측두하악장애 골관절염 환자에서 cone-beam CT를 이용한 관절면의 변화 추적 연구 = Follow-up Study of Condylar Bone Changes using Cone Beam Computed Tomography in Patients with Osteoarthritis

국문 초록 (Abstract)

2007년부터 2011년까지 부산대학교 병원 구강내과를 내원한 측두하악장애 환자 중 임상 검사 및 방사선 검사, cone beam computed tomography(CBCT) 영상 촬영 결과 측두하악장애 골관절염으로 진단된 환자 114명 228개의 관절을 대상으로, 치료 후 6~35.5개월(평균 10개월)후 CBCT를 재촬영하고, 임상 검사를 실시하였다. 구강내과 전문의와 구강악안면방사선과 전문의가 영상 진단을 하였고, 임상 검사 결과와 CBCT의 영상 결과를 추적 연구 비교하여 다음과 같은 결과를 얻었다. 1. 측두하악관절 관절염의 골변화 양상은 다음과 같다. 1) 관절염의 골변화 진행 양상은 대부분 초기 상태를 유지하였다. 2) 침식은 침식, 편평화, 정상 관절, 골경화, 골증식체 순으로 골변화 진행 양상이 나타났다. 3) 편평화는 편평화, 골증식체, 정상 관절 및 골경화 순으로 진행 양상이 나타났다. 4) 골증식체는 골증식체, 침식, 골경화, 편평화 순으로 진행 양상이 나타났다. 5) 골경화는 골경화, 골증식체, 침식, 정상 관절 순으로 진행 양상이 나타났다. 2. 골변화에 따른 임상 증상의 변화는 다음과 같다. 1) 침식은 침식으로 유지된 경우 통증, 관절음, 개구제한, 최대 편이 개구량 모두 증상 개선이 있었고, 편평화로 이행된 경우 통증, 개구제한, 최대 편이 개구량에서, 정상 관절면으로 이행된 경우 통증, 관절음, 개구제한에서 증상 개선이 있었다. 침식에서 침식으로 유지된 경우 보다 침식에서 편평화로 이행된 경우 최대 편이 개구량에 있어 개선 효과가 높았다. 2) 편평화는 편평화로 유지된 경우 통증, 관절음, 개구제한에서 증상 개선을 보여 주었고, 편평화가 골경화로 이행된 경우, 개구제한에 있어 유의성있는 증상 개선을 보여주었다. 3) 골증식체가 골증식체로 유지된 경우 통증, 개구제한, 최대 편이 개구량에서 증상 개선 효과가 있었다.

다국어 초록 (Multilingual Abstract)

This study was designed to assess follow-up study of condylar bone changes using cone beam computed tomography in patients with osteoarthritis. The author performed clinical examination for osteoarthritis patients who visited Orofacial Pain Clinic, Department of Oral Medicine, Pusan National University Hospital. CBCT(Cone beam computed tomography) was taken for 228 joints in 114 subjects. After average 10 months, CBCT was retaken. A Oral medicine and Oral radiologist evaluated CBCT each other. Condyle bone changes were classified by no bone change, flattening, erosion, osteophyte and sclerosis. The obtained results were as follow. 1. The condylar bone changes of osteoarthritis in temporomandibular disorder were as follow: 1) The transitions of each types of condylar bone changes was maintained at the initial state of the majority. 2) The transition of erosion was distributed erosion, flattening, sclreosis, osteohyte in order. 3) The transition of flattening was distributed flattening, osteohyte, normal, sclreosis in order. 4) The transition of osteohyte was distributed osteohyte, erosion, sclreosis, flattening in order. 5) The transition of sclreosis was distributed sclreosis, osteohyte, erosion, normal in order. 2. The signs and symptoms according to transition of each types of condylar bone changes were as follow 1) In the transition of condylar bone changes from erosin to erosion, pain, noise, LOM and MCO had symptomatic improvement. In the transition of condylar bone changes from erosin to flattening, pain, LOM, MCO had symptomatic improvement. In the transition of condylar bone changes from erosin to no bony change, pain, noise, LOM had symptomatic improvement. In the transition of condylar bone changes from erosion to flattening than the maintenance of eosion, MCO had symptomatic improvement. 2) In the transition of condylar bone changes from flattening to flattening, pain, noise and MCO had symptomatic improvement. In the transition of condylar bone changes from flattening to sclerosis, LOM had symptomatic improvement. 3) In the transition of condylar bone changes from osteophyte to osteophyte, pain, LOM and MCO had symptomatic improvement.

