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[咀嚼侧偏倚的颞下颌关节骨关节炎患者临床症状特点及锥形束CT影像改变分析]

[Analysis of the characteristic of clinical symptoms and cone-beam CT imaging changes in temporomandibular joint osteoarthritis patients with chewing side preference].

作者信息

Zhai X T, Huang D Z, Hu Y F, Xu X Y, Wang J Z, Li H B, Hu M, Liu H C, Jiang H

机构信息

Department of Prosthodontics, General Hospital of Chinese PLA, Beijing 100853, China.

Department of Radiology, General Hospital of Chinese PLA, Beijing 100853, China.

出版信息

Zhonghua Kou Qiang Yi Xue Za Zhi. 2022 Jul 2;57(7):688-693. doi: 10.3760/cma.j.cn112144-20220430-00226.

Abstract

To investigate the clinical symptoms and cone-beam CT (CBCT) imaging characteristics of temporomandibular joint osteoarthritis (TMJOA) with chewing side preference (CSP). One hundred patients with TMJOA diagnosed in the Department of Stomatology, General Hospital of the Chinese PLA from January 2018 to December 2020 were enrolled, including 32 males and 68 females, with an median age of 27.5 years (16-71 years). According to the habit of CSP, 100 cases were divided into 71 cases of TMJOA with CSP group and 29 cases of TMJOA without CSP group. The clinical symptoms were observed, including pain, TMJ sounds, limited mouth opening as well as the radiograph imaging changes of condylar bone. When analyzing the radiograph imaging changes of condylar, the cases with bilateral TMJ symptoms were excluded and the remaining cases were divided into symptomatic sides and asymptomatic sides with CSP or without CSP according to the symptoms of the chief complaint. SPSS 25.0 was used to analyze the statistical data. Age data did not conform to normal distribution so that median and quartile spacing were used for description, and Mann-Whitney test was used for nonparametric test. Qualitative data such as gender, clinical symptoms and condylar lesion types were described by composition ratio and Chi-Square test was performed. There was no statistical significance in age and gender of TMJOA patients in the group with or without CSP (>0.05). There incidence of pain in CSP group [83.1% (59/71)] was margina uy higher than that in non-CSP group but without statistical difference[65.5% (19/29)] (χ²3.71, =0.054). There was also no significant difference in TMJ sounds and limitation of mandibular movement between the two groups(χ²0.11, =0.742; χ²0.48, =0.489). Among all of joints, the most common types of TMJOA were articular flattening and shortening and erosion. CBCT showed that erosion [65.0% (130/200)], flattening and shortening [73.0% (146/200)], subcortical sclerosis [42.0% (84/200)], osteophyte [30.5% (61/200)] and subcortical cystic [15.5% (31/200)]. According to the different groups of chief complaint sides, intra-group comparisons show that the proportion of erosion in symptomatic sides of CSP group [80.0% (40/50)] was significantly higher than that in asymptomatic sides of CSP group [50.0% (25/50)] (χ²=9.89, =0.002). Inter-group comparisons show that the proportion of condyle flattening and shortening in symptomatic sides of CSP group [84.0% (42/50)] was significantly higher than that in bilateral joint of non-CSP group (8/15) (χ²=8.81, =0.032). There was no significant difference in the proportion of subcortical sclerosis, osteophyte and subcortical cystic between the group with or without CSP (>0.05). TMJOA patients with CSP may be more prone to clinical symptoms of pain and CBCT imaging changes of condyle erosion as well as flattening and shortening. CSP may be a promoting factor for the development of TMJOA.

摘要

探讨有咀嚼侧偏好(CSP)的颞下颌关节骨关节炎(TMJOA)的临床症状及锥形束CT(CBCT)影像学特征。选取2018年1月至2020年12月在中国人民解放军总医院口腔科确诊的100例TMJOA患者,其中男性32例,女性68例,年龄中位数为27.5岁(16 - 71岁)。根据CSP习惯,将100例患者分为有CSP的TMJOA组71例和无CSP的TMJOA组29例。观察临床症状,包括疼痛、颞下颌关节弹响、张口受限以及髁突骨的影像学改变。在分析髁突的影像学改变时,排除双侧颞下颌关节症状的病例,其余病例根据主诉症状分为有CSP或无CSP的患侧和健侧。采用SPSS 25.0分析统计数据。年龄数据不符合正态分布,故用中位数和四分位数间距进行描述,采用曼 - 惠特尼检验进行非参数检验。性别、临床症状和髁突病变类型等定性数据用构成比描述,并进行卡方检验。有CSP组和无CSP组的TMJOA患者在年龄和性别上无统计学意义(>0.05)。有CSP组的疼痛发生率[83.1%(59/71)]略高于无CSP组,但无统计学差异[65.5%(19/29)](χ² = 3.71,P = 0.054)。两组在颞下颌关节弹响和下颌运动受限方面也无显著差异(χ² = 0.11,P = 0.742;χ² = 0.48,P = 0.489)。在所有关节中,TMJOA最常见的类型是关节面扁平、缩短和侵蚀。CBCT显示侵蚀[65.0%(130/200)]、扁平及缩短[73.0%(146/200)]、皮质下硬化[42.0%(84/200)]、骨赘[30.5%(61/200)]和皮质下囊肿[15.5%(31/200)]。根据主诉侧别不同分组,组内比较显示,有CSP组患侧的侵蚀比例[80.0%(40/50)]显著高于有CSP组健侧的侵蚀比例[50.0%(25/50)](χ² = 9.89,P = 0.002)。组间比较显示,有CSP组患侧的髁突扁平及缩短比例[84.0%(42/50)]显著高于无CSP组双侧关节的比例(8/15)(χ² = 8.81,P = 0.032)。有CSP组和无CSP组在皮质下硬化、骨赘和皮质下囊肿的比例上无显著差异(>0.05)。有CSP的TMJOA患者可能更容易出现疼痛的临床症状以及髁突侵蚀和扁平及缩短的CBCT影像学改变。CSP可能是TMJOA发展的一个促进因素。

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