Anderson G C, Schiffman E L, Schellhas K P, Fricton J R
TMJ and Craniofacial Pain Clinic, School of Dentistry, University of Minnesota, Minneapolis 55455.
J Dent Res. 1989 May;68(5):826-9. doi: 10.1177/00220345890680051501.
Internal derangements of the temporomandibular joint (TMJ) have gained increased recognition as a potential source of pain and dysfunction of the masticatory system. The objective of this study was to evaluate the reliability of clinicians in predicting an arthrographic diagnosis of articular disc position in a typical patient population presenting for TMJ arthrographic evaluation. Two clinicians utilized a brief history, clinical examination (including evaluation of mandibular movement and TMJ auscultation), and tomographic TMJ imaging in evaluating 60 patients. The radiologist subsequently performed the arthrographic procedures on 102 TMJs (18 unilateral and 42 bilateral). Diagnostic agreement was determined for all possible diagnostic categories including: normal disc position, TMJ internal derangement with reduction, TMJ internal derangement without reduction/acute, TMJ internal derangement without reduction/chronic, and osteoarthrosis. The significance of the diagnostic agreement between the clinicians and arthrography was evaluated with a Kappa Statistical Test, which showed good reliability. For epidemiological studies, it was concluded that clinical and tomographic evaluation would provide sufficient reliability for determination of the presence and stage of TMJ internal derangement. However, in a specific clinical situation, a difficult diagnostic problem may require the use of arthrography, depending on the impact of the diagnosis on subsequent treatment decisions.
颞下颌关节（TMJ）内紊乱作为咀嚼系统疼痛和功能障碍的潜在来源已得到越来越多的认识。本研究的目的是评估临床医生在预测接受TMJ关节造影评估的典型患者群体中关节盘位置的关节造影诊断方面的可靠性。两名临床医生利用简短病史、临床检查（包括下颌运动评估和TMJ听诊）以及TMJ断层成像对60例患者进行评估。随后，放射科医生对102个TMJ（18个单侧和42个双侧）进行了关节造影检查。确定了所有可能诊断类别的诊断一致性，包括：关节盘位置正常、可复性TMJ内紊乱、不可复性/急性TMJ内紊乱、不可复性/慢性TMJ内紊乱和骨关节炎。采用Kappa统计检验评估临床医生与关节造影之间诊断一致性的意义，结果显示可靠性良好。对于流行病学研究，得出的结论是，临床和断层成像评估将为确定TMJ内紊乱的存在和阶段提供足够的可靠性。然而，在特定的临床情况下，根据诊断对后续治疗决策的影响，一个困难的诊断问题可能需要使用关节造影。
