颞下颌关节紊乱病患者关节盘与髁突距离的定量分析研究

doi:10.3969/j.issn.1674-8115.2025.06.003

上海交通大学学报（医学版） ›› 2025, Vol. 45 ›› Issue (6): 684-692.doi: 10.3969/j.issn.1674-8115.2025.06.003

颞下颌关节紊乱病患者关节盘与髁突距离的定量分析研究

孙磊¹^,²(), 戴世锋¹, 陈裕华¹, 许新怡², 姜克乐³, 李筱文², 李承靖², 吴婷婷¹

^1.安徽医科大学口腔医学院，安徽医科大学附属口腔医院，安徽省口腔疾病研究重点实验室，合肥 230032
^2.安徽医科大学第二附属医院口腔科，合肥 230601
^3.安徽医科大学公共卫生学院流行病与卫生统计学系，合肥 230601

收稿日期:2025-01-13 接受日期:2025-04-03 出版日期:2025-06-28 发布日期:2025-06-28
通讯作者: 孙磊（1984—），女，副教授，副主任医师，博士；电子信箱：sunlei@ahmu.edu.cn。
基金资助:
安徽省自然科学基金(2308085MH264)

Quantitative analysis of the distance between articular disc and condyle in patients with temporomandibular disorders

SUN Lei¹^,²(), DAI Shifeng¹, CHEN Yuhua¹, XU Xinyi², JIANG Kele³, LI Xiaowen², LI Chengjing², WU Tingting¹

^1.College & Hospital of Stomatology, Anhui Medical University; Key Laboratory of Oral Diseases Research of Anhui Province, Hefei 230032, China
^2.Department of Stomatology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
^3.Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230601, China

Received:2025-01-13 Accepted:2025-04-03 Online:2025-06-28 Published:2025-06-28
Contact: SUN Lei, E-mail: sunlei@ahmu.edu.cn.
Supported by:
Natural Science Foundation of Anhui Province(2308085MH264)

摘要/Abstract

摘要：

目的·通过颞下颌关节磁共振（magnetic resonance imaging，MRI）检查，评价颞下颌关节紊乱病（temporomandibular disorders，TMD）患者盘髁距离（关节盘与髁突距离）与关节盘前移位、关节盘形态相关指标之间的关系。方法·选取2023年9月至2024年3月于安徽医科大学第二附属医院口腔科颞下颌关节门诊就诊且临床上出现TMD症状且MRI判断为颞下颌关节盘前移位或无明显移位的90位患者，将其180个颞下颌关节纳入研究。采集患者的临床资料，通过MRI图像测量关节盘移位角度、盘髁距离、关节盘长度及厚度，判断关节盘变形程度，分析患者临床症状与关节盘前移位之间的关系、关节盘前移位与关节盘形态及盘髁距离的关系，以及盘髁距离与关节盘形态的关系。结果·90例患者中男性16例、女性74例，平均年龄（28.1±14.5）岁。在180个颞下颌关节中，有临床症状的关节175个，无症状关节5个；未移位关节盘40个，可复性前移位关节盘78个，不可复性前移位关节盘62个。不可复性前移位关节盘中出现2个及以上症状的关节比例略高，为62.9%，但与关节盘未移位以及可复性前移位的关节之间差异无统计学意义。通过MRI评估发现，不可复性前移位的关节盘较未移位关节盘变形程度Ⅲ型及以上的占比显著升高，关节盘长度显著缩短，中间带厚度显著增大，闭口和最大开口位时的关节盘移位角度显著增大（均P<0.001）。未移位、可复性前移位和不可复性前移位关节盘的盘髁距离分别为3.10（2.70，3.70）、3.40（3.00，4.00）和6.60（4.78，7.90）mm，差异具有统计学意义（P<0.001）；Ⅰ、Ⅱ、Ⅲ、Ⅳ/Ⅴ型关节盘的盘髁距离分别为3.10（2.80，3.60）、3.70（3.10，4.60）、5.10（4.00，7.30）、6.80（4.98，8.20）mm，差异具有统计学意义（P<0.001）；盘髁距离与关节盘长度呈负相关（r_s=-0.469，P<0.001），与关节盘中间带厚度呈正相关（r_s=0.319，P<0.001），与闭口位时关节盘移位角度呈正相关（r_s=0.626，P<0.001）。结论·随着颞下颌关节盘变形严重程度、中间带厚度、闭口位时前移位角度的增加，以及关节盘长度的缩短，盘髁距离增大；盘髁距离是MRI评估TMD病理改变的重要指标。

