JPH0566813B2 - - Google Patents

Description

Claim 1: An apparatus for diagnosing bone-joint abnormalities, comprising: means for detecting the presence or absence of a sound pattern, defined as a bone-joint guided sound pattern, propagating at a joint or joint between bones; Means for detecting bone displacement that changes over time in a three-dimensional synchronous manner in response to a detected bone-joint induced sound pattern, and means for detecting bone displacement that changes over time in a three-dimensional synchronous manner with respect to the corresponding bone movement duration and linear displacement of a region for diagnosing a joint abnormality. A diagnostic device comprising means for correlating bone-articular induced sound patterns.

2. The diagnostic device according to claim 1, further comprising means for amplifying the detected joint guidance sound pattern.

3. The diagnostic apparatus according to claim 2, further comprising means for filtering the amplified detected joint guidance sound pattern.

4. The diagnostic device according to claim 1, further comprising means for amplifying the detected temporally varying bone displacement.

5. The diagnostic device according to claim 4, further comprising means for integrating the amplified detected time-varying bone displacement.

6. The diagnostic device according to claim 1, comprising means for detecting temporally varying bone displacement in any one of the X, Y, or Z planes.

7. The diagnostic device according to claim 6, comprising means for switching between Y, Y or Z planes during detection of temporally varying bone displacements.

8. The diagnostic device according to claim 1, wherein said correlation means comprises graphical correlation means.

9. The diagnostic apparatus of claim 8, wherein said graphical correlation means includes a computer.

10. The diagnostic device according to claim 1, wherein the detection is a detection of a temporomandibular joint (TMJ).

11. Claim 1, wherein the means for detecting temporally varying bone displacement is of the mandible, and the corresponding movement of the bone is movement of the mandible.
Diagnostic device according to item 0.

12. In a device for diagnosing temporomandibular joint (TMJ) abnormalities, means for detecting sound patterns defined as TMJ-induced sound patterns propagated in the TMJ in a temporal order;
means for detecting time-varying mandibular linear bone displacement in three dimensions with respect to the guided sound pattern; and means for correlating the TMJ guided sound pattern with the duration of the corresponding mandibular movement and its occurrence and duration with respect to the linear displacement. A diagnostic device.

BACKGROUND OF THE INVENTION The present invention relates to a device for non-invasive analysis of joint abnormalities. More particularly, the present invention relates to an improved non-invasive method of detecting and analyzing joint abnormalities that utilizes a novel signal processing procedure called Arthrophonometry. The present invention is particularly suited for the detection and identification diagnosis of temporomandibular joint (TMJ) abnormalities, which are a type of frequently occurring abnormality resulting from any of several different underlying medical conditions.

Although the following description of the invention and related background primarily relates to the temporomandibular (TMJ) and related abnormalities, the invention is equally applicable to the diagnosis of any type of joint abnormality throughout the body. You must first understand that.

TMJ-related pain and functional impairment affects 20% of the population.
It is estimated that it bothers ~50%. Although many patients appear to have functional impairment, it is certain that some of them have organic joint abnormalities. Unfortunately, distinguishing true joint pathology from other conditions is difficult or impossible because the associated clinical signs and symptoms are relatively nonspecific. Furthermore, simple, subjective and unambiguous diagnostic methods have become of greater importance to distinguish between the increasing number of different types of joint abnormalities. Conditions such as myofascial pain dysfunction (MPD), meniscal dislocations (internal disorders), rheumatoid and degenerative arthritis, subluxations, and chronically dislocated fractures, tumors, and joint adhesions are all clearly identified as distinct entities. , the diagnosis usually relies on clinical impression and complex radiographic methods. MPD TMJ disease
There is a general tendency to recognize that this is the case, but this may be due to inadequate diagnostic techniques and the inability to identify specific disease components based on objective criteria. As the range of effective surgical and non-surgical treatments for specific joint abnormalities is expanding, further improvements in diagnostic accuracy are required.

With the exception of direct clinical examination, most of the most common TMJ diagnostic methods rely on radiography. Historically, radiographic evidence of TMJ changes has been considered the gold standard for distinguishing between organic joint disease and functional abnormalities. Radiographic evaluation of TMJ is generally limited to standard radiography, arthrography, tomography, and joint tomography. Although standard radiography and tomography are useful in evaluating gross abnormalities of bone structure, they are of little value in assessing the viability and function of soft tissue segments. It is not surprising that 86% to 95% of patients with TMJ dysfunction have completely normal tomography images. As impression-based evidence has established the importance of soft tissue abnormalities in TMJ dysfunction, significant limitations of standard radiography and tomography have become apparent. Even in assessing the normal state of bone structure, standard methods have been shown to have limited value and require significant radiation exposure.

