【作者】 苏畅；

【导师】 李明贺；

【作者基本信息】 吉林大学 ， 口腔医学硕士（专业学位）， 2023， 硕士

【摘要】 目的:通过对大量颞下颌关节紊乱综合征(temporomandibular disorders,TMD)患者的磁共振成像(magnetic resonance imaging,MRI)图像进行定性及定量的综合评估,筛选出关节盘前移位(anterior disc displacement,ADD)的危险因素,指导临床的诊断与治疗。方法:纳入了504例TMD患者,共计1008侧颞下颌关节(temporomandibular joint,TMJ),对所有TMJ的MRI图像进行以下评估:(1)关节盘长度;(2)关节盘形态:依据关节盘畸形及折叠程度分为Ⅰ型、Ⅱ型、Ⅲ型、Ⅳ型及Ⅴ型;(3)髁突高度:采用下颌支平面(ramal plane,RP)法进行测量;(4)髁突形态:分为卵圆形、扁平形、角形及鸟嘴形;(5)髁突位置:分为前位、中立位及后位;(6)关节结节形态:分为箱形、C形、扁平形及不规则形。根据开口位及闭口位时关节盘的位置是否前移分为正常关节盘位置(normal articular disc position,NADP)组、可复性盘前移位(anterior disc displacement with reduction,ADDWR)组及不可复性盘前移位(anterior disc displacement without reduction,ADDWo R)组。采用单因素分析比较3组之间年龄、性别及各项评估指标的差异,将单因素分析后具有统计学意义的变量纳入多元Logistic回归分析,根据结果,筛选出ADD的危险因素。结果:1.504例TMD患者中80.16%(404例)为女性。患者的平均年龄为23.83±10.76岁,10-19岁及20-29岁的患者较多(占比分别为40.87%、39.48%)。2.单因素分析结果显示,3组之间年龄、性别、关节盘长度、关节盘形态、髁突高度、髁突形态、髁突位置及关节结节形态均有显著性差异。3.Logistic回归分析结果显示:(1)ADDWR相较于NADP而言:1)男性发生ADDWR的风险较女性显著升高;2)年龄与ADDWR之间不存在显著的统计学联系;3)关节盘越短,发生ADDWR的风险越高;4)与Ⅰ型关节盘相比,Ⅲ型、Ⅳ型、Ⅴ型发生ADDWR的风险显著升高;5)髁突高度与ADDWR之间不存在显著的统计学联系;6)与卵圆形髁突相比,角形发生ADDWR的风险显著升高;7)与中立位髁突相比,后位发生ADDWR的风险显著升高;8)与C形关节结节相比,箱形发生ADDWR的风险显著升高。(2)ADDWo R相较于NADP而言:1)男性发生ADDWo R的风险较女性显著升高;2)年龄与ADDWo R之间不存在显著的统计学联系;3)关节盘越短,发生ADDWo R的风险越高;4)与Ⅰ型关节盘相比,Ⅱ型、Ⅲ型、Ⅳ型、Ⅴ型发生ADDWo R的风险均显著升高;5)髁突高度越低,发生ADDWo R的风险越高;6)与卵圆形髁突相比,扁平形、角形及鸟嘴形发生ADDWo R的风险均显著升高;7)与中立位髁突相比,后位发生ADDWo R的风险显著升高;8)与C形关节结节相比,箱形及扁平形发生ADDWo R的风险显著升高。结论:1.TMD 10-29岁多见。2.相较于NADP,男性、关节盘长度短、Ⅲ型/Ⅳ型/Ⅴ型关节盘、角形髁突、后位髁突、箱形关节结节是ADDWR及ADDWo R的共同危险因素。3.相较于NADP,Ⅱ型关节盘、髁突高度低、扁平形/鸟嘴形髁突、扁平形关节结节是ADDWo R的危险因素。4.评估这些危险因素对预测ADD的发生有一定价值,可为临床早期干预提供依据。更多还原

【Abstract】 Purpose:To screen out the risk factors for ADD by evaluating MRI images of a large number of patients with TMD quantitatively and qualitatively,and guide clinical diagnosis and treatment..Methods:A total of 504 patients with TMD,including 1008 TMJs,were included.The results of MRI of all TMJs were evaluated as follows:(1)The length of articular disc;(2)The shape of articular disc: According to the deformity and folding degree of articular disc,it can be divided into type I,type II,type III,type IV and type V;(3)The height of condyle: The mandibular plane(RP)method was used to measure;(4)The morphology of condyle: oval,flat,angular and beak;(5)The condylar position: anterior position,neutral position and posterior position;(6)The morphology of articular eminence: box,C-shaped,flat and irregular.According to whether the position of the articular disc moves forward in the open position and the closed position,it is divided into NADP group,ADDWR group and ADDWo R group.Single factor analysis was used to compare the differences of age,sex and various evaluation indexes among the three groups,and the statistically significant variables after single factor analysis were included in multivariate logistic regression analysis.According to the results,the risk factors of ADD were screened out.Results:1.Among 504 TMD patients,80.16%(404 cases)were women.The average age of patients is 23.83±10.76 years old,and there are more patients aged 10-19 and 20-29 years old(accounting for 40.87% and 39.48% respectively).2.The results of univariate analysis showed that there were significant differences in age,sex,articular disc length,articular disc shape,condyle height,condyle shape,condyle position and articular eminence shape among the three groups.3.Logistic regression analysis shows that:(1)Compared with NADP,ADDWR: 1)The risk of ADWR in men is significantly higher than that in women;2)There is no significant statistical relationship between age and ADDWR;3)The shorter the articular disc,the higher the risk of ADDWR;4)Compared with type Ⅰ articular disc,the risk of ADDWR is significantly higher for typeⅢ,Ⅳ and Ⅴ;5)There is no significant statistical relationship between condyle height and ADDWR;6)Compared with oval condyle,the risk of angle-shaped ADDWR is significantly higher;7)Compared with neutral condyle,the risk of ADDWR in posterior position is significantly higher;8)Compared with C-shaped articular eminence,the risk of ADDWR is significantly higher for box-shaped joint.(2)Compared with NADP,ADDWo R: 1)The risk of ADDWo R in men is significantly higher than that in women;2)There is no significant statistical relationship between age and ADDWo R;3)The shorter the articular disc,the higher the risk of ADDWo R;4)Compared with type I articular disc,the risk of type II,type III,type IV and type V ADDWo R is significantly increased;5)The lower the height of condyle,the higher the risk of ADDWo R;6)Compared with oval condyle,the risk of ADDWo R in flat,angular and beak shape is significantly higher;7)Compared with the neutral condyle,the risk of ADDWo R in the posterior position is significantly higher;8)Compared with C-shaped articular eminence,the risk of box-shaped and flat-shaped articular eminence is significantly higher.Conclusions:1.TMD is common in 10-29 years old.2.Compared with NADP,male,short disc length,type Ⅲ/Ⅳ/Ⅴ disc,angular condyle,posterior condyle and box-shaped articular tubercle are the common risk factors for ADDWR and ADDWo R.3.Compared with NADP,type Ⅱ articular disc,low condyle height,flat/beakshaped condyle and flat articular eminence are the risk factors for ADDWo R.4.Evaluating these risk factors is valuable for predicting the risk of ADD,and can provide a basis for early clinical intervention.更多还原