青少年接受非手术治疗后颞下颌关节（TMJ）骨侵蚀性病变的改善：一项纵向研究。
Improvement of bone-erosive temporomandibular joint (TMJ) abnormalities in adolescents undergoing non-surgical treatment: a longitudinal study.
机构信息
Department of Maxillofacial Radiology, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway.
Department of Health, Nutrition and Management, Oslo Metropolitan University, Oslo, Norway.
出版信息
Dentomaxillofac Radiol. 2020 Jul;49(5):20190338. doi: 10.1259/dmfr.20190338. Epub 2020 Mar 26.
OBJECTIVES
To investigate the longitudinal changes of the imaging temporomandibular joint (TMJ) characteristics in young patients with TMJ-related symptoms and treated with non-surgical methods. The severity of self-reported symptoms at follow-up was also investigated.
METHODS
A cone beam CT (CBCT)/CT follow-up examination [median follow-up 4.1 (1.3-6.4) years] was performed in 22 patients with erosive TMJ abnormalities [baseline median age 16 (12-18) years]. Imaging characteristics were analyzed and the changes between the examinations were categorized as (A) improvement, (B) no change, or (C) worsening. Severity of follow-up symptoms was evaluated using Jaw Functional Limitation Scale (JFLS-8) and Graded Chronic Pain Scale (Grade 0-IV). Analyses were performed separately for left and right TMJ. Findings at baseline and follow-up were compared using McNemar test to account for dependencies. Changes in proportions of hard tissue findings between examinations were assessed using Wilcoxon signed ranks test.
RESULTS
A significant reduction in the proportion of patients with erosive abnormalities was found [59.1%, 95% CI (36.4-79.3) %]. Baseline erosions improved in 9/12 (75%) right and 14/15 (93%) left TMJs. About half repaired; developed an intact cortical outline. Number of joints with osteophytes increased (right: < 0.04, left: < 0.003). New osteophytes were mostly found in joints with erosive findings. Low or no limitation of jaw function (Jaw Functional Limitation Scale) was found in 12/22 (55%) and no or low intensity of pain (Graded Chronic Pain Scale Grade 0 or I) in 19/22 (86%) at follow-up.
CONCLUSION
We found a high potential for repair of erosive TMJ abnormalities. However, the patient series was small. The majority of patients assessed their symptom severity at follow-up as low.
目的
探讨伴 TMJ 相关症状且接受非手术治疗的年轻患者 TMJ 影像学特征的纵向变化，同时研究其随访时的自报告症状严重程度。
方法
对 22 例伴侵蚀性 TMJ 异常的患者进行 CBCT/CT 随访检查（中位随访时间 4.1[1.3-6.4]年）。分析影像学特征，并将两次检查的变化分为（A）改善、（B）无变化或（C）恶化。采用 Jaw Functional Limitation Scale（JFLS-8）和 Graded Chronic Pain Scale（Grade 0-IV）评估随访时的症状严重程度。分别对左侧和右侧 TMJ 进行分析。为了考虑相关性，采用 McNemar 检验比较基线和随访时的发现。采用 Wilcoxon 符号秩检验评估两次检查之间的硬组织发现比例变化。
结果
患者中侵蚀性异常的比例显著降低[59.1%，95%可信区间（36.4-79.3）%]。12 例右侧和 14 例左侧 TMJ 的基线侵蚀性病变改善。约一半修复，皮质边缘完整。骨赘数量增加（右侧：<0.04，左侧：<0.003）。新骨赘主要出现在伴侵蚀性发现的关节中。12/22（55%）的患者颌功能受限程度较低或无受限，19/22（86%）的患者疼痛强度较低或无疼痛（Graded Chronic Pain Scale Grade 0 或 I）。
结论
我们发现侵蚀性 TMJ 异常有较高的修复潜力，但患者数量较少。大多数患者在随访时将其症状严重程度评估为低水平。
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