46名青少年原發性關節炎患者顳下頜關節病的臨床及影像學表現

胡玉乾++薛冬++呂秀梅++藍仁剛++孫竹萍

[摘要] 目的 研究包含各型青少年原發性關節炎（JIA）亞型的一組患者顳下頜關節病發病情況、臨床和影像學表現。 方法 對46名JIA患者進行臨床風濕病學和正畸學評估。所有患者進行曲面斷層和頭顱側位檢查。研究顳下頜關節病的發病率與JIA亞型和疾病特點的相關性；頭顱側位片的測量結果與年齡和性別匹配的健康對照組進行比較。 結果 65%的JIA患者具有至少一個顳下頜關節炎的癥狀，78.3%的患者顯示出髁突的病損。髁突損傷的發病率與正畸學治療以及JIA亞型、疾病的活動期、JIA的嚴重程度及病程沒有相關性（P>0.05）。JIA患者的下頜平面角以及ANB角角度大，前面高，上下中切牙角及SNB角比較小。顱面部的改變與髁突病損直接相關（P<0.05）。結論 JIA患者的髁突損傷非常常見，髁突病損出現較早，輕微病損也能導致嚴重的顱面部形態的改變。通過本研究建議JIA患者應該進行早期和定期的正畸學及TMJ影像學檢查。

[關鍵詞] 青少年原發性關節炎（JIA）；顳下頜關節（TMJ）；下頜平面角；髁突

[中圖分類號] R782.6 [文獻標識碼] A [文章編號] 1673-9701（2017）03-0007-04

Clinical and imaging performance of temporomandibular joint disease in 46 young patients with juvenile idiopathic arthritis

HU Yuqian1 XUE Dong2 LV Xiumei1 LAN Rengang1 SUN Zhuping3

1.Department of Stomatology， School of Medicine， Liaodong College， Dandong 118002， China； 2.Dandong Yuqian Oral Clinic in Liaoning Province， Dandong 118002， China； 3.Department of Rheumatology， Dandong Central Hospital in Liaoning Province， Dandong 118002， China

[Abstract] Objective To study the incidence， clinical and radiographic manifestations of temporomandibular joint disease in a group of patients with subtypes of juvenile idiopathic arthritis（JIA）. Methods 46 patients with JIA were evaluated for clinical rheumatism and orthodontics. All patients underwent surface faults and head lateral examination. The relationship between the incidence of temporomandibular joint disease and JIA subtype and the characteristics of disease was analyzed. The measurement results between the contralateral lateral radiograph in the observation group and the age and sex matched healthy control group were compared. Results 65% of the patients with JIA had at least one symptom of temporomandibular arthritis，and 78.3% of patients showed condylar lesions. The incidence of condylar injury was not correlated with orthodontic treatment and JIA subtype， disease activity， severity of JIA and course of disease（P>0.05）. The angle of mandibular plane and ANB was big and the front is high in JIA patients. And also the angle of incision and SNB was small in JIA patients. Craniofacial changes were directly related to condylar lesions（P<0.05）. Conclusion Condylar injury in patients with JIA is very common， and condylar lesions occur at early stage and mild lesions can lead to severe changes in craniofacial morphology. JIA patients should be recommended for early and regular orthodontics and TMJ imaging examinations.

[Key words] Juvenile idiopathic arthritis（JIA）； Temporomandibular joint（TMJ）； Mandibular plane angle； Condyle

青少年原發性關節炎（juvenile idiopathic arthritis，JIA）的顳下頜關節（TMJ）損傷是JIA的典型癥狀之一。由于JIA分類標準不同，顳下頜關節病在JIA患者中的發病率差異很大，從17%～87%不等[1，2]。TMJ受損被認為發生在JIA的活動期，在此期間炎癥產生軟骨和軟骨下骨缺損，最終導致髁突吸收，從而干擾下頜骨生長，改變頜面部形態和咬合，典型的面部形態特點是凸面型、下頜平面變陡、下頜后縮以及小頜畸形[3，4]。

有關JIA患者的顳下頜關節研究通常不區分JIA亞型，該類研究顯示JIA患者伴有TMJ損害時表現出較高的TMJ損傷率、下頜后縮發生率和下頜骨向后旋轉[3，5]。盡管以前的研究記載了在青少年慢性關節炎患者中TMJ損傷帶來的頜面部形態的變化，但是ILAR標準修訂后[6]，缺乏頭顱側位研究來分析髁突損傷和頜面部形態之間的關聯。本……