An improved, but not sufficient, procedure for objectively examining TMJ soft tissue function was found in simple arthrography. Even better data can be obtained by combining arthrography and tomography (ie joint tomography). Although this method can clearly identify anterior meniscal dislocations and subluxations, meniscal perforations, degenerative changes, and adhesions, it requires considerable expertise to interpret the resulting joint tomography images. The difficulty in unambiguously interpreting such films also limits the value of joint tomography as a routine technique.

Although it cannot be denied that joint tomography has allowed unprecedented diagnostic certainty for some TMJ abnormalities, this method must be considered moderately invasive. As it is a tomography procedure (often performed under fluoroscopic control), the patient necessarily receives high levels of radiation. In order to obtain valuable diagnostic information, the patient must be exposed to contrast media containing iodine, which can cause allergies, and the patient must endure considerable pain, but
These inherent shortcomings of joint tomography overshadow the potential value of non-invasive, non-radiation-based, quantitative methods that should provide the same or better information than existing methods. It emphasizes the size.

Finally, computer tomography (CT) of the TMJ has been proposed as an alternative to conventional tomography and joint tomography. CT improves the sensitivity and reliability of both hard and soft tissue examinations and reduces patient exposure and pain compared to other radiographic methods. However, CT scanning of the TMJ is a procedure that can only be performed in a hospital, requiring expensive equipment and facilities, specially trained doctors, and a moderate radiation dose.

Appropriate quantitative non-intrusiveness to overcome the above-mentioned problems
The structure of a TMJ diagnostic procedure should be developed taking into account two related assumptions: (1) abnormal joints exhibit friction losses that are greater than normal joints and can be easily detected by instrumentation; (2) Different pathologies exhibit different types of friction losses that can be acoustically distinguished and quantitatively analyzed.

Several non-invasive acoustic evaluation methods are well known in medical diagnostic technology. For example, Brackin
US Pat. No. 3,181,528 describes a method and apparatus for analyzing joint abnormalities using an acoustic diagnostic device. A graphical record of the sound (amplitude) versus signal time is taken from this procedure and analyzed to detect joint abnormalities.

Medical & Biological Engineering &
Computing magazine article “A Noninvasive
Electroacoustical Evaluation Technique of
Cartilage Damage in Pathological Knee
In ``Joints,'' the authors describe a method similar to the Brackin patent in which knee joint abnormalities are diagnosed by measuring and recording the occurrence of unique acoustic signals and the corresponding statistical patterns. As in Brackin's case, this method obtains results in the form of graphs by measuring the relationship between sound and time. Another diagnostic device similar to the joint noise detection system described above is described in Russian Patent No. 304939.

All of the above-mentioned methods and devices are unfortunately clinically unsatisfactory in terms of the extent of quantitative analysis and diagnostic accuracy. Therefore, these prior art methods are acceptable only to a limited extent, primarily because they are only qualitative methods for the diagnosis of specific abnormalities.

It would therefore be advantageous to provide a non-invasive acoustic diagnostic tool for accurate quantitative detection and differential diagnosis of joint abnormalities, particularly TMJ abnormalities.

SUMMARY OF THE INVENTION The above-mentioned and other problems of the prior art are overcome or alleviated by the device for non-invasive analysis of joint abnormalities of the present invention. According to the invention, the inventor:
We unexpectedly discovered that by graphically correlating joint-induced sound patterns with temporal and spatial joint positions, a specific and accurate diagnosis of joint abnormalities can be obtained for each case. This tell-tale relationship between sound pattern and position is
Hitherto, it has not been taught by the prior art that only a record-based analysis of the sound-time relationship is performed. In fact, the teachings of the Brackin patent are worded far from this type of analysis (column 4, paragraphs 63-63).
(see line 74).

Thus, the acoustic signal processing diagnostic device of the present invention provides a novel non-invasive procedure for the detection and identification diagnosis of joint abnormalities, including, for example, abnormalities of the temporomandibular (TMJ) joint. The inventor named the present invention a joint sonometry method.

According to the invention, in a device for diagnosing osteoarticular abnormalities, the presence or absence of a sound pattern, defined as an osteoarticular induced sound pattern, propagating at a joint or joint between bones is detected. means for detecting bone displacement that changes over time in a three-dimensional synchronous manner in response to the detected bone-joint induced sound pattern; A diagnostic device is provided comprising means for correlating the osteoarticular induced sound pattern to displacement.

