Larheim T A, Bjørnland T, Smith H J, Aspestrand F, Kolbenstvedt A
Faculty of Dentistry, University of Oslo, Norway.
Oral Surg Oral Med Oral Pathol. 1992 Apr;73(4):494-501. doi: 10.1016/0030-4220(92)90333-l.
The preoperative examination findings in the soft tissue and bone of 22 temporomandibular joints of 15 patients with rheumatic disease were compared with the diagnosis after TMJ surgery. Agreement was found in 15 joints with rheumatic involvement and in 4 with internal derangement. In 5 (with unsuccessful arthrotomography) of the 15 rheumatic joints, magnetic resonance imaging showed destruction of disks with soft-tissue replacement, corresponding to fibrous tissue/ankylosis observed at surgery. Bony fusions in 2 of these joints were depicted with computed tomography. In the remaining 10 joints, arthrotomography showed irregularly outlined small compartments corresponding to synovial proliferations observed during surgery. Similar arthrotomographic interpretation, however, was made in 2 of 3 temporomandibular joints with imaging-surgery disagreement; surgery showed fibrous adhesions. In the third joint with unsuccessful arthrotomography, magnetic resonance imaging showed internal derangement but no synovial proliferations that were surgically observed. As experienced with other joints, synovial proliferations (or fibrous adhesions) could not be depicted with magnetic resonance imaging. Thus, differentiation between internal derangement with and without rheumatic involvement could be impossible with both arthrotomography and unenhanced magnetic resonance imaging.
将15例风湿性疾病患者22个颞下颌关节的软组织和骨骼术前检查结果与颞下颌关节手术后的诊断结果进行比较。发现15个关节有风湿性病变，4个关节有内部紊乱。在15个风湿性关节中的5个（关节造影未成功），磁共振成像显示盘状结构破坏并被软组织替代，这与手术中观察到的纤维组织/关节强硬相符。其中2个关节的骨性融合通过计算机断层扫描显示。在其余10个关节中，关节造影显示轮廓不规则的小腔隙，与手术中观察到的滑膜增生相符。然而，在3个颞下颌关节中有2个，尽管影像检查与手术结果不一致，但关节造影的解释相似；手术显示为纤维粘连。在第三个关节造影未成功的关节中，磁共振成像显示内部紊乱，但未显示手术中观察到的滑膜增生。正如在其他关节中所经历的那样，磁共振成像无法显示滑膜增生（或纤维粘连）。因此，关节造影和未增强磁共振成像都无法区分有无风湿性病变的内部紊乱。
