Co-operative Study on the Pathologic Process of the Articular Disk in Patients with Internal Derangements of the Temporomandibular Joint

本研究的目的是获得更多的病理过程在磁盘内部紊乱的信息。对280例患者的327个关节进行了TMJ透视。关节造影结果显示222个关节（67.9%）出现关节盘运动异常。诊断为无复位前移位155个（69.8%），复位前移位57个（25.7%），不协调8个（3.6%），复位后移位2个（0.9%）。椎间盘畸形81例（24.8%）。诊断为穿孔破裂56例（69.1%），粘连18例（22.2%），厚度异常7例（8.6%）。在局麻或全身麻醉下采用外外侧入路，将关节镜置入上关节间室，观察结果。关节镜下表现为间隙狭窄、充血、纤维团块和椎间盘穿孔。关节镜下观察到18个关节纤维粘连，纤维带由前囊至内侧壁上下延伸，折叠盘与前附着体紧密接触，纤维棒位于滑膜内间隙。改进了先前开发的彩色x射线CT图像处理系统，从x射线CT扫描仪的一系列原始轴向扫描数据中重建冠状、矢状和斜向处理的三维图像。彩色重构的TMJ骨组织和软组织图像清晰，各种软组织如肌肉组织和脂肪组织易于区分。然而，双对比关节CT数据不适合彩色重构图像。本研究显示矢状面扫描图像显示典型的髁突畸形和椎间盘前移位。本研究显示了椎间盘前内侧移位的冠状位扫描图像。以前我们的研究描述了退行性改变（弹性蛋白减少或丧失）、动脉壁增厚和内部紊乱椎间盘钙化的存在。对10例切除的颞下颌关节椎间盘行椎间盘切除术后的组织病理学观察。本研究结果显示椎间盘后部中央发生退行性改变，后带血管量增加。少

The purpose of this study is to gain more information about pathologic process in the disks of internal derangements. TMJ fluorarthorography on 327 joints in 280 patients were performed.1. Arthrographic results showed that abnormal disk movements were found in 222 joints (67.9%). These diagnosis were as follows, anterior displacement without reduction was 155 joints (69.8%), anterior displacement with reduction was 57 joints (25.7%), incoordination was 8 joints (3.6%) and posterior displacement with reduction was 2 joints (0.9%). Disk deformity were found in 81 joints 24.8%). These diagnosis were as follows, perforation and rupture were 56 joints (69.1%), adhesion was 18 joints (22.2%) and abnormal thickness was 7 joints (8.6%).2. Inferolateral approach method was used under local or general anesthesia, arthroscope was inserted to upper joint compartment and examined the findings. Arthroseopic findings were narrowing of the space, hyperemid, existence of fibrous mass and discal perfora … More tion. Arthroseopic finding of fibrous adhesion was observed in 18 joints, those were fibrous band running up to down from anterior pouch to medial wall, close contact between folded disk and anterior attachment, and fibrous bar in the intra-synovial space.3. The Color X-ray CT images processing system developed previously was improved to reconstruct three-dimensional images of coronal, sagittal, and oblique processing from a series of original axial scan data of the X-ray CT scanner. The color-reformatted images reconstructed for TMJ bone and soft tissues clearly and various soft tissues such as muscular and fatty tissues are easily distinguishable. However, the double contrast arthrographic CT data is not suitable for color- reformatted image reconstruction. This study shows the sagittal scan image with typical deformity of the condyle and anterior displacement of disk was demonstrated. This study shows the coronal scan image with anteromedial displacement of disk.4. Former our study described the presence of degenerative changes (decreased or loss of elastin), thickened arterial wall and calcification in the disks of internal derangements. Histopathological observation was examined 10 resected TMJ disks under diskectomy. Results of this study demonstrate degenerative changes in the central posterior part of the disks, and increased amount of vascularity in the posterior band. Less