摘要
咬合与颞下颌关节髁突位于关节窝中的位置是否有关系,以及是否对功能有影响,一直存有争议。临床上二者相关的观点很受重视,但是从目前发表的研究结果(多为单因素方差分析研究结果)来看,其中存在很多不确定性。主要问题是分布方面有重叠,灵敏度及特异性都比较低,不具有预测性。由于形态与功能的关系是生物学研究的最基本内容,许多问题亟待研究。大多数生物学问题都没有像咬合与颞下颌关节髁-窝的位置关系这样,在研究工作中遇到这么多困难。该文从把颞下颌关节解剖结构当成一个多因素的、封闭的滑膜系统进行分析的角度,作以阐述,这种多因素分析方法就数据进行分析,减少偏倚。分类树分析采用逐步回归法,可以提供有价值的预测,并帮助建立合理的临床模型。该文分析结果显示,用变量R2作预测,结果 TMD患者中的关节结构正常的比例预测为32.6%。该预测的灵敏度为67.9%,特异性为85.7%。有37%为可复性关节盘前移位,28%为不可复性关节盘前移位。关节弹响和绞锁患者的关节骨性结构的形态差异很大,但不能证明关节铰锁是继发于弹响后的疾病进程,而仅表明弹响关节如果有关节绞锁特征,其症状更具有进展趋势。部分实验证实了TMJ骨性结构与功能之间具有相关性,但这种相关程度为中等程度,不应被夸大。文献中关于正常和异常的生物模型不止一个,该文讨论了一些与临床诊疗方案关系密切的内容。
Belief in and rejection of a relationship of occlusion and temporomandibular joint （TMJ） condyle-fossa position with normal and abnormal function are still contentious issues. Clinical opinions can be strong, but support in most published data （mostly univariate） is problematic. Distribution overlap, low sensitivity and specificity are a common basis to reject any useful prediction value. Notwithstanding, a relationship of form with function is a basic tenet of biology. These are multifactor problems, but the questions mostly have not been analysed as such. This review moves the question forward by focusing on TM joint anatomic organisation as the multifactor system it is expected to be in a closed system like a synovial joint. Multifactor analysis allows the data to speak for itself and reduces bias. Classification tree analysis revealed useful prediction values and usable clinical models which are illustrated, backed up by stepwise logistic regression. Explained vari- ance, R2, predicting normals from pooled TMJ patients was 32.6%, sensitivity 67.9% , specificity 85.7% ; 37% versus disc displacement with reduction; and 28.8% versus disc displacement without reduction. Significant osseous organisational differences between TM joints with clicking and locking suggest that this is not necessarily a single disease continuum. However, a subset of joints with clicking contained char- acteristics of joints with locking that might contribute to symptom progression versus resistance. Moderately strong models confirm there is a relationship between TMJ osseous organisation and function, but it should not be overstated. More than one model of normals and of TM de- rangement organisation is revealed. The implications to clinical decision-makinz are discussed.
出处
《实用口腔医学杂志》
CAS
CSCD
北大核心
2015年第4期560-576,共17页
Journal of Practical Stomatology
关键词
颞下颌关节
解剖结构
多因素
模型
预测
功能
紊乱
正常
异常
Temporomandibular joint
Anatomic relationships
Multifactor
Models
Prediction
Function
Derange-ment
Normal
Abnormal
