改良人工全颞下颌关节置换术及效果评价  

Modified total alloplastic temporomandibular joint reconstruction and evaluation of efficiency

作　　者：刘欢[1] 张晓虎[1] 杨驰[1] 张善勇[1] 陈敏洁[1] 何冬梅[1] 邱亚汀[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

出　　处：《中国口腔颌面外科杂志》2014年第4期318-322,共5页China Journal of Oral and Maxillofacial Surgery

基　　金：国家自然科学基金(81371168);上海市自然科学基金(10ZR1418200);2011年上海市浦江人才计划~~

摘　　要：目的：介绍一种人工全颞下颌关节（temporomandibular joint,TMJ）置换的改良术式并评价其临床应用效果。方法：自2006年9月,我院开始引进Biomet-Lorenz公司（Jacksonville,FL）标准型假体系统进行人工全TMJ置换术,对手术方法进行改良,包括1切取关节结节/髁突骨块填充关节窝,增加关节窝假体固定的稳定性;2保留关节盘,作为髁突假体的内侧充填物,防止发生异位骨化;3经下颌下切口切取皮下游离脂肪瓣,避免腹部切口。拍摄全口曲面体层片（panoramic radiographs,PR）或CT,分别于术后即刻、6个月、1年观察假体位置及其周围骨结构。采用SAS 9.13软件包对数据进行统计学处理。结果：随访12例（14侧）患者,平均随访期26.08个月（4~48个月）。11例（13侧）采用自体骨转移,辅助关节窝假体固位,其中采用关节结节骨块7例（10侧）,髁突骨块2例（2侧）,下颌支残端骨块1例（2侧）;5例（5侧）保留关节盘作为髁突假体内侧充填物;10例（10侧）从下颌下切口切取皮下游离脂肪瓣。术后即刻、6个月、1年影像学（PR或CT）检查均显示关节窝及下颌假体位置良好,患者假体周围骨结构均未见异常。术后所有患者咬合关系稳定,未见假体松动现象。结论：人工全TMJ置换改良术式有助于提高假体的稳定性,减少术后异位成骨的发生,避免额外手术切口,值得推广应用。PURPOSE： To introduce modified surgical techniques of total alloplastic temporomandibular joint（TMJ）reconstruction and evaluate the clinical outcomes. METHODS： In 2006, we began to use the Biomet-Lorenz（Jacksonville,FL） stock replacement, and made some modifications regarding to surgical techniques as follows： 1The eminence or condyle bone was used for filling the fossa to make it flat and ensure the stability of the retention of the fossa prosthesis; 2The disc was filled into the condylar prosthesis to prevent heterotopic bone; 3Free fat graft was obtained from the submandibular approach to avoid abdominal incision. Postoperative follow-up was made based on panoramic radiographs（PR） or CT to observe the position of the prostheses and the surrounding bone structure for 6 months and 1 year, respectively. SAS 9.12 software package was used for data analysis. RESULTS： Twelve patients（14 sides） were followed up. The average follow-up period was 26.08 months（4 to 48 months）. Thirteen fossa prostheses（11 cases） were fitted with bone graft： the bone in 7cases（10 sides） was from the eminence, 2 cases（2 sides） from the condyle, 1 case（2 sides） from the mandibular notch; The discs in 5 cases（5 sides） were reserved to fill into the condylar prostheses; Free fat graft in 10 cases（10 sides） was obtained via the submandibular approach. Postoperative imaging examination（PR or CT） at 6-month and 1-year showed the position of fossa and mandibular prostheses was good in all patients and the periprosthetic bone structure showed no abnormalities.All patients showed postoperative occlusal stability and no phenomenon of prostheses loosening. CONCLUSIONS： Modified total alloplastic TMJ reconstruction can help to improve the stability of prostheses, to reduce postoperative heterotopic bone,and to avoid additional surgical incision, which is worth of wide application.

关 键 词：人工全关节置换 颞下颌关节 改良术式 

分 类 号：R782.6[医药卫生—口腔医学]