Emshoff Rüdiger, Rudisch Ansgar, Bösch Renato, Strobl Heinrich
Department of Oral and Maxillo-Facial Surgery, University of Innsbruck, Austria.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 Jul;96(1):12-8. doi: 10.1016/s1079-2104(03)00219-1.
Arthrocentesis of the temporomandibular joint (TMJ) is purported to be an effective modality in the treatment of patients with closed-lock symptoms. The purpose of this study was to determine whether the clinical findings of disk displacement without reduction associated with pain in the TMJ are related to the discovery of TMJ osteoarthrosis (OA) through the use of magnetic resonance (MR) imaging and whether the presence of OA affects the treatment outcome of patients who undergo arthrocentesis of the TMJ.
The study population consisted of 38 patients with TMJ pain who were assigned a clinical diagnosis of unilateral internal derangement (ID) of the TMJ, type III (disk displacement without reduction), in combination with capsulitis/synovitis (C/S) and an MR imaging diagnosis of disk displacement without reduction in the painful TMJ only. Before the patients underwent arthrocentesis, bilateral sagittal and coronal MR images were obtained to confirm the presence or absence of ID and OA. The preoperative and postoperative levels of TMJ function with respect to pain and mandibular range of motion were evaluated and compared. Multiple logistic regression analysis was used to compute the odds ratios for successful outcomes for OA (n = 24) versus unsuccessful outcomes for TMJs (n = 14).
The preoperative data revealed a significant relationship between the clinical diagnosis of TMJ ID type III with C/S and the discovery of OA on MR images (P =.048). At the 2-month follow-up, a clinical evaluation revealed a significant reduction in TMJ pain during function (P =.000); a significant reduction in the clinical diagnoses of ID type III (P =.000), and C/S (P =.000); and a significant increase in the mandibular range of motion (P =.000). The patients with successful outcomes were more likely to be associated with an MR imaging finding of OA than were the patients with unsuccessful outcomes. (10.4 odds ratio; P =.016).
Our preliminary findings suggest that the presence of OA revealed on MR images is related to clinical pain; furthermore, OA proved to be an important prognostic determinant of successful arthrocentesis.
颞下颌关节（TMJ）穿刺术据称是治疗闭锁症状患者的一种有效方式。本研究的目的是确定与TMJ疼痛相关的不可复性盘移位的临床发现是否与通过磁共振（MR）成像发现TMJ骨关节炎（OA）有关，以及OA的存在是否会影响接受TMJ穿刺术患者的治疗结果。
研究人群包括38例TMJ疼痛患者，他们被临床诊断为TMJ单侧关节内紊乱（ID），III型（不可复性盘移位），合并囊炎/滑膜炎（C/S），且MR成像诊断仅在疼痛的TMJ存在不可复性盘移位。在患者接受穿刺术前，获取双侧矢状位和冠状位MR图像以确认是否存在ID和OA。评估并比较术前和术后TMJ在疼痛和下颌运动范围方面的功能水平。采用多元逻辑回归分析计算OA患者（n = 24）成功结果与TMJ患者（n = 14）失败结果的优势比。
术前数据显示TMJ ID III型合并C/S的临床诊断与MR图像上OA的发现之间存在显著相关性（P = 0.048）。在2个月的随访中，临床评估显示功能期间TMJ疼痛显著减轻（P = 0.000）；III型ID（P = 0.000）和C/S（P = 0.000）的临床诊断显著减少；下颌运动范围显著增加（P = 0.000）。成功结果的患者比失败结果的患者更有可能与MR成像发现的OA相关（优势比10.4；P = 0.016）。
我们的初步研究结果表明，MR图像上显示的OA与临床疼痛有关；此外，OA被证明是穿刺术成功的重要预后决定因素。
