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关于内盘错乱的病理过程的信息。对280例327个关节进行了TMJ X线摄片。关节造影发现关节盘运动异常222个(67.9%)。其中前移位未复位155个关节(69.8%)，前移位合并复位57个关节(25.7%)，关节不协调8个关节(3.6%)，后移位合并复位2个关节(0.9%)。关节盘畸形81个，占24.8%。诊断：穿孔破裂56个关节(69.1%)，粘连18个关节(22.2%)，厚度异常7个关节(8.6%)。在局麻下或全身麻醉下采用外侧入路，关节镜下置入上关节间隙检查。关节镜下表现为间隙变窄、多动症、纤维性肿块和椎间盘穿孔…。更多的挑战。关节镜下可见18个关节出现纤维粘连，分别为纤维带从前囊到内侧壁，折叠盘与前附着体紧密接触，滑膜内有纤维条。对先前开发的彩色X射线CT图像处理系统进行了改进，使其能够从X射线CT扫描仪的一系列原始轴向扫描数据重建出冠状面、矢状面和斜面处理的三维图像。彩色重建的TMJ骨和软组织图像清晰，各种软组织如肌肉和脂肪组织易于区分。然而，双对比CT数据不适用于彩色重建图像。本研究显示矢状位扫描图像表现为典型的髁状突畸形和盘前移位。本研究显示的是有椎间盘前内侧移位的冠状扫描图像。以前我们的研究描述了退行性改变(弹性蛋白减少或丢失)、动脉壁增厚和内部排列紊乱的盘中钙化的存在。对10个经手术切除的TMJ椎间盘进行组织病理学观察。本研究结果显示，腰椎间盘中央后部有退行性改变，后腰带内血管增多。较少

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