참고문헌 (Reference)

1 노창세, "측두하악관절 골관절염 환자의 진단에서 Cone Beam 전산화 단층촬영의 유용성" 대한안면통증∙구강내과학회 34 (34): 81-90, 2009

2 손대은, "측두하악골관절염 환자의 보존적 치료에 관한 연구" 대한안면통증∙구강내과학회 32 (32): 227-239, 2007

3 고철희, "전산화단층사진을 이용한 과두걸림을 가진 측두하악관절의 과두면 평가" 대한안면통증∙구강내과학회 29 (29): 67-77, 2004

4 정성창, "악관절 장애와 교합" 군자출판사 326-330, 1999

5 Rohlin M, "Tomography as an aidto detect macroscopic change of the temporomandibualr joint. An autopsy study of the aged" 44 (44): 131-140, 1986

6 Mejersjo C, "Therapeutic and prognostic considerations in TMJ osteoarthrosis: a literature review and a long-term study in 11 subjects" 5 (5): 69-78, 1987

7 Muir CB, "The radiologic morphology of painful temporomandibular joints" 70 (70): 355-359, 1990

8 Sato H, "Temporomandibular joint osteoarthritis: a comparative clinical and tomographic study pre-and post-treatment" 21 (21): 383-395, 1994

9 Rasmussen OC., "Temporomandibular arthropathy. Clinical, radiologic, and therapeutic aspects, with emphasis on diagnosis" 12 (12): 365-97, 1983

10 Hatcher D, "Science and Practice of Occlusion. 1st ed" Quintessence Publishing Co. 259-270, 1997

11 Hussain AM, "Role of different imaging modalities in assessment of temporomandibular joint erosions and osteophytes: a systematic review" 37 (37): 63-71, 2008

12 Ahmad M, "Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analysis" 107 (107): 844-860, 2009

13 de Leeuw R, "Radiographic signs of temporomandibular jointosteoarthrosis and internal derangement 30 years after nonsurgical treatment" 79 (79): 382-392, 1995

14 Christiansen EL, "Radiographic signs of temporomandibular joint diseases : an investigation utilizing X-ray computed tomography" 69-77, 1986

15 Tsiklakis K, "Radiographic examination of the temporo-mandibualr joint using cone beam computed tomography" 33 : 196-201, 2004

16 Toller PA, "Osteoarthrosis of the mandibular condyle" 134 (134): 223-231, 1973

17 Stegenga B, "Osteoarthrosis as the cause of craniomandibular pain and dysfunction: a unifying concept" 47 (47): 249-256, 1989

18 Chung SC, "Orofacial pains and temporomandibular disorders. 2nd ed" Shinhung Co. 149-153, 1996

19 Yamada K, "Observation of three cases of temporomandibualr joint osteoarthritis and mandibular morphology during adolescence using helical CT" 30 : 298-305, 2004

20 Rasmussen OC, "Longitudinal study of transpharyngeal radiography in temporomandibular arthropathy" 88 (88): 257-268, 1980

21 Yoshimura Y, "Long-term evaluation of non-surgical treatment of osteoarthrosis of the temporomandibular joint" 11 : 7-13, 1982

22 Koyama J, "Follow-up study of condylar bony changes using helical computed tomography in patients with temporomandibular disorder" 36 : 472-477, 2007

23 Kamelchuk LS, "Degenerative disease of the temporomandibular joint" 9 (9): 168-180, 1995

24 Larheim TA, "Current trends in temporomandibular joint imaging" 80 (80): 555-76, 1995

25 Fu KY, "Cone beam computed tomography in the diagnosis of temporomandibular joint osteoarthrosis" 42 (42): 417-420, 2007

26 Barghan S, "Cone beam computed tomography imaging in the evaluation of the temporomandibular joint" 38 (38): 33-39, 2010

27 Tanimoto K, "Comparison of computed with conventional tomography in the evaluation of temporomandibular joint disease: a study of autopsy specimens" 19 (19): 21-27, 1990

28 de Leeuw R, "Clinical signs of TMJ osteoarthrosis and internal derangement 30 years after nonsurgical treatment" 8 (8): 18-24, 1994

29 Rasmussen OC, "Clinical findings during the course of temporomandibular arthropathy" 89 (89): 283-288, 1981

30 Hansson LG, "Clinical and radiologic six-year follow-up study of patients with crepitation of the temporomandibular joint" 8 (8): 277-287, 1984

31 Honey OB, "Accuracy of cone-beam computed tomography imaging of the temporomandibular joint: Comparisions with panoramic radiology and linear tomography" 132 : 429-438, 2007