游离冠突与肋骨移植治疗颞下颌关节强直的疗效分析  

Comparison of temporomandibular joint reconstruction with free coronoid process graft and costochondral graft in the treatment of temporomandibular joint ankylosis

作　　者：黄栋[1] 何冬梅[1] 杨驰[1] 陆川[1] 白果[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》2016年第1期33-38,共6页China Journal of Oral and Maxillofacial Surgery

基　　金：国家自然科学基金(81472117);上海市卫计委青年项目(20154Y0189);上海交通大学医工交叉面上项目(YG2014MS05);上海交通大学医工交叉基金青年项目(YG2015QN04)

摘　　要：目的：比较游离冠突移植（free coronoid processgraft，CPG）与肋骨移植（costochondral graft，CCG）治疗颞下颌关节强直的疗效。方法：回顾2011—2014年我科收治的采用CPG和CCG治疗的10例（15侧）颞下颌关节强直患者，对手术后CT及至少6个月以上随访期的CT进行三维重建．采用Proplan CMF1．4软件（Materialize。比利时）测量植骨块的高度，比较不同方法移植骨的吸收情况，同时对随访期患者的开口度和咬合关系进行比较。采用SPSS19．0软件包中的配对t检验比较2种方法移植骨的吸收量，评价2种方法的效果。结果：5例（7侧）CPG患者术后平均随访16．8个月（6。22个月），冠突平均吸收5．41mm，占移植骨高度的21．9％，冠突顶部圆钝改建。随访期末最大开口度平均为31．6mm，较术前显著增加fP〈0．05）；4例出现前牙开猞，1例关节强直复发；5例（8侧）CCG患者术后平均随访14．4个月（6。30个月），肋骨平均吸收2．44mm，占移植骨高度的6．2％；随访期末最大开口度平均为33．6mm，较术前显著增加fP〈0．05）：4例咬合关系稳定，1例出现开猞，无关节强直复发。结论：颞下颌关节强直的治疗中，游离冠突移植比肋骨移植的骨吸收率高，易引起咬合关系改变。PURPOSE： To compare the effect of free coronoid process graft （CPG） and costochondral graft （CCG） in the treatment of temporomandibular joint ankylosis （TMJA）. METHODS： Ten TMJA patients （15 joints） treated with CPG or CCG in our department from 2011 to 2014 were included in this study. All patients were followed up for more than 6 months after operation. Post operative CT scan data within 1 week after operation and during follow up were imported into the Proplan CMF 1.4 software （Materialize, Belgium） for 3 dimensional reconstruction and measurement. Bone absorption was measured and compared between the 2 methods using paired t test with SPSS 19.0 software package. Maximum mouth opening （MMO） and occlusion were also evaluated and compared before and after operation. RESULTS： In CPG group, the average follow-up duration was 16.8 months （ranged from 6-22 months）. The average bone absorption was 5.41 mm （21.9% of the initial height）. Tip of the grafted bone was reformed to be round. The average MMO was 31.6ram, which had significant difference between the preoperative values （P〈0.05）. Four of 5 patients developed open bite, one patient had TMJA recurrence. In CCG group, the average follow-up duration was 14.4 months （ranged from 6-30 months）. The average bone absorption was 2.44 mm （6.2% of the initial height）. The average MMO was 33.6 mm, which had a significant difference between the preoperative values （P〈0.05）. One of 5 patients developed open bite, the other 4 patients had stable occlusion. No patient had recurrence. CONCLUSIONS： In the treatment of TMJA, bony absorption rate in CPG patients was higher than that in CCG patients, which was easy to cause occlusion changes.

关 键 词：颞下颌关节强直 游离冠突移植 游离肋骨移植 颞下颌关节重建 

分 类 号：R782.6[医药卫生—口腔医学]