Evaluation of the position, mobility, and morphology of the disc by MRI before and after four different treatments for temporomandibular joint disorders
Evaluation of the position, mobility, and morphology of the disc by MRI before and after four different treatments for temporomandibular joint disorders
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DOI：
10.1259/dmfr/25020275
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发表时间：
2006-03-01
影响因子：
3.3
通讯作者：
Miyamoto, Y
中科院分区：
文献类型：
--
作者：
Ohnuki, T;Fukuda, M;Miyamoto, Y
目的：本研究的目的是利用磁共振成像（MRI）评估四种不同治疗方法（夹板治疗、pUrnpill手法、关节穿刺和关节镜手术）对颞下颌关节疾病（TMD）患者椎间盘位置、活动度和形态的变化。方法：85例成功治疗的单侧关节紊乱或骨关节炎患者共85个关节。将患者分为四组：夹板治疗组、泵操作组、关节穿刺组、关节镜手术组。通过MRI比较四组治疗前后椎间盘位置、活动度和形态的变化。结果：所有椎间盘均出现前椎间盘移位（ADD），治疗前未复位。只有10%的关节在治疗后出现了多动症，但病情有所减轻，而其他关节在治疗后仍然没有好转。与术前相比，关节镜手术后椎间盘的位置更靠前。治疗前MRI显示，椎间盘卡滞率随治疗阶段的进展而增加。在治疗后的MRI中，所有颞下颌关节（TMJs）均有活动椎间盘。椎间盘畸形在关节穿刺和关节镜手术后加重。结论：虽然经治疗后临床症状和体征得到缓解，但大部分椎间盘在MRI上仍保持ADD，未见减少。这表明，这四种治疗方法并不一定能改善椎间盘的位置和畸形，关节镜手术会加剧椎间盘的畸形和前移位。椎间盘活动对改善临床症状和体征很重要。
Objectives: The purpose of this study was to evaluate changes in disc position, mobility, and morphology in patients with temporomandibular joint disorders (TMD) in response to four different treatments, splint therapy, pUrnpill- Manipulation, arthrocentesis, and arthroscopic surgery, using magnetic resonance imaging (MRI).Methods: Eighty-five joints (85 patients) with unilateral internal derangement or osteoarthritis that were successfully treated were included in this Study. The patients were divided into four groups as follows: splint therapy group, pumping manipulation group, arthrocentesis group, and arthroscopic Surgery group. Changes in the disc position, mobility, and morphology before and after treatment were compared among the four groups using MRI.Results: All discs showed anterior disc displacement (ADD) Without reduction before treatment. Only 10% of the joints became ADD with reduction after treatment, and the other joints remained ADD without reduction in spite of treatment. Discs treated by arthroscopic surgery were located more anteriorly compared with pre-treatment. In pre-treatment MRI, the rate of stuck disc increased as the stage of the treatment advanced. In post-treatment MRI, all temporomandibular joints (TMJs) had mobile discs. The disc deformity advanced after arthrocentesis and arthroscopic surgery.Conclusions: Even though clinical signs and symptoms were alleviated by treatment, most discs remained ADD without reduction on MRI in spite of treatment. This suggests that the four treatments do not necessarily improve the position and deformity of the disc, and that arthroscopic surgery advances the deformity and anterior displacement of the disc. Disc mobility is important for improving clinical signs and symptoms.