Mejersjö C
Swed Dent J Suppl. 1984;22:1-58.
The purpose of this thesis was to investigate the long-term development of signs and symptoms in patients with temporomandibular joint (TMJ) pain/dysfunction after treatment, to analyse factors of importance for the long-term prognosis, to evaluate TMJ radiography in these disorders and to develop a model for experimental joint lesions where also the effects of intra-articular injections of corticosteroid and hyaluronic acid in such joint lesions were studied. Signs and symptoms of dysfunction in the patients treated for TMJ pain/dysfunction were few at the follow-up and significantly reduced compared with the findings at the start of treatment. Less than one fifth of the patients had had recurrent symptoms of some significance. Poor general health was found to have a negative influence on the prognosis. Few correlations were found between occlusal factors and dysfunction. In patients with extremely long periods of treatment psychosocial factors were evident. The long-term prognosis of TMJ osteoarthrosis was as good as for neuromuscular problems but crepitation often persisted at the follow-up. Radiographic abnormalities of structure and shape of the TMJ generally of a small extent were frequent in patients with TMJ pain/dysfunction both in those examined during the treatment period and in those only radiographed at the follow-up. Findings were frequent also in patients treated for mainly mandibular (neuromuscular) dysfunction. At the follow-up a slight increase in number and extent of abnormalities were found. Signs and symptoms of dysfunction showed poor correlation with the radiographic findings. Decreased number of occluding pair of teeth, as well as crepitation, was however positively correlated to abnormalities of structure and shape. The intra-articular injection of papain in guinea-pig knee-joints constantly resulted in development of joint lesions with individual variations. Treatment of such joint lesions with corticosteroid and hyaluronic acid had little influence on the overall lesions, but the results indicate that hyaluronic acid inhibit granulation tissue formation and development of deviation in shape of the joint components.
本论文的目的是研究颞下颌关节（TMJ）疼痛/功能障碍患者治疗后体征和症状的长期发展情况，分析对长期预后具有重要意义的因素，评估这些疾病中TMJ的影像学表现，并建立一个实验性关节损伤模型，同时研究关节内注射皮质类固醇和透明质酸对此类关节损伤的影响。接受TMJ疼痛/功能障碍治疗的患者在随访时功能障碍的体征和症状较少，与治疗开始时的表现相比显著减轻。不到五分之一的患者有具有一定意义的复发症状。发现总体健康状况不佳对预后有负面影响。咬合因素与功能障碍之间几乎没有相关性。在治疗时间极长的患者中，社会心理因素较为明显。TMJ骨关节炎的长期预后与神经肌肉问题一样好，但随访时弹响常常持续存在。TMJ疼痛/功能障碍患者中，TMJ结构和形状的影像学异常通常程度较小，在治疗期间接受检查的患者以及仅在随访时进行影像学检查的患者中均很常见。主要接受下颌（神经肌肉）功能障碍治疗的患者中也经常出现这些表现。随访时发现异常的数量和程度略有增加。功能障碍的体征和症状与影像学表现的相关性较差。然而，咬合牙对数量减少以及弹响与结构和形状异常呈正相关。在豚鼠膝关节内注射木瓜蛋白酶会持续导致关节损伤的发生，且存在个体差异。用皮质类固醇和透明质酸治疗此类关节损伤对整体损伤影响不大，但结果表明透明质酸可抑制肉芽组织形成以及关节部件形状偏差的发展。