关键词: 颞下颌关节紊乱病, 磁共振成像, 颞下颌关节盘, 盘髁距离

Abstract:

Objective ·To evaluate the relationships between disc-condyle distance and anterior disc displacement, as well as between disc-condyle distance and disc morphology, in patients with temporomandibular disorders (TMD) using magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ). Methods ·From September 2023 to March 2024, 90 patients (180 TMJs) who visited the TMJ clinic of Department of Stomatology, The Second Affiliated Hospital of Anhui Medical University, with clinical symptoms of TMD and were diagnosed via MRI with either anterior disc displacement or no significant displacement, were included. Clinical data were collected, and MRI images were used to measure the angle of disc displacement, disc-condyle distance, disc length, and thickness. The degree of disc deformation was assessed. The relationships between clinical symptoms and anterior disc displacement, between anterior disc displacement and both disc morphology and disc-condyle distance, and between disc-condyle distance and disc morphology were analyzed. Results ·Among the 90 patients, there were 16 males and 74 females, with a mean age of (28.1±14.5) years. Among the 180 TMJs, 175 had clinical symptoms and 5 were asymptomatic. There were 40 joints with no displacement, 78 with reducible anterior disc displacement, and 62 with irreducible anterior disc displacement. In the joints with irreducible anterior disc displacement, the proportion of those with two or more symptoms was slightly higher at 62.9%, but the difference was not statistically significant compared with the joints with no displacement or reducible anterior disc displacement. MRI assessment revealed that in the joints with irreducible anterior disc displacement, the proportion of disc deformation type Ⅲ or higher was significantly higher compared with the non-displaced joints (P<0.001). The disc length was significantly shorter (P<0.001), and the intermediate zone thickness was significantly greater (P<0.001) compared with the non-displaced joints. The disc displacement angles at centric closure and maximum opening were also significantly larger (P<0.001). The disc-condyle distance was 3.10 (2.70, 3.70) mm for non-displaced joints, 3.40 (3.00, 4.00) mm for joints with reducible anterior disc displacement, and 6.60 (4.78, 7.90) mm for joints with irreducible anterior disc displacement, with significant differences (P<0.001). The disc-condyle distance was 3.10 (2.80, 3.60) mm for type Ⅰ discs, 3.70 (3.10, 4.60) mm for type Ⅱ discs, 5.10 (4.00, 7.30) mm for type Ⅲ discs, and 6.80 (4.98, 8.20) mm for type Ⅳ/Ⅴ discs, with significant differences (P<0.001). The disc-condyle distance was negatively correlated with disc length (r_s=-0.469, P<0.001), positively correlated with intermediate zone thickness (r_s=0.319, P<0.001), and positively correlated with disc displacement angle at centric closure (r_s=0.626, P<0.001). Conclusion ·With increasing severity of disc deformation, intermediate zone thickness, and disc displacement angle at centric closure, as well as decreasing disc length, the disc-condyle distance increases. The disc-condyle distance is an important indicator for MRI assessment of pathological changes in TMD.

Key words: temporomandibular disorders (TMD), magnetic resonance imaging (MRI), temporomandibular joint disc, disc-condyle distance

中图分类号:

R782.6

孙磊, 戴世锋, 陈裕华, 许新怡, 姜克乐, 李筱文, 李承靖, 吴婷婷. 颞下颌关节紊乱病患者关节盘与髁突距离的定量分析研究[J]. 上海交通大学学报（医学版）, 2025, 45(6): 684-692.

SUN Lei, DAI Shifeng, CHEN Yuhua, XU Xinyi, JIANG Kele, LI Xiaowen, LI Chengjing, WU Tingting. Quantitative analysis of the distance between articular disc and condyle in patients with temporomandibular disorders[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(6): 684-692.

