Israel H A, Diamond B, Saed-Nejad F, Ratcliffe A
Division of Oral and Maxillofacial Surgery, Columbia University, New York, NY, USA.
J Oral Maxillofac Surg. 1999 Sep;57(9):1034-9. doi: 10.1016/s0278-2391(99)90321-x.
The purpose of this investigation was to assess the relationship between parafunctional masticatory activity and arthroscopically visualized changes in patients with severe, unremitting symptoms caused by intra-articular temporomandibular joint pathology. The working hypothesis was that the presence of parafunctional activity leads to increased arthroscopically diagnosed pathology.
Temporomandibular joint arthroscopy was performed on 124 joints in 83 patients (female:male, 5.4:1; mean age, 35 years; mean duration of symptoms, 49 months) with severe symptoms unresponsive to nonsurgical management. Preoperatively, the presence of parafunctional habits (bruxism, clenching) was assessed, and joints were classified as either with or without parafunctional influences. Joints were diagnosed arthroscopically and assessed for the presence or absence of osteoarthritis, synovitis, and adhesions. Analyses were performed to determine significant relationships between parafunctional activity and the presence of osteoarthritis, synovitis, and adhesions.
Parafunctional influences were present in 82 of 124 joints (66%). Clinically diagnosed osteoarthritis was present in 59 of 124 joints (48%) and arthroscopically diagnosed osteoarthritis was seen in 82 of 124 joints (66%). Arthroscopically, synovitis was diagnosed in 123 of 124 joints (99%) and adhesions in 93 of 124 joints (75%). Statistical analyses showed a significant relationship between parafunction and clinically diagnosed osteoarthritis, and suggested a close relationship between parafunction and arthroscopically diagnosed osteoarthritis. A significant association between clinically and arthroscopically diagnosed osteoarthritis and adhesions was also demonstrated. There also was no significant relationship detected between parafunction and the presence of synovitis or adhesions seen arthroscopically.
It was concluded that parafunctional masticatory activity and its influence on joint loading contribute to osteoarthritis of the temporomandibular joint. Such osteoarthritis is associated with adhesions of the joint. Arthroscopically diagnosed synovitis is not specifically associated with parafunction, and it appears that numerous other causative factors may contribute to its development in the TMJ. Because abnormal joint loading is a major causative factor in cartilage degradation, biochemical and biomechanical abnormalities, and intraarticular temporomandibular pathology, clinicians must identify and address parafunctional masticatory activity during nonsurgical, surgical, and postsurgical treatment regimens.
本研究旨在评估由颞下颌关节内病变引起的严重、持续性症状患者的副功能咀嚼活动与关节镜下可见变化之间的关系。研究的假设是副功能活动的存在会导致关节镜诊断的病变增加。
对83例（女性与男性比例为5.4:1；平均年龄35岁；平均症状持续时间49个月）对非手术治疗无反应的严重症状患者的124个关节进行颞下颌关节镜检查。术前评估副功能习惯（磨牙症、紧咬牙）的存在情况，并将关节分为受或未受副功能影响两类。通过关节镜对关节进行诊断，并评估是否存在骨关节炎、滑膜炎和粘连。进行分析以确定副功能活动与骨关节炎、滑膜炎和粘连的存在之间的显著关系。
124个关节中有82个（66%）存在副功能影响。临床诊断为骨关节炎的有124个关节中的59个（48%），关节镜诊断为骨关节炎的有124个关节中的82个（66%）。关节镜检查显示，124个关节中有123个（99%）诊断为滑膜炎，124个关节中有93个（75%）存在粘连。统计分析显示副功能与临床诊断的骨关节炎之间存在显著关系，并表明副功能与关节镜诊断的骨关节炎之间存在密切关系。临床和关节镜诊断的骨关节炎与粘连之间也存在显著关联。在副功能与关节镜下可见的滑膜炎或粘连的存在之间未检测到显著关系。
得出的结论是，副功能咀嚼活动及其对关节负荷的影响会导致颞下颌关节骨关节炎。这种骨关节炎与关节粘连有关。关节镜诊断的滑膜炎与副功能无特异性关联，似乎许多其他致病因素可能导致其在颞下颌关节中的发展。由于异常的关节负荷是软骨降解、生化和生物力学异常以及颞下颌关节内病变的主要致病因素，临床医生在非手术、手术和术后治疗方案中必须识别并处理副功能咀嚼活动。
