关节盘复位锚固术术后稳定性的影像学评价  

Imaging evaluation of disc position and condylar status after temporomandibular joint disc repositioning surgery with miniscrew anchor

作　　者：朱慧敏[1] 周琴[1] 何冬梅[1] 杨驰[1] 董敏俊[1] 黄栋[1] ZHU Hui-min;ZHOU Qin;HE Dong-mei;YANG Chi;DONG Min-jun;HUANG Dong(Department of Oral Surgery,Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine &Shanghai Key Laboratory of Stomatology &Shanghai Research Institute of Stomatology &National Clinical Research Center of Stomatology ,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院口腔外科,上海市口腔医学重点实验室,上海市口腔医学研究所,国家口腔疾病临床研究中心,上海200011

出　　处：《中国实用口腔科杂志》2018年第12期731-734,共4页Chinese Journal of Practical Stomatology

基　　金：国家自然科学基金(81472117);上海交通大学医工交叉基金(YG2014MS05);上海市科学技术委员会科研项目(15140902500,17441900300);上海申康医学发展中心项目(16CR3045A);上海市卫计委青年基金(20154Y0189);上海交通大学医工交叉基金青年项目(YG2015QN04)

摘　　要：目的通过MRI评价颞下颌关节盘复位锚固术术后稳定性及髁突的改建情况。方法选择2009年2月至2017年7月在上海交通大学医学院附属第九人民医院口腔外科行关节盘复位锚固术的150例颞下颌关节盘前移位(anterior disc displacement,ADD)患者(210侧关节)。经术后1周和至少1年MRI随访,评估关节盘的位置和髁突骨质变化。随访期间若出现不可复性ADD,则认为术后复发,根据骨质状态,将髁突改变分为再生或吸收。结果术后1周MRI显示所有移位关节盘均复位。经12～96个月(平均26.73个月)的随访,MRI显示95.71%(201/210)的关节盘位置良好,而5.71%(12/210)的关节盘前移复发。77.62%(163/210)的髁突有新骨形成,20.48%(43/210)的髁突无骨质变化,1.90%(4/210)的髁突发生骨吸收。结论关节盘复位锚固术是治疗ADD的有效手段,盘复位位置稳定,并能刺激髁突骨再生。ObjectiveTo evaluate the stability of disc position and condylar status by magnetic resonance imaging(MRI)after temporomandibular joint(TMJ)disc repositioning surgery with miniscrew anchor technique.MethodsTotally 150 cases of patients diagnosed with anterior disc displacement(ADD)who received disc repositioning(210 joints)were selected from February 2009 to July 2017 in the Department of Oral Surgery,Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine. MRIs within 1 week after operation and during at least 1 year follow-up were used to evaluate changes in the disc position and condylar bone. During follow-up,ADD without reduction was considered relapse and the bone status was classified as regeneration or degeneration.ResultsPostoperative MRIs showed that all the discs were repositioned. During 12 to 96 months of follow-up(averaged 26.73 months),95.71%(201/210)of the discs were still in position,whereas 5.71%(12/210)of the discs had relapsed anteriorly. Condylar new bone formation was observed in 77.62%(163/210)of the joints,no bone change in 20.48%(43/210)of the joints,and bone resorption in 1.90%(4/210)of the joints.Conclusion TMJ disc repositioning by miniscrew anchor provides an effective means for the treatment of anterior disc displacement with stable result. Disc repositioin can also stimulate condylar bone regeneration.

关 键 词：颞下颌关节 关节盘前移位 关节盘锚固术 MRI 

分 类 号：R78[医药卫生—口腔医学]