Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Kocaeli University, Kocaeli, Turkey.
J Craniomaxillofac Surg. 2022 Aug;50(8):643-650. doi: 10.1016/j.jcms.2022.07.003. Epub 2022 Jul 8.
This study aimed to investigate the effects of arthrocentesis with intra-articular hyaluronic acid (HA) injection on mandibular condyles using fractal dimension (FD) analysis. Patients with temporomandibular joint (TMJ) internal derangement (ID) were divided into three groups according to how many times the arthrocentesis with HA injection was performed. FD analysis is a quantitative concept that provides information about trabecular bone microstructures. Regions of interest were selected from bone areas close to the articular surfaces of the right and left condyles on panoramic radiographs, which were taken before the procedure (T0) and at the sixth month (T1) after the procedure. Then, the FD values were calculated. All images were reviewed by the same researcher. A two-way repeated-measures analysis of variance was used to determine whether there was a significant interaction between groups, treatment sides, and time on the FD values. A total of 140 patients, including 118 patients who received bilateral arthrocentesis with HA injection and 22 control patients, were included in the study. The images of 20 randomly selected patients were re-evaluated after 2 weeks. As a result of the correlation analysis, there was no significant difference between the two measurements (P > 0.05). The main effect of time on the FD value was significant [F (1, 136) = 157.879, P < 0.001]. This effect was qualified by a significant time × group interaction effect [F (3, 136) = 18.533, P < 0.001]. The increases in the mean FD values on the right and left sides in all treatment groups between T0 and T1 times were significant (P < 0.001 for all), whereas changes in FD values on the right and left sides between T0 and T1 times were not significant in the control group (P = 0.164 and P = 0.557, respectively). After arthrocentesis with HA injections, the mean FD values increased in the mandibular condyles, depending on time in all treatment groups. Patients with TMJ ID are likely to have radiologically detectable degenerative changes and abnormalities in the condyles. The FD analysis method, which provides quantitative data, is recommended as an adjunct and guide for oral and maxillofacial surgeons in radiological examinations that should be performed together with clinical examination for the follow-up of microstructural changes in the condyle after arthrocentesis with HA injection.
本研究旨在通过分形维数（FD）分析探讨关节内注射透明质酸（HA）关节穿刺术对下颌髁突的影响。根据关节内注射 HA 关节穿刺术的次数，将颞下颌关节（TMJ）内部紊乱（ID）患者分为三组。FD 分析是一种定量概念，提供有关小梁骨微观结构的信息。在术前（T0）和术后第 6 个月（T1），从右侧和左侧髁突关节表面附近的骨区域的全景片上选择感兴趣区域，然后计算 FD 值。所有图像均由同一位研究人员进行评估。采用双因素重复测量方差分析来确定组间、治疗侧和时间对 FD 值是否存在显著交互作用。共纳入 140 例患者，其中 118 例接受双侧 HA 关节内注射关节穿刺术，22 例为对照组。随机选择 20 例患者的图像在 2 周后重新评估。相关性分析结果显示，两次测量无显著差异（P>0.05）。FD 值的时间主效应显著[F（1，136）=157.879，P<0.001]。时间与组间的交互作用效应显著，使这一效应具有显著性[F（3，136）=18.533，P<0.001]。所有治疗组在 T0 到 T1 时间点右侧和左侧 FD 值的均值均显著增加（所有 P<0.001），而对照组右侧和左侧 FD 值在 T0 到 T1 时间点的变化无统计学意义（P=0.164 和 P=0.557）。在 HA 关节内注射关节穿刺术后，所有治疗组的下颌髁突的 FD 值随时间增加。TMJ ID 患者可能存在影像学可检测的退行性改变和髁突异常。FD 分析方法提供定量数据，建议作为口腔颌面外科医生在进行放射学检查时的辅助和指导，应与临床检查相结合，以跟踪 HA 关节内注射后髁突的微观结构变化。
