磁共振成像在无髁突骨折的颞颌关节即刻损伤中的诊断价值

张莉; 岳梨蓉; 王睿; 陈涌; 岳万远; 丁昱

doi:10.12259/j.issn.2095-610X.S20211228

磁共振成像在无髁突骨折的颞颌关节即刻损伤中的诊断价值

doi: 10.12259/j.issn.2095-610X.S20211228

张莉¹,
岳梨蓉^2, ,,
王睿¹,
陈涌^1, ,,
岳万远¹,
丁昱¹

1.
云南省第二人民医院口腔医学中心
2.
放射科，云南昆明　650021

基金项目: 云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目（2015FB077）；中华口腔医学会口腔临床科研基金资助项目（CSA-W2019-11）；云南省科技人才和平台计划基金资助项目（2017TC025）

详细信息

作者简介:
张莉（1968～），女，云南通海人，医学学士，主任医师，主要从事口腔颌面外科临床工作。王睿与张莉对本文有同等贡献

通讯作者:
岳梨蓉， E-mail：461846392@qq.com

陈涌，E-mail：yncy168@yahoo.com.cn

中图分类号: R782.4
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出版历程
- 收稿日期: 2021-09-06
- 网络出版日期: 2021-11-17
- 刊出日期: 2021-12-15

Diagnostic Value of Magnetic Resonance Imaging in Immediate Injury of Temporomandibular Joint Without Condylar Fracture

Li ZHANG¹,
Li-rong YUE^{2
, ,},
Rui WANG¹,
Yong CHEN^{1
, ,},
Wan-yuan YUE¹,
Yu DING¹

1.
Stomatology Center
2.
Dept. of Radioligy，The Second People’s Hospital of Yunnan Province，Kunming Yunnan 650021，China

摘要

摘要: 目的探讨磁共振成像（magnetic resonance imaging,MRI）在无髁突骨折的颞颌关节即刻损伤后的潜在诊断价值。方法选取云南大学附属医院口腔颌面外科2018年6月至2021年3月收治的无髁突骨折的颞下颌关节损伤患者36例，共72侧关节纳入研究。所有的患者锥形束CT结果均显示髁突及关节窝无骨折且伤后髁突表面骨质“完整”。患者伤前均无关节疾患，伤后均出现不同程度的关节区疼痛和张口受限及弹响，其中24例合并有面部及其他部位的骨折。通过MRI对纳入患者进行影像检查，并对结果进行分析。结果 MRI检查显示有关节48侧关节发生不同程度损伤，发生率为66.7%。损伤类型为骨髓水肿12侧（25%），关节盘后区损伤撕裂27侧（56.25%），关节盘移位33侧（68.75%）以及关节腔积血、积液36侧（75%）。关节盘后区损伤撕裂，关节盘移位，关节腔积血（积液）与骨髓水肿的发生率相比较，前3者发病率明显高于骨髓水肿，差异有统计学意义（ P < 0.05）。结论 MRI在无髁突骨折的颞颌关节即刻损伤后，能清楚的显示出关节软组织的损伤部位和类型。此外，在这些损伤中关节盘后区损伤撕裂，关节盘移位，关节腔积血（积液）与骨髓水肿的发生率相比较，前三者发生率明显高于骨髓水肿。MRI是无髁突骨折的颞颌关节即刻损伤后重要检查和评价手段。
- 磁共振成像(MRI) /
- 锥形束CT /
- 无髁突骨折 /
- 颞颌关节
Abstract: Objective To investigate the diagnostic value of MRI in immediate injury of temporomandibular joint without condylar fracture. Methods 36 patients with temporomandibular joint injury without condylar fracture treated in the Department of Oral and Maxillofacial Surgery of the Affiliated Hospital of Yunnan University from June 2018 to March 2021 were selected, with a total of 72 joints included in the study. Cone beam CT results of all patients showed that there was no fracture of condyle and articular fossa, and the bone on the surface of condyle was “complete” after injury. All patients had no history of joint diseases. After injury, they had varying degrees of joint pain, limited opening and popping. Among them, 24 cases were complicated with fractures of face and other parts. The included patients were examined by MRI, and the results were statistically analyzed. Results MRI showed that 48 joints had different degrees of injury, and the incidence was 66.7%. The injury types included 12 joints with bone marrow edema （25%）, 27 joints with posterior disc tear （56.25%）, 33 joints with disc displacement （68.75%）, and 36 joints with joint cavity hematocele and effusion （75%）. The incidence of posterior disc disruption, disc displacement, and intraarticular blood accumulation （bone effusion） were significantly higher than those of bone marrow edema（ P ＜0.05）. Conclusion MRI can clearly show the location and type of injury of joint soft tissue after immediate injury of temporomandibular joint without condylar fracture. In addition, in these injuries, the incidence of posterior disc tear, disc displacement, joint cavity hematocele （effusion） was significantly higher than that of bone marrow edema. MRI is an important examination and evaluation method after immediate injury of temporomandibular joint without condylar fracture.
- Magnetic resonance imaging （MRI） /
- Cone beam CT /
- No condylar fracture /
- Temporomandibular joint

HTML全文

图 1 髁突骨髓水肿

白色箭头为水肿处。

Figure 1. Marrow edema of condyle

下载: 全尺寸图片幻灯片

图 2 关节盘后区损伤撕裂

白色箭头为损伤撕裂区域。

Figure 2. Laceration in the posterior area of the articular disc

下载: 全尺寸图片幻灯片

图 3 关节上下腔积液

黑色箭头为关节腔积液。

Figure 3. Joint effusion

下载: 全尺寸图片幻灯片

图 4 关节盘移位

黑色箭头为移位的关节盘。

Figure 4. Disc displacement

下载: 全尺寸图片幻灯片

表 1 患者的基本资料

Table 1. Basic information of the patients

项目	性别		致伤因素				面部相关损伤
项目	男	女	摔伤	车祸	运动	高坠伤	伴有颏部裂伤或下颌正中骨折	全面部骨折	同侧颧骨颧弓骨折	同侧耳区鼓板骨折，外耳道出血
病例数（n）	21	15	12	12	9	3	27	3	3	3
构成比（%）	58.33	41.67	33.33	33.33	25.00	8.33	75.00	8.33	8.33	8.33

下载: 导出CSV

表 2 颞下颌关节即刻损伤的MRI评价

Table 2. MRI evaluation of immediate injury of temporomandibular joint

MRI评价	损伤侧数（侧）	发生率（%）
骨髓水肿（A）	12/48	25.00
关节盘后区损伤撕裂（B）	27/48	56.25^*
关节盘移位（C）	33/48	68.75^*
关节腔积血（液）（D）	36/48	75.00^*
与A组比较，^*P < 0.05。

下载: 导出CSV

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