Schmitter Marc, Kress Bodo, Rammelsberg Peter
Department of Prosthodontics, University of Heidelberg, Germany.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 Mar;97(3):318-24. doi: 10.1016/j.tripleo.2003.10.009.
We sought to determine the prevalence of joint diseases in patients with either of 2 forms of myofascial pain (with and without limited mouth opening) and to verify the accuracy of temporomandibular joint-related clinical diagnoses through the use of magnetic resonance imaging (MRI).
On the basis of the results of a clinical examination carried out according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), 61 patients were divided into 2 subgroups. The first group consisted of 36 patients who had myofascial pain with limited mouth opening (MPLO), whereas the other 25 patients were diagnosed with myofascial pain without limited mouth opening. MRI was carried out on all patients. The clinical joint-related diagnoses from RDC/TMD were compared with MRI results.
Patients with MPLO often had joint diseases that were not detected by means of a clinical examination alone. The kappa statistic was used to compare MRI and clinical diagnoses, confirming poor agreement in patients with MPLO (kappa=0.13) and acceptable agreement in patients with myofascial pain without limited mouth opening (kappa=0.72).
Restricted mandibular mobility is frequently associated with temporomandibular joint diseases that were not identified during a clinical examination. Therefore, an adaptation of the classification scheme used for the RDC/TMDs may result in the improvement of the sensitivity of clinical joint-related diagnoses, especially in patients with MPLO.
我们试图确定两种形式的肌筋膜疼痛（伴或不伴张口受限）患者中关节疾病的患病率，并通过使用磁共振成像（MRI）来验证颞下颌关节相关临床诊断的准确性。
根据颞下颌关节紊乱病研究诊断标准（RDC/TMD）进行临床检查的结果，将61例患者分为2个亚组。第一组由36例伴有张口受限的肌筋膜疼痛（MPLO）患者组成，而另外25例患者被诊断为不伴有张口受限的肌筋膜疼痛。对所有患者进行了MRI检查。将RDC/TMD的临床关节相关诊断与MRI结果进行比较。
MPLO患者常患有仅通过临床检查无法检测到的关节疾病。使用kappa统计量比较MRI和临床诊断，结果证实MPLO患者的一致性较差（kappa=0.13），而不伴有张口受限的肌筋膜疼痛患者的一致性尚可（kappa=0.72）。
下颌运动受限常与临床检查中未发现的颞下颌关节疾病相关。因此，调整用于RDC/TMD的分类方案可能会提高临床关节相关诊断的敏感性，尤其是在MPLO患者中。
