创伤性颞下颌关节强直伴内侧髁突残存的手术治疗  

Surgical treatment of traumatic temporomandibular joint ankylosis with medially displaced residual condyle

作　　者：何冬梅[1] 杨驰[1] 陈敏洁[1] 杨秀娟[1] 李凌志[1] 蒋倩[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6期487-490,共4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伴内侧髁突残存的手术治疗方法及疗效。方法:上海交通大学医学院附属第九人民医院口腔颌面外科关节组2001—2009年收治的内侧有髁突残存的创伤性颞下颌关节强直60例82侧关节纳入研究,分别采用外侧成形术、外侧成形+咬肌瓣和外侧成形+颞筋膜脂肪瓣进行治疗。通过临床和CT随访,评价3种治疗方法的疗效,采用SPSS 13.0软件包对术后开口度的改善进行统计学分析。结果:22侧关节采用外侧成形术;28侧关节采用外侧成形+咬肌瓣;32侧关节采用外侧成形+颞筋膜脂肪瓣。38例48侧关节术后随访1～4a。其中,4/11侧外侧成形术关节复发,占36.4%;3/17侧外侧成形+咬肌瓣治疗的关节复发,占17.6%;20侧外侧成形+颞筋膜脂肪瓣治疗的关节无一例复发。3种治疗方法中,外侧成形+颞筋膜脂肪瓣与单纯外侧成形术相比,开口度改善有显著差异(P<0.05)。结论:外侧成形术保留了残存的关节结构,与颞筋膜脂肪瓣结合,可以很好地预防颞下颌关节强直复发。PURPOSE： A surgical method for the treatment of traumatic temporomandibular joint（TMJ） ankylosis with medially displaced residual condyle was described,and the long-term results were compared.METHODS： From 2001 to 2009,60 patients and 82 joints diagnosed with traumatic TMJ ankylosis with medially displaced residual condyle were included in the present study.Lateral arthroplasty（LAP） was performed,and either the masseter muscle flap（MMF） or temporal fascial fat flap（TFF） were used as interpositional material to fill the lateral space.The long-term results of these treatments were compared by performing postoperative CT and clinical follow-up.SPSS 13.0 software package was used to analyze mouth opening improvement.RESULTS： In total,22 joints were treated with LAP,28 joints were treated with LAP and MMF,and 32 joints were treated with LAP and TFF.Thirty-eight patients with 48 joints were followed up for 1 to 4 years.Four of the 11 joints（36.4%） treated with LAP had reankylosis,3 of the 17（17.6%） joints treated with LAP and MMF had reankylosis,and 0 of the 20（0%） joints treated with LAP and TFF had reankylosis.Compared with LAP treatment,LAP with TFF significantly improved the maximal incisal opening（MIO） in long-term follow-up.CONCLUSION： LAP can reserve the residual TMJ structure.TFF is a reliable interpositional material in LAP for prevention of reankylosis.

关 键 词：创伤 颞下颌关节强直 治疗 

分 类 号：R782.6[医药卫生—口腔医学]