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[关节盘前移位对颞下颌关节骨结构关系影响的三维成像研究]

[A three-dimensional imaging study of the effect of anterior disc displacement on the bony structural relationship of the temporomandibular joint].

作者信息

Liu X, Li C X, Gong Z C, Ma Y Y, Tuersun Saibinuer

机构信息

Department of Oral and Maxillofacial Oncology & Surgery, the First Affiliated Hospital of Xinjiang Medical University, School and Hospital of Stomatology, Xinjiang Medical University, Stomatological Research Institute of Xinjiang Uygur Autonomous Region, Urumqi 830054, China.

出版信息

Zhonghua Kou Qiang Yi Xue Za Zhi. 2024 Feb 9;59(2):157-164. doi: 10.3760/cma.j.cn112144-20230718-00015.

Abstract

To investigate the correlation between the osseous structure of temporomandibular joint (TMJ) and three different status of anterior disc location, so that it could guide the clinical diagnosis further. Fifty-two patients [46 females and 6 males, with an age of (27.8±8.3) years] who treated with MRI and cone beam CT, were recruited from the Temporomandibular Joint Specialist Clinic, The First Affiliated Hospital of Xinjiang Medical University, between March 2018 to December 2021. According to the radiographic findings of the level of anterior disc displacement (ADD) in TMJ, patients were divided into three groups: normal articular disc position (NADP, =28 TMJs), anterior disc displacement with reduction (ADDWR, =28 TMJs), and anterior disc displacement without reduction (ADDWoR, =28 TMJs). In the light of the reconstructed three-dimensional model, ten representative morphological parameters including condylar volume (CV), condylar superficial area (CSA), fossa volume (FV), fossa superficial area (FSA), the proportion of the condylar volume in the articular fossa (CV%), the proportion of the condylar superficial area in the articular fossa (CSA%), superior joint space (SJS), anterior joint space (AJS), posterior joint space (PJS), and medial joint space (MJS), were measured respectively under one-way analysis of variance (ANOVA), Kruskal-Wallis test and receiver operator characteristic curve(ROC curve) analyses. CV and CSA values varied significantly in the pathological progression from normal location to irreversible anterior displacement in TMJ. For CV value, NADP group [(1 834.90±667.67) mm]>ADDWR group [(1 747.34±369.42) mm]>ADDWoR group [(1 256.29±418.27) mm] [=4.31, <0.001; =3.66, <0.001], for CSA value, NADP group [(859.27±216.01) mm]>ADDWR group [(838.23±118.82) mm]>ADDWoR group [(669.14±150.26) mm] [=4.27, <0.001; =3.80, <0.001]. The difference of SJS value in NADP group [(2.22±0.88) mm], ADDWR group [(1.94±0.64) mm] and ADDWoR group [(1.45±0.57) mm], was statistically significant [=4.11, <0.001; =2.63, =0.010]. The results of MJS in NADP group [(5.03±1.41) mm], ADDWR group [(3.86±1.32) mm], and ADDWoR group [(4.91±1.65) mm] were significantly different [=3.00, =0.004; =2.63, =0.009]. As calculated by the ROC curve analysis, CV, CSA and SJS showed that (AUC=0.77, AUC=0.76; AUC=0.76) for the NADP and ADDWoR groups, and (AUC=0.80; AUC=0.80; AUC=0.72) for the ADDWR and ADDWoR groups. While the diagnostic accuracy of MJS for the comparison in NADP versus ADDWR and ADDWR versus ADDWoR was respectively AUC=0.73, and AUC=0.69. CV, CSA, SJS, and MJS were significantly associated with the different disc displacement status, and the condyle in TMJ ADD exhibited three-dimensionally altered dimensions. They could be considered as promising biometric markers to diagnose the ADD status.

摘要

探讨颞下颌关节(TMJ)骨结构与关节盘前移位三种不同状态之间的相关性,以进一步指导临床诊断。选取2018年3月至2021年12月在新疆医科大学第一附属医院颞下颌关节专科门诊接受MRI和锥形束CT检查的52例患者[46例女性,6例男性,年龄(27.8±8.3)岁]。根据TMJ中关节盘前移位(ADD)程度的影像学表现,将患者分为三组:关节盘位置正常(NADP,28个TMJ)、可复性关节盘前移位(ADDWR,28个TMJ)和不可复性关节盘前移位(ADDWoR,28个TMJ)。根据重建的三维模型,测量包括髁突体积(CV)、髁突表面积(CSA)、关节窝体积(FV)、关节窝表面积(FSA)、髁突体积在关节窝中的比例(CV%)、髁突表面积在关节窝中的比例(CSA%)、上关节间隙(SJS)、前关节间隙(AJS)、后关节间隙(PJS)和内侧关节间隙(MJS)在内的10个代表性形态学参数,分别进行单因素方差分析(ANOVA)、Kruskal-Wallis检验和受试者工作特征曲线(ROC曲线)分析。在TMJ从正常位置到不可逆前移位的病理进展过程中,CV和CSA值有显著变化。对于CV值,NADP组[(1834.90±667.67)mm]>ADDWR组[(1747.34±369.42)mm]>ADDWoR组[(1256.29±418.27)mm][F = 4.31,P < 0.001;F = 3.66,P < 0.001];对于CSA值,NADP组[(859.27±216.01)mm]>ADDWR组[(838.23±118.82)mm]>ADDWoR组[(669.14±150.26)mm][F = 4.27,P < 0.001;F = 3.80,P < 0.001]。NADP组[(2.22±0.88)mm]、ADDWR组[(1.94±0.64)mm]和ADDWoR组[(1.45±0.57)mm]的SJS值差异有统计学意义[F = 4.11,P < 0.001;F = 2.63,P = 0.010]。NADP组[(5.03±1.41)mm]、ADDWR组[(3.86±1.32)mm]和ADDWoR组[(4.91±1.65)mm]的MJS结果有显著差异[F = 3.00,P = 0.004;F = 2.63,P = 0.009]。通过ROC曲线分析计算,CV、CSA和SJS显示,NADP组与ADDWoR组比较时(AUC = 0.77,AUC = 0.76;AUC = 0.76),ADDWR组与ADDWoR组比较时(AUC = 0.80;AUC = 0.80;AUC = 0.72)。而MJS在NADP与ADDWR以及ADDWR与ADDWoR比较时的诊断准确性分别为AUC = 0.73和AUC = 0.69。CV、CSA、SJS和MJS与不同的关节盘移位状态显著相关,TMJ ADD中的髁突在三维尺寸上发生改变。它们可被视为诊断ADD状态的有前景的生物测量标志物。

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