标准型人工颞下颌关节置换术应用效果初步报告  

A primary application and evaluation of temporomandibular joint replacement with stock prosthesis

作　　者：张晓虎[1] 陈敏洁[1] 邱亚汀[1] 杨驰[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：《上海口腔医学》2012年第3期298-302,共5页Shanghai Journal of Stomatology

基　　金：上海市科学技术委员会资助项目(08411967400;114129a3800)~~

摘　　要：目的:介绍标准型人工全关节置换术应用于颞下颌关节重建的方法,初步评价其疗效及应用价值。方法:6例(10侧)颞下颌关节病患者,年龄49～66岁,平均59岁。3例(5侧)有既往颞下颌关节手术治疗史,3例(5侧)为内紊乱伴骨关节炎。术前均有明显开口受限及关节区疼痛,开口度1.0～2.9cm,平均1.9cm。采用标准型人工关节置换术,术后定期观察开口度及关节疼痛等变化,结合影像学检查等评价治疗效果。结果:成功完成6例(10侧)人工关节置换术。术后随访7～49个月,平均17.5个月。植入关节未出现因感染、排异、松动或断裂等导致的失败。有既往手术的病例中,1例(2侧)发生假体内侧异位成骨,1例(2侧)耳颞区疼痛无法缓解,其余4例(6侧)开口受限及关节区疼痛均有较明显改善。影像学检查均未见假体松动等异常情况。结论:标准型人工全关节置换术对缓解关节疼痛有明显效果,可有效改善开口度及提高咀嚼能力,但对咀嚼肌疼痛的缓解效果不理想。PURPOSE： To evaluate the effect of total joint replacement in treatment of temporomandibular joint （TMJ） osteoarthropathy with stock prostheses. METHODS： Six female patients involving 10 joints （2 unilateral and 4 bilateral）, with an average age of 59 years old, were involved in this study. Three patients （5 joints） were diagnosed as internal derangement in V stage depending on MRI, 3D-CT findings and clinical characteristics. The other 3 patients （5 joints） had histories of failed temporomandibular joint operation using costochondral graft or temporalis fascial flap. The maximal mouth opening was 1.9 cm on average （range, 1.0 to 2.9cm）. All the joints were replaced with Biomet standard prosthesis under general anesthesia. RESULTS： The follow-up period was from 7 to 49 months （average, 17.5 months）. All the operations were successfully performed. Heterotopic ossification happened in a bilateral case 1 year postoperatively. One patient with bilateral joint disease complained of severe uncomfortable feeling in the region of the ears and the temples, although there was no significant positive signs according to an ENT examination. Pain relief of the joint and mouth opening improvement were significant in 4 patients. No failure was noted secondary to infection or loosening of the prostheses. The occlusal relationship kept stable postoperatively in all cases. CONCLUSIONS： Total TMJ joint replacement with standard prosthesis is a good choice for TMJ reconstruction. It can significantly reduce joint pain and the mouth opening limitation resulted from osteoarthritis. Long-term result remains to be evaluated based on a long-term follow-up.

关 键 词：标准型 人工关节 颞下颌关节 置换 

分 类 号：R782.6[医药卫生—口腔医学]