According to the invention, there is also provided a device for diagnosing temporomandibular joint (TMJ) abnormalities, comprising means for detecting in temporal order sound patterns defined as TMJ-induced sound patterns propagating in the TMJ, corresponding times. Detected TMJ in the order of
means for detecting time-varying mandibular linear bone displacement in three dimensions with respect to the guided sound pattern; and means for offsetting the TMJ guided sound pattern and the duration of the corresponding mandibular movement and its occurrence and duration relative to the linear displacement. A diagnostic device is provided.

As an example of the present invention, in the analysis of TMJ joints, the device measures joint motion friction losses as indicated by acoustic signatures. Since different diseases of the temporomandibular joint are characterized by different physical conditions (and consequently different frictional losses), the associated joint sounds correspond categorically uniquely to specific disease states. Acoustic representations of joint friction are mapped in relation to both temporal and spatial characteristics of jaw movement and further characterized by acoustic signal processing. The method involves placing a vibration transducer in the region of the temporomandibular joint and a position sensor in the lower central incisor.
This includes recording bone joint induced sounds and jaw movements, respectively. The sensor generates a voltage that corresponds to both the acoustic waveform radiated from the joint and the spatial joint position. These voltages are simultaneously displayed in the form of a graph on a computer display terminal. The relationship between acoustic markers and joint pathology has been confirmed by comparison with conventional diagnostic methods and by preliminary examination by palpable surgery.

As mentioned above, the known methods currently used for diagnosing temporomandibular joint abnormalities are invasive, painful, require exposure to allergenic iodine-containing contrast agents, and require considerable must be exposed to high levels of radiation. Current methods are all hospital-based, personnel intensive,
It's expensive. Furthermore, conventional non-invasive acoustic techniques, such as those described in the Brackin patent, are ineffective in obtaining specific quantitative diagnostic diagnoses. Accordingly, among the many features and advantages of the present invention, arthrographic sonography is non-invasive, non-allergenic, non-radiation-free, painless, inexpensive, and provides a permanent record. This includes being able to provide both diagnosis and evaluation of treatment effects.

The above and other advantages of the invention will be apparent to those skilled in the art from the following detailed description and drawings.
It will be understood.

[Brief explanation of the drawing]

Next, the drawings will be explained. In the drawings, similar elements are designated by the same reference numerals in several figures: FIG. 1 is a graphical representation of acoustic waveforms and joint positions for a normal joint extracted in accordance with the present invention; FIG. , a graphical representation of acoustic waveforms and joint positions for a joint with meniscal dislocation extracted in accordance with the present invention; FIG. 4 is a graphical representation of acoustic waveforms and joint positions for a joint with myofascial pain syndrome (MPD) extracted in accordance with the present invention; and FIG. 1 is a schematic diagram of the equipment used according to the procedure.

DESCRIPTION OF THE PREFERRED EMBODIMENTS As mentioned above, the device of the present invention has two related prerequisites: (1) that the abnormal joint exhibits friction losses that are greater than the normal joint and that are easily detectable by instrumentation; , and; (2) it is based on the fact that different medical conditions exhibit different types of frictional losses that can be acoustically distinguished and quantitatively analyzed. For example, if a temporomandibular (TMJ) internal disorder is characterized by disc displacement during jaw opening and return upon jaw closure, there is a detectable click at the actual point of displacement and return. It should appear. Similarly, if a degenerative joint disease is characterized by disc perforation and joint surface roughness, then detectable friction losses should appear as a longer lasting non-periodic noise.

Preferably, an accurate and extensive database of graph patterns consisting of multiple classifications and subclassifications of different joints and joint abnormalities is created. In conjunction with such a database, a physician may use a diagnostic device (described below) to evaluate a particular graph pattern by comparing it to standardized patterns in the database. Accordingly, the present invention provides a non-invasive acoustic technique for the detection and identification diagnosis of joint abnormalities.

Examples 1 to 4 described below and corresponding Figures 1 to 4
FIG. 4 shows graph patterns derived from the present invention for three different states of the TMJ.

Examples 1-4 are TMJs with three conditions, including normal TMJ (Example 1), internal disorders (Example 2), degenerative arthritis (Example 3), and true myofascial pain syndrome (Example 4). It concerns joints. Testing on the examples was performed under clinical conditions including the methodology described below.

