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目的:测定颞下颌关节(temporomandibular joint,TMJ)结构紊乱(internal derangement,ID)患者关节液中纤维蛋白的含量,并探讨其意义。方法:选取2007年12月—2008年6月期间收治的TMJ疾病患者进行临床检查,在初步诊断为结构紊乱后进行MRI检查,以获取评价关节盘情况的影像学依据,并按照Wilkes-Bronstein分期标准进行分期,将处于Ⅱ～Ⅴ期的患者纳入治疗范围,进行关节镜下盘复位固定手术,在关节镜手术前采集关节液1mL,-40℃或-70℃冰箱低温保存。采用免疫荧光激光共聚焦显微镜半定量测定纤维蛋白的含量。按照ID分期、不同年龄段、男女分组及左右侧关节分组,应用SPSS16.0软件包对所得数据进行t检验,比较不同组别之间关节液的平均荧光强度的差异。结果:所有125侧关节液的免疫荧光强度平均为4.43±3.67(0～31.68)。ID各期关节液的平均荧光强度Ⅱ期为2.38±1.17,Ⅲ期为4.68±3.98,Ⅳ期为4.80±2.80,Ⅴ期为3.58±2.64,其中Ⅱ期与Ⅲ期(P=0.0065<0.05)、Ⅳ期(P=0.0207<0.05)之间有显著差异。男性患者关节液的荧光强度平均为4.05±2.70,女性患者关节液的荧光强度平均为5.57±4.71,男女之间有显著差异(P<0.05)。左侧TMJ关节液的平均荧光强度为4.37±3.04,右侧平均为5.97±5.20,两者有显著差异(P<0.05)。10～19岁为4.55±2.45,20～29岁为4.56±3.39,30～39岁为2.60±1.12,40岁以上为5.68±6.71,其中第1和第3组,第2和第3组及第3和第4组年龄段之间有显著差异。结论:关节液的平均荧光强度随着ID分期增高,呈现升高趋势,为IA形成假说提供了理论支持。
Objective: To determine the content of fibrin in synovial fluid of temporomandibular joint (TMJ) patients with structural derangement (ID). Methods: The patients with TMJ disease admitted from December 2007 to June 2008 were selected for clinical examination. The MRI examination was performed after the initial diagnosis of structural disorder to obtain the imaging evidence for evaluating the status of the articular disk. According to the Wilkes-Bronstein classification The patients in stage Ⅱ ~ Ⅴ were enrolled in the treatment. The patients underwent arthroscopic plate reduction and fixation. One mL of synovial fluid was collected before arthroscopy, and stored in refrigerator at -40 ℃ or -70 ℃. Semi-quantitative determination of fibrin content using immunofluorescence confocal laser scanning microscopy. According to the ID staging, different age groups, men and women group and left and right side of the joint group, SPSS 16.0 software package was used to t test the data to compare the different groups of synovial fluid between the average fluorescence intensity differences. Results: The immunofluorescence intensity of all 125 articular fluid on average was 4.43 ± 3.67 (0 ~ 31.68). The mean fluorescence intensity of synovial fluid in each stage of ID was 2.38 ± 1.17, in stage Ⅲ was 4.68 ± 3.98, in stage Ⅳ was 4.80 ± 2.80 and in stage Ⅴ was 3.58 ± 2.64, of which stages Ⅱ and Ⅲ (P = 0.0065 <0.05) , Ⅳ (P = 0.0207 <0.05) between the significant differences. The average fluorescence intensity of synovial fluid of male patients was 4.05 ± 2.70. The average fluorescence intensity of synovial fluid of female patients was 5.57 ± 4.71. There was a significant difference between men and women (P <0.05). The average fluorescence intensity of the TMJ synovial fluid on the left was 4.37 ± 3.04 and the average on the right was 5.97 ± 5.20 (P <0.05). 4.55 ± 2.45 at 10-19 years, 4.56 ± 3.39 at 20-29 years, 2.60 ± 1.12 at 30-39 years and 5.68 ± 6.71 at 40 years of age, with groups 1 and 3, groups 2 and 3 and There were significant differences between age groups 3 and 4. Conclusions: The average fluorescence intensity of synovial fluid increased with the increase of ID staging and presented a rising trend, which provided theoretical support for the formation of IA.