创伤性颞下颌关节强直的分类和治疗-84例临床资料分析  

Classification and treatment of traumatic temporomandibular joint ankylosis:An analysis of 84 consecutive patients

作　　者：杨驰[1] 何冬梅[1] 陈敏洁[1] 张晓虎[1] 邱亚汀[1] 杨秀娟[1] 李凌志[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院.口腔医学院口腔颌面外科上海市口腔医学重点实验室,上海200011

出　　处：《中国口腔颌面外科杂志》2011年第1期45-50,共6页China Journal of Oral and Maxillofacial Surgery

基　　金：上海市科学技术委员会资助项目(08DZ2271100)~~

摘　　要：目的:探讨创伤性颞下颌关节强直以冠状CT为基础的分类和治疗方法。方法:选择2001—2009年上海交通大学口腔颌面外科关节组收治的创伤所致颞下颌关节强直84例(124侧)患者作为研究对象,所有患者术前、术后均进行CT扫描,关节区冠状重建,据此提出创伤性关节强直的4型分类,即A1～A4型。根据分类进行相应的治疗。A1型,纤维组织松解或髁突切除+肋骨移植+颞肌筋膜瓣修复;A2和A3型,切除外侧融合骨球,保留内侧髁突和关节盘+颞肌瓣或咬肌瓣外侧间隙填塞(外侧成形术),如果内侧髁突残余较小不能负重,骨球切除后用肋骨移植+颞肌瓣或咬肌瓣修复;A4型,切除全部骨球,肋骨移植关节置换+颞肌瓣或咬肌瓣修复。对治疗结果进行CT和临床随访评价。结果:84例124侧创伤性关节强直中,A1型14侧,占11.3%;A2型43侧,占34.7%;A3型46侧,占37.1%;A4型21侧,占16.9%。其中部分A1型,全部A2和A3型有内侧移位的髁突残余,占75%(93/124)。根据分类采用的治疗方式包括外侧成形术82侧,占66.1%;肋骨移植重建33侧,占26.6%;其他9侧,占7.3%。48例68侧关节强直术后随访10个月～4a,占57%。其中,48侧行外侧成形术的关节中有7侧复发,占14.6%;17侧行肋骨移植的关节中有4侧复发,占23.5%。结论:基于冠状CT的关节强直新分类对于临床治疗有重要指导意义。外侧成形术+颞肌瓣修复是治疗A2和部分A3型关节强直(内侧有足够承重的髁突和关节盘残余)的理想方法,肋骨移植+颞肌瓣修复治疗完全骨性强直效果良好。PURPOSE：This study was to investigate the classification of traumatic temporomandibular joint ankylosis（TMJA） based on coronal CT scan and to present our treatment experience in the TMJ division of Shanghai Ninth People＇s Hospital.METHODS：From 2001 to 2009,130 patients diagnosed of TMJA were treated in TMJ division.Among them,84 patients with 124 joints were caused by trauma and treated first by our group of surgeons.They were included in this study.All of them had CT scan,especially coronal reconstruction through the TMJ area before and after surgery.A new classification based on the coronal CT scan was proposed.The treatment protocol for Type A1 ankylosis was fibrous tissue release or condylar head resection with costochondral graft（CCG） and temporalis myofascial flap（TMF）.For Type A2 and A3 ankylosis,the lateral bony fusion was resected while the intact residual condylar fragment displaced medially was remained.The operation was named ＂lateral arthroplasty＂（LAP）.TMF or masseter muscle flap（MMF） was used as a barrier in the lateral gap between temporomandibular joint fossa and stump of the mandibular ramus.If the medial condylar fragment in Type A3 ankylosis was too small to bear the load,it was resected with the bony mass.The joint was then reconstructed with CCG and TMF or MMF.For Type A4 ankylosis,the bony fusion was completely removed and the joint was reconstructed with CCG and TMF or MMF.The result of the treatment were evaluated by CT scan and clinical follow-up.RESULTS：Among the 124 ankylotic joints,14 were Type A1 ankylosis（11.3%）;43 were Type A2（34.7%）;46 were Type A3（37.1%） and 21 were Type A4 ankylosis（16.9%）.Part of Type A1,all Type A2 and A3 ankylosis had residual condylar head displaced medially which accounted for 75%（93/124） of the TMJ ankylosis.Treatment according to the classification was：LAP for 82 joints（66.1%）;CCG for 33 joints（26.6%）;and other treatment for 9 joints（7.3%）.Forty-eighty patients with 68 joints had long time f

关 键 词：创伤 颞下颌关节强直 分类 治疗 

分 类 号：R782.6[医药卫生—口腔医学]