The "no abnormality" population consisted of 20 dental school students with no previous history of TMJ abnormality or who were not currently showing signs of TMJ abnormality.
The clinical population consisted of 6 patients diagnosed with internal disorders (unilateral or bilateral) and 6 patients with degenerative arthritis. Diagnosis was based on joint tomography evidence, surgical observation, or both. Jaw displacement was tracked both vertically and anteroposteriorly using a lower tsubo motion camera (Myotronics Research). The device consists of an array of six sensitizers that detect the position of small magnets attached to the mandibular central incisors with dental adhesive. Acoustic recording was performed using a contact microphone placed in the zygomatic arch (attached to the headband).
was obtained by directly placing . The jaw displacement signal and the acoustic signal were simultaneously recorded on separate tracks of the measurement tape recorder, with the displacement signal in FM mode and the acoustic signal in direct mode. In order to obtain a hard copy of the reading of the displacement tracking and the reading of the joint propagating acoustic signal in a time-aligned state,
The output of the tape recorder was input to an optical oscillograph (Honeywell Visicoder).

Example 1 FIG. 1 shows a normal reading of a normal joint. The upper trace 10 shows the vertical displacement of the jaw during full opening and closing movements. lower trace 1
2 shows the amplified output of the contact microphone channel. The vertical lines are timing indication lines drawn at 100 msec intervals. In this case, the jaw opening is gradual and continuous through about two-thirds of the cycle, with subsequent jaw closing being more rapid. It is particularly important that the acoustic track is nearly silent, except for an abrupt transition at 14, which corresponds to the time of tooth contact at the end of the closing phase of the movement.

Example 2 In this example, the surgical procedure
It was pointed out that he had an internal disorder in his TMJ. Prior to the surgical examination, joint ultrasound measurements according to the present invention were performed. Typical readings obtained for simple opening and closing movements of the jaw are shown in FIG. Again, the upper trace 16 shows the vertical jaw displacement and the lower trace 18 shows the output of the contact microphone. two distinct short-term transitions 20 in which the track of the contact microphone appears in both the open and closed portions of the jaw movement cycle;
It should be noted that 22 is shown. When released, click 20 gomplex lasts about 75 msec,
It appears to contain two separate components. The onset of the click appears to be slightly after the onset of jaw opening, approximately 100 msec after the onset of the movement. The closing click 22 complex is slightly shorter in duration (approximately 50 msec) and appears to be late in the closure phase, although its termination occurs approximately before the teeth make contact.
100 msec ago; this suggests a mutually inverse relationship with the open click. It should also be noted that each click complex is composed of two separate components and actually appears to be a double click. It is speculated that each individual spike represents a different physiological event, the first perhaps reflecting passage along the articular meniscal eminence, and the second reflecting a rebound or rebound at the .

The temporal pattern of click-reverse click is
It is also typical of other patients diagnosed with TMJ internal disorders. We also note that in at least three other patients with internal disorders, the presence of clicks with much less quantitative indication of temporal and spatial location could not be detected using conventional stethoscope means. Should. This is probably due to the low sensitivity of the transducer and the filter characteristics of the stethoscope tube.

Example 3 Figure 3 shows a graphic reading for a patient surgically diagnosed with bilateral degenerative TMJ arthritis. Joint sound measurements according to the invention prior to surgery show that the acoustic pattern of the joint-borne sounds is quite different from the previous patient's acoustic pattern (FIG. 2). Rather than exhibiting a click-back click in pattern 23, this patient exhibits a prolonged friction loss 24 associated with nearly all of the opening portion of the jaw movement, indicated at 26. The onset of noise occurs approximately 125 msec after entering the opening phase, and continues for approximately 600 msec until the point corresponding to maximum opening. Noise then does not appear during the closing phase of the movement. This pattern of long duration noise is typical of all other patients in this diagnostic group.

Example 4 A graphic reading for a patient diagnosed with true myofascial pain syndrome (MPD) is shown in Figure 4. The two traces 25 (position) and 27 (sound), including the abrupt transition at 29, appear to be the same as the intact joint shown in FIG.
MPD problems are due to diseases with causes outside the TMJ; therefore, this does not contradict the clinical diagnosis since the joint itself is essentially normal.

In summary, the present invention is capable of identifying and diagnosing diseases of the temporomandibular joint in a manner currently permitted by medical technology. The present invention quantitatively analyzes the independent mechanical conditions of normal joints, joints with meniscal dislocation, and joints with degenerative arthritis using joint sounds as fricative sounds. It can be identified by

As mentioned above, the use of sounds generated by biological structures for diagnostic purposes is not new.
However, graphic patterns for quantitatively analyzing the relationship between joint sounds and joint positions have never been used as a clear diagnostic procedure. For example, existing methods and apparatus for timing and characterizing articulation sounds described in the Brachin patent are strictly qualitative and subjective. The joint sonometry analysis of the present invention provides precise timing of joint-borne sounds and correlates them directly with open/close cycles. Moreover, the devices and methods according to the present invention have joint noise detection sensitivity that far exceeds the sensitivity obtained through the use of conventional stethoscopes or other devices.

