Larheim T A, Westesson P L, Sano T
Department of Maxillofacial Radiology, Faculty of Dentistry, University of Oslo, Norway.
Int J Oral Maxillofac Surg. 2001 Apr;30(2):104-12. doi: 10.1054/ijom.2000.0017.
The purpose of this study was to investigate temporomandibular joint (TMJ) effusion on magnetic resonance (MR) images, and its association with specific categories of disk displacement, bone marrow abnormalities and pain. From a series of 523 consecutive TMJ MR imaging studies of patients referred to imaging because of pain and dysfunction, those with TMJ effusion, defined as an amount of fluid that exceeded the maximum amount seen in a control group of asymptomatic volunteers, were analysed. The selected patients were reassessed and the amount of TMJ fluid was graded bilaterally according to a set of reference films. Other parameters recorded included disk displacement categories and condyle marrow abnormalities. Pain self-records were obtained from the patients immediately before MR imaging. The association between the recorded parameters and TMJ pain was analysed with t-tests and regression analysis. Of the 523 patients, 70 (13%) had TMJ effusion, which was unilateral in 61%. Only 9% of the 70 patients had effusion bilaterally, whereas bilateral disk displacement was found in 80%. In the 76 joints with effusion, 83% showed two specific categories of disk displacement at closed mouth. Condyle marrow abnormalities were found in 31% of the 70 patients, mostly on one side, and in 24% of the 76 joints. An in-patient regression analysis of the side difference in TMJ pain showed that effusion and condyle marrow abnormalities were significant pain-increasing factors. In conclusion, patients with TMJ effusion represent a subgroup with pain and dysfunction with more severe intra-articular pathology than those with disk displacement but no other joint abnormalities.
本研究的目的是调查磁共振(MR)图像上的颞下颌关节(TMJ)积液,及其与特定类型的盘移位、骨髓异常和疼痛的关系。在一系列因疼痛和功能障碍而转诊至影像科进行TMJ MR成像检查的523例连续患者中,对那些有TMJ积液(定义为超过无症状志愿者对照组所见最大积液量的液体量)的患者进行分析。对选定的患者进行重新评估,并根据一组参考片双侧对TMJ液量进行分级。记录的其他参数包括盘移位类别和髁突骨髓异常。在MR成像前立即从患者处获取疼痛自我记录。使用t检验和回归分析来分析记录的参数与TMJ疼痛之间的关联。在523例患者中,70例(13%)有TMJ积液,其中61%为单侧积液。70例患者中只有9%双侧有积液,而双侧盘移位的发生率为80%。在76个有积液的关节中,83%在闭口时显示出两种特定类型的盘移位。70例患者中有31%发现髁突骨髓异常,大多为单侧,76个关节中有24%发现髁突骨髓异常。对TMJ疼痛的侧别差异进行住院回归分析显示,积液和髁突骨髓异常是显著的疼痛增加因素。总之,与那些有盘移位但无其他关节异常的患者相比,有TMJ积液的患者代表了一个有疼痛和功能障碍且关节内病理更严重的亚组。