不同关节盘状态下的颞下颌关节紊乱病患者发生退行性关节病的风险评估分析

doi:10.13591/j.cnki.kqyx.2024.04.002

摘要/Abstract

摘要：

目的本研究探讨不同关节盘状态下颞下颌关节紊乱病(temporomandibular disorder diseases,TMD)患者发生退行性关节病(degenerative joint diseases,DJD)的风险及严重程度。方法 78例TMD患者共156个颞下颌关节,基于MRI图像被分为3组:正常关节盘位置、可复性关节盘前移位(anterior disc displacement with reduction,ADDR)和不可复性关节盘前移位(anterior disc displacement without reduction,ADDNR)。CBCT或CT图像用于诊断DJD及评估髁突骨质变化严重程度。通过Logistic回归估计不同关节盘状态下DJD发生的OR(odds ratio),通过最小二乘法回归估计不同关节盘状态下髁突骨质改变严重程度的回归系数。结果与正常关节盘位置相比,ADDR组、ADDNR组发生DJD的OR分别为4.652(P<0.001)、16.739(P<0.001)。ADDR组髁突骨质缺损的回归系数为0.646(P<0.001)。ADDNR组髁突囊变、骨质缺损、骨赘形成、髁突变平、骨质硬化的回归系数分别为0.241(P<0.05)、1.486(P<0.001)、0.759(P<0.001)、0.566(P<0.001)、0.381(P<0.05)。结论 TMD患者中ADDR及ADDNR均与DJD的发生有关,ADDNR较ADDR发生DJD的风险更高,ADDNR髁突骨质改变的程度较ADDR严重。

关键词: 颞下颌关节紊乱病, 锥形束CT, CT, MRI, 退行性关节病

Abstract:

Objective To investigate the risk and severity of degenerative joint diseases(DJD)in patients with temporomandibular disorder diseases(TMD) under different joint disc states. Methods A total of 156 temporomandibular joints in 78 TMD patients were divided into three groups based on MRI images: normal disc position, anterior disc displacement with reduction(ADDR) and anterior disc displacement without reduction(ADDNR). CBCT or CT images were used to diagnose DJD and assess the severity of condylar bone changes. The OR value of DJD under different joint disc states was estimated by Logistic regression, and the regression coefficient of the severity of condylar bone changes under different joint disc states was estimated by ordinary least square regression. Results Compared with the normal disc position, the OR value of DJD in ADDR group and ADDNR group were 4.652(P<0.001), 16.739(P<0.001), respectively. The regression coefficient for condylar erosion in the ADDR group was 0.646(P<0.001). The regression coefficients for condylar cysts, condylar erosion, condylar osteophytes, condylar flattening, condylar bone sclerosis of ADDNR group were 0.241(P<0.05), 1.486(P<0.001), 0.759(P<0.001), 0.566(P<0.001), 0.381(P<0.05). Conclusion ADDR and ADDNR are associated with the occurrence of DJD in TMD patients, and the risk of DJD is higher in ADDNR than in ADDR. The degree of condylar bone changes in ADDNR is more serious than that of ADDR.

Key words: temporomandibular joint disorder, CBCT, CT, MRI, degenerative joint disease

中图分类号:

R782.6

陶星星, 王继周, 陈佩瑶, 马思维. 不同关节盘状态下的颞下颌关节紊乱病患者发生退行性关节病的风险评估分析[J]. 口腔医学, 2024, 44(4): 245-249.

TAO Xingxing, WANG Jizhou, CHEN Peiyao, MA Siwei. Risk assessment and analysis of degenerative joint diseases in patients with temporomandibular disorder diseases under diffe-rent joint disc states[J]. Stomatology, 2024, 44(4): 245-249.

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分组	非DJD	DJD	P
年龄组			0.7
≤18岁	20(28.2%)	26(30.6%)
>18岁	51(71.8%)	59(69.4%)
性别			0.5
女	50(70.4%)	64(75.3%)
男	21(29.6%)	21(24.7%)

关节盘状态	OR	OR的95%可信区间
正常关节盘状态vs.ADDR	4.652^***	[2.191,10.270]
正常关节盘状态vs.ADDNR	16.739^***	[5.199,75.634]

关节盘状态	囊变	骨质缺损	骨赘形成	髁突变平	骨质硬化
正常关节盘状态vs.ADDR
回归系数	0.122	0.646^***	0.170	0.168	0.137
95%可信区间	[-0.041,0.284]	[0.317,0.975]	[-0.120,0.460]	[-0.093,0.428]	[-0.113,0.387]
正常关节盘状态vs.ADDNR
回归系数	0.241^*	1.486^***	0.759^***	0.566^***	0.381^*
95%可信区间	[0.040,0.442]	[1.081,1.891]	[0.402,1.115]	[0.245,0.886]	[0.074,-0.689]