Next, FIG. 5 will be explained. In Figure 5,
A schematic diagram of representative equipment used in accordance with the method of the invention is shown. As mentioned above, the jaw-induced sound is detected by a microphone or vibration transducer 28, and then the voltage signal is amplified via an amplifier 30 and passed through a filter 32 to a frequency band (100Hz~
5kHz) and then recorded on one axis of an X-Y plotter or oscilloscope 34 as shown in FIGS. 1-4.

The position of the joint in the X, Y and/or Z planes is measured in time and space by accelerometers 36. The voltage signal extracted from the accelerometer is then sent via amplifier 38 to integrators 40 and 42.
The switch 44 of the electronic device is one of the X, Y or Z signals.
Select one or more. Finally, switch 4
4 is recorded on the second axis of the X-Y plotter or oscilloscope 34, thereby providing a precise quantitative association of the joint-induced sound pattern with the joint position in time and space.

It should be understood that a velocity transducer or a position transducer (with appropriate modifications to the electronics) may be used in place of the accelerometer 36. It would also be possible to move the accelerometer rather than switching it. Finally, it would be possible to implement the entire system shown in FIG. 4 with a single chip microprocessor having analog/digital and digital/analog capabilities.

Based on preliminary studies, the present invention appears to be a potentially significant method for diagnosing various types of TMJ abnormalities, both in terms of accuracy and cost. Currently, existing methods used to diagnose TMJ abnormalities are invasive, painful, and require allergenic iodine-containing contrast agents and exposure to significant radiation intensity. . Current methods are all hospital-based and expensive due to their intensive use of personnel. The obvious advantages of the present invention are that it is non-invasive, non-allergenic, does not require X-rays, is painless, is inexpensive, provides a permanent record, and allows for both diagnosis and evaluation of treatment effectiveness. That's true.

It is particularly important to be able to utilize costs effectively. As simple acoustic criteria are developed for the diagnosis of TMJ pathology, it is expected that data collection and analysis equipment will be correspondingly simplified. The cost of the required instrumentation is expected to be affordable to individual practitioners; it is expected that the system will be easy to adapt to an outpatient office configuration. Costs are minimized because the patient does not have to be referred to a hospital facility or the hospital's technical or specialized staff is required.
The basic interpretation of the data obtained in accordance with the present invention is simple and clear and appears to be sufficient for the abilities of the novice treating clinician. None of these advantages are available with current joint tomography.

The device of the present invention is painless, non-invasive, safe, and reasonably priced, so it has significant potential as a screening method. There is currently no objective means to screen large numbers of patients for pre-pathological TMJ conditions prior to overt disease. For the reasons mentioned above, it would be inappropriate to apply radiography on a large scale for this purpose. Thus, there has been no evidence to date that links joint function that borders on normal and abnormal to the eventual development of joint disease symptoms. Since the present invention requires minimal time and techniques, it is a method suitable for screening large populations. Although findings from such screening tests are not predictive of the future, it is reasonable to consider the possibility that subtle acoustic abnormalities may precede true joint disease. The present invention suggests predictive or prognostic value for disease-free joints.

This screening feature may be useful in examining the TMJ of patients who have developed joint problems as a result of certain dental pathologies. For example, the long-term effects of increasing or decreasing vertical dimension in patients with complete dentures are unknown. TMJ joint sound wave measurements can objectively display changes that occur over decades in a graphical manner and reveal fundamental changes in joint function that occur secondary to dental treatment. Dew.

Continuous measurement of joint sound waves can be said to be an important method for evaluating the effects of various treatments. This method will allow us to assess whether surgical correction of meniscal dislocation is appropriate. The effectiveness of splinting and other treatments could be determined in a similar manner. At the very least, the method should reduce the number of X-ray examinations required for treatment.

The advantage of joint sonographic analysis of the TMJ according to the present invention is not only because it can truly replace some radiographic methods (and the attendant risks), but also because it analyzes acoustic indications of joint function. This unique perspective is thought to be recognized because it can actually provide basic descriptive information regarding normal joint function.

Although most of the disclosure regarding the present invention has been related to TMJ diagnosis, it must be understood and reiterated that the present invention is equally applicable to the analysis of any joint abnormality.

Although the preferred embodiment has been illustrated and described, various changes and substitutions may be made without departing from the spirit of the invention. Accordingly, it should be understood that the invention has been described by way of example and not by way of limitation.