Yano Keisuke, Sano Tsukasa, Okano Tomohiro
Department of Radiology, Showa University School of Dentistry, Tokyo, Japan.
Cranio. 2004 Jan;22(1):64-71. doi: 10.1179/crn.2004.008.
It has been reported that joint effusion, the excessive accumulation of joint fluid in and around the joint, is related to temporomandibular joint (TMJ) disorders such as pain and disk displacement. However, there have been no longitudinal studies of this phenomenon. We performed a longitudinal study on the relationship between joint fluid and various pathological disk conditions. The subjects were 17 patients who visited our facility for orthodontic treatment and were diagnosed using MRI as having internal derangement of one or both TMJs (three males and 14 females; age 12-31 years; mean age 20.5 years). MRI was performed before, during, or after treatment for their disorders. We evaluated the relationship between changes in joint fluid in the joint space and the state of the disk, as well as the presence or absence of pain. Joint fluid was evaluated by classifying the extent of high-signal areas in the upper and lower articular cavities on T2-weighted images. The extent of high-signal areas was classified into five levels. Disk displacement and the extent of displacement were evaluated using proton density-weighted images. Statistical analysis was performed using the chi-square test, and differences in the distribution among the groups were examined. Effusion was noted on the first MRI in nine of the eleven joints (81.8%) in which joint fluid decreased on the second MRI (p<0.01). Displacement remained unchanged or worsened in 18 of the 21 joints (85.7%) that showed joint fluid on the first MRI (p<0.01). Pain was alleviated or absent in all joints in which the fluid decreased. These results suggest that joint fluid may be a factor in the outcome of disk recapture treatment as well as in the evaluation of pain.
据报道，关节积液，即关节内及关节周围关节液的过度积聚，与颞下颌关节（TMJ）紊乱如疼痛和盘状移位有关。然而，尚未有关于这一现象的纵向研究。我们对关节液与各种病理性盘状情况之间的关系进行了一项纵向研究。研究对象为17例因正畸治疗前来我院就诊的患者，经MRI诊断为一个或两个TMJ存在内紊乱（男性3例，女性14例；年龄12 - 31岁；平均年龄20.5岁）。在其疾病治疗前、治疗期间或治疗后进行了MRI检查。我们评估了关节间隙内关节液变化与盘状状态之间的关系，以及疼痛的有无。通过对T2加权图像上上下关节腔高信号区域的范围进行分类来评估关节液。高信号区域的范围分为五个级别。使用质子密度加权图像评估盘状移位及其移位程度。采用卡方检验进行统计分析，并检查各组间分布的差异。在第二次MRI检查时关节液减少的11个关节中的9个（81.8%）在首次MRI检查时发现有积液（p<0.01）。在首次MRI检查时显示有关节液的21个关节中的18个（85.7%）移位保持不变或加重（p<0.01）。在所有关节液减少的关节中疼痛得到缓解或消失。这些结果表明，关节液可能是盘状复位治疗结果以及疼痛评估中的一个因素。
