功能性矫治器治疗青少年可复性盘移位的MRI评价  

MRI evaluation of functional treatment in juvenile disk displacement with reduction

作　　者：马志贵[1] 杨驰[1] 谢千阳[1] 沈宇清[1] 沈佩[1] 房兵[2] 张善勇[1] 蔡协艺[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院·口腔医学院口腔外科,上海市口腔医学重点实验室,上海200011 [2]上海交通大学医学院附属第九人民医院·口腔医学院口腔颅颌面科,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》2013年第2期131-135,共5页China Journal of Oral and Maxillofacial Surgery

基　　金：上海高校青年教师培养资助计划(jdy11027)~~

摘　　要：目的:使用MRI评价功能性矫治器对青少年颞下颌关节(temporomandibular joint,TMJ)可复性盘移位(disk displacement with reduction,DDWR)的治疗效果。方法:采用功能性矫治器对57例(78侧关节)诊断为DDWR的青少年患者进行矫治,平均治疗期8个月,分别于戴矫治器前、拆除矫治器时拍摄TMJ MRI进行分析。依据MRI评价标准,治疗后达正常盘-髁关系,明显的髁突生长改建,则疗效定为"优";正常的盘-髁关系,髁突改建不明显或轻度盘移位,盘后区发生类盘样变,定为"良";与治疗前相同或更差,则定为"差"。将"优"和"良"定为有效。结果:MRI评价显示,57例78侧关节经功能性矫治器治疗后,"优"57侧,占73.08%(57/78);"良"11侧,占14.10%(11/78);"差"10侧,占12.82%(10/78),总有效率为87.18.%(68/78)。各种功能性矫治器中,前伸复位垫(anterior repositioning splint,ARS)治疗的有效率为84.09%,Twin-block矫治器为87.5%,Herbst为94.44%。对复位"差"者改行关节镜或开放性锚固术。结论:功能性矫治器是治疗青少年DDWR的有效方法,其远期疗效尚需进一步研究。PURPOSE： To evaluate the effect of functional treatment for disk displacement with reduction （DDWR） of the temporomandibular joint （TMJ）. METHODS： Fifty-seven juvenile patients （78 joints） diagnosed as DDWR underwent functional treatment. MRIs were used before and after functional treatment. The disk position was judged according to the success criteria which included all sagittal planes after treatment. Those patients, whose disk of TMJ was in normal position with remarkable condylar remolding, were evaluated to be excellent. If normal disk-condyle relationship with no remarkable condylar remolding or mild disk displacement with disk-like structure of the bilaminar zone were found, the outcome was evaluated to be good. Compared with pre-treatment, if the disk position was the same or became worse, the outcome was evaluated to be poor. Cases evaluated as ＂excellent＂and ＂good＂ ,were considered as successful. RESULTS： MRI for all joints confirmed that 73.08% （57/78） were excellent; 14.10% （11/78） were good, and only 12.82% （10/78） were poor. The total effective rate was 87.18% （68/78）. The effective rate for anterior repositioning splint therapy was 84.09%, 87.50% for twin-block appliance, and up to 94.44% for the Herbst functional appliance. Arthroscopic surgery or open surgery was carried out for the joints which were evaluated as poor. CONCLUSION： This study indicates that functional appliance is effective in repositioning the DDWR confirmed by MRI examination, but long-time follow-up is necessary for the evaluation of its stability. Supported by Research Fund for Young College and University Teachers from Shanghai Municipal Education Commission （jdy11027）.

关 键 词：颞下颌关节 功能性矫治器 可复性盘移位 青少年 MRI 

分 类 号：R782.6[医药卫生—口腔医学]