the closing position.In class Ⅱ,the posterior zone of the disc contacts the anterior inclined plane of condyle from the beginning of opening position to maximum opening position.In class Ⅲ,the posterior zone of the disc is always in contact with the anterior inclined plane of condyle throughout the entire movement process.And among them,the articular disc presents a forward displacement state at the closing position,its morphology undergoes folding phenomenon.When the openness is 2.5 cm,the articular disc moves up to a certain extent,and is closer to the anterior inclined plane of condy

关 键 词：颞下颌关节 动态MR 错[牙合] 安氏Ⅰ类 错[牙合] 安氏Ⅱ类 错[牙合] 安氏Ⅲ类 下颌骨髁状突 

分 类 号：R782.6[医药卫生—口腔医学]