VTIQ评估颞下颌关节紊乱病患者咬肌弹性变化

doi:10.3969/j.issn.2095-9400.2021.06.007

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摘要目的：应用声触诊组织成像与量化技术（VTIQ）评估颞下颌关节紊乱病（TMD）患者咬肌的厚度和弹性变化。方法：收集2019年10月至2020年5月在温州市中西医结合医院五官科确诊的TMD患者50例作为病例组，同期健康成年人50例作为对照组。所有受检者双侧咬肌均进行常规超声和VTIQ弹性成像检查，分别在双侧咬肌闭口和开口状态下检测咬肌厚度及中段剪切波速度（SWV）。比较各组内及各组间咬肌在闭口和开口状态下，左右侧咬肌厚度和SWV差异，同时分析咬肌在开口和闭口状态下，咬肌厚度与SWV的相关性。结果：对照组左侧咬肌、右侧咬肌、病例组健侧咬肌及患侧咬肌的厚度在开口状态均大于闭口状态，差异有统计学意义（P＜0.05）。无论开口状态还是闭口状态，病例组患侧咬肌的厚度均大于对照组左侧咬肌、右侧咬肌及病例组健侧咬肌，差异有统计学意义（P＜0.05）；对照组左侧咬肌、右侧咬肌及病例组健侧咬肌厚度比较差异无统计学意义（P＞0.05）。对照组左侧咬肌、右侧咬肌、病例组健侧咬肌及患侧咬肌的SWV在开口状态均大于闭口状态，差异有统计学意义（P＜0.05）。在闭口状态，病例组患侧咬肌的SWV均大于对照组左侧咬肌、右侧咬肌及病例组健侧咬肌，差异有统计学意义（P＜0.05）；对照组左侧咬肌、右侧咬肌及病例组健侧咬肌SWV比较差异无统计学意义（P＞0.05）。在开口状态，病例组患侧咬肌的SWV均大于对照组左侧咬肌、右侧咬肌及病例组健侧咬肌，差异有统计学意义（P＜0.05）；病例组健侧咬肌的SWV均大于对照组左侧咬肌、右侧咬肌，差异有统计学意义（P＜0.05）；对照组左侧咬肌、右侧咬肌SWV比较差异无统计学意义（P＞0.05）。在开口和闭口状态下，病例组患侧、健侧和对照组左侧、右侧的咬肌厚度与SWV无明显相关性。结论：TMD患者患侧咬肌厚度增加，硬度增加；VTIQ可客观地评价TMD患者咬肌的硬度，提供咬肌量化弹性信息。

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关键词 ：声触诊组织成像与量化技术, 颞下颌关节结构紊乱, 超声检查, 肌, 骨骼

Abstract：Objective: To investigate the changes in masseter muscle thickness and elasticity in healthy people and patients with temporomandibular joint disorder (TMD), using acoustic palpation tissue imaging and quantification technology (VTIQ). Methods: A total of 50 patients with TMD diagnosed in the Department of Otology, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from October 2019 to May 2020 were collected as the case group, and 50 healthy adults during the same period as the control group. All subjects underwent conventional ultrasound and VTIQ elastography to detect masseter muscle thickness and mid-range shear wave velocity (SWV) in closed and open bilateral masseter muscles. The differences in SWV and thickness of the left and right masseter muscle were compared between and within each group under closed and open state, and the correlation between thickness of the masseter muscle and SWV in the open and closed state was analyzed. Results: The thickness of the left masseter muscle and right masseter muscle of the control group, the healthy side masseter muscle and the affected side masseter muscle of the case group were greater in the open state than in the closed state, with statistical difference (P<0.05). Whether the mouth was open or closed, the thickness of the masseter muscle on the affected side of the case group was greater than that of the left masseter muscle and the right masseter muscle of the control group as well as the contralateral masseter muscle of the case group, the difference being statistically significant (P<0.05); The thickness of the left masseter muscle and the right masseter muscle of the control group and the healthy side masseter muscle of the case group showed no significant difference (P>0.05). In the control group, the left masseter muscle, the right masseter muscle, the contralateral masseter muscle and the affected side masseter muscle of the case group had greater SWV in the open state than in the closed state, and the difference was statistically significant (P<0.05). In the closed state, the SWV of the masseter muscle on the affected side of the case group was greater than that of the left masseter muscle and the right masseter muscle of the control group and the contralateral masseter muscle of the case group, with significant difference (P<0.05); The left masseter muscle, right masseter muscle of the control group and the contralateral masseter muscle SWV of the case group showed no significant difference (P>0.05). In the open state, the SWV of the masseter muscle on the affected side of the case group was greater than that of the left masseter muscle and the right masseter muscle of the control group as well as the contralateral masseter muscle of the case group, with significant difference (P<0.05); The SWV of the contralateral masseter muscle in the case group was greater than that of the left and right masseter muscles of the control group, the difference being statistically significant (P<0.05); There was no statistical difference in SWV between the left masseter muscle and the right masseter muscle of the control group (P>0.05). In the open and closed state, there was no significant correlation between the masseter muscle thickness and SWV of the affected side, the healthy side and the left and right sides of the control group. Conclusion: VTIQ can objectively evaluate the stiffness of the masseter muscle in patients with TMD, which provides quantitative information on the elasticity of the masseter muscle and an objective imaging basis for the clinic

Key words： virtual touch tissue imaging & quantification temporomandibular joint structural disorder ultrasonography muscle, skeletal

收稿日期: 2020-10-23

基金资助:温州市基础性科研项目（Y20190681）。

通讯作者: 邹春鹏，主任医师，Email：chpzou@126.com。 E-mail: chpzou@126.com

作者简介: 赵悦子，主治医师，Email：zhao88yuezi@126.com。

链接本文:

https://xb.wmu.edu.cn/CN/10.3969/j.issn.2095-9400.2021.06.007 或 https://xb.wmu.edu.cn/CN/Y2021/V51/I6/468

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