图/表 8

图1 MRI阅片时的定位平面Note： PDWI images. A. Axial plane. l1—the transverse axis of the condyle (the line connecting the internal and the external poles of the condyle); l2—the positioning plane perpendicular to the condylar transverse axis. B. Oblique sagittal plane. a—condyle; b—articular disc; c—lateral pterygoid muscle.

Fig 1 Positioning planes for MRI image reading

图2 MRI影像中正常的盘髁位置关系Note： Oblique sagittal PDWI images. A. Closed-mouth position. B. Open-mouth position. a—condyle; b—articular disc; c—articular eminence.

Fig 2 Normal disc-condyle relationship in MRI images

图3 关节盘移位角度的测量Note： An oblique sagittal PDWI image. l1—the line connecting the articular eminence and the vertex of the posterior tubercle; O—the midpoint of the intersection of line l1 with the condyle; l2—the perpendicular line to l1 through point O; l3—the line connecting the posterior edge of the articular disc with point O; α—the angle between l2 and l3, which is the angle of disc displacement.

Fig 3 Measurement of articular disc displacement angle

图4 盘髁距离及关节盘长度的测量Note： An oblique sagittal PDWI image. A—the midpoint of the anterior edge of the anterior band of the articular disc; B—the midpoint of the intermediate zone of the articular disc; C—the midpoint of the posterior edge of the posterior band of the articular disc; y—the long axis of the condylar head; D—the intersection of y-axis with the condyle; AB+BC—the length of the articular disc; CD—the disc-condyle distance.

Fig 4 Measurement of disc-condyle distance and articular disc length

图5 颞下颌关节盘厚度测量Note： An oblique sagittal PDWI image. a—anterior band thickness; b—intermediate zone thickness; c—posterior band thickness.

Fig 5 Measurement of articular disc thickness

图6 关节盘变形程度分型Note： Oblique sagittal PDWI images. Typical articular disc morphology of type Ⅰ‒Ⅴ.

Fig 6 Classification of articular disc deformation degrees

表1 关节盘前移位与临床症状之间的关系

Tab 1 Relationship between clinical symptoms and anterior disc displacement

Disc displacement	Asymptomatic	With one symptom	With two or more symptoms	P value
No disc displacement/n(%)	1 (2.5)	21 (52.5)	18 (45.0)	0.115
Anterior disc displacement with reduction/n(%)	3 (3.8)	43 (55.1)	32 (41.0)
Anterior disc displacement without reduction/n(%)	1 (1.6)	22 (35.5)	39 (62.9)

表2 不同关节盘前移位状态下关节盘形态及盘髁距离的差异

Tab 2 Differences in disc morphology and disc-condyle distance under different anterior disc displacement states

Item	No displacement	Anterior disc displacement with reduction	Anterior disc displacement without reduction	P value
Type/n(%)				<0.001
Ⅰ	24 (60)	36 (46.2)^①	5 (8.1)^①②
Ⅱ	16 (40)	29 (37.2)	9 (14.5)
Ⅲ	0 (0)	9 (11.5)	14 (22.6)
Ⅳ/Ⅴ	0 (0)	4 (5.1)	34 (54.8)
Disc length/mm	9.41±1.40	9.64±1.79	6.46±1.61^①②	<0.001
Disc thickness/mm
Anterior band	2.40 (2.00, 2.60)	2.20 (2.10, 2.63)	2.30 (2.08, 2.73)	0.759
Intermediate band	0.90 (0.80, 0.90)	0.90 (0.80, 1.00)	1.00 (0.90, 1.20)^①③	<0.001
Posterior band	2.95 (2.80, 3.08)	2.90 (2.70, 3.00)	2.90 (2.60, 3.23)	0.648
Displacement angle/(°)
Closed-mouth position	8.75 (0.69, 11.03)	25.74 (18.83, 56.24)^①	95.97 (85.86, 106.36) ^①②	<0.001
Maximum opening position	-65.32 (-81.38, -41.68)	-51.56 (-77.58, -33.09)	79.62 (64.11, 88.44)^①②	<0.001
Disc-condyle distance/mm	3.10 (2.70, 3.70)	3.40 (3.00, 4.00)	6.60 (4.78, 7.90)^①②	<0.001

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颞下颌关节紊乱病患者关节盘与髁突距离的定量分析研究

Quantitative analysis of the distance between articular disc and condyle in patients with temporomandibular disorders

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