内镜辅助开放性手术治疗颞下颌关节滑膜软骨瘤病36例临床分析  

Open surgery assisted with arthroscopy to treat synovial chondromatosis of temporomandibular joint: a retrospective study of 36 consecutive cases

作　　者：白果[1] 杨驰[1] 邱亚汀[1] 陈敏洁[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4期328-331,共4页China Journal of Oral and Maxillofacial Surgery

基　　金：上海市科学技术委员会科研计划项目(14DZ2294300);上海市卫生与计划生育委员会科研基金(201440548)

摘　　要：目的:利用内镜辅助开放性手术治疗颞下颌关节滑膜软骨瘤病,探讨其适应证及应用效果。方法 :选择2010年9月—2015年2月间收治的36例滑膜软骨瘤病患者,术前进行临床资料采集及影像学检查,明确诊断并确定病灶范围。对其中病变位于关节上腔,且MRI冠状位重建上显示关节囊内侧沟扩张低于髁突内侧嵴而未达颞下间隙的患者,选择开放性手术配合内镜行游离体摘除,并彻底进行关节囊及滑膜清扫。术后临床检查关节-颌骨-咬合情况并进行远期影像学随访,以评价应用效果。结果:36例患者先行开放性手术摘除关节腔内可见游离体,再利用内镜行关节上腔探查,发现14例患者在内侧沟、前后隐窝等区域存在游离体残余,配合杯状钳取出,最后行关节囊清扫和病变滑膜切除,术后病理提示滑膜软骨瘤病。术后33例患者完成随访,其颞下颌关节功能恢复良好,咬合及面型稳定,平均33.3个月的磁共振随访显示无肿瘤复发。结论:颞下颌关节镜辅助开放性手术可观察关节腔各个位置,以彻底清除病灶,避免术中截骨和病灶残留,减小手术创伤并缩短手术时长,是传统手术方案的有力补充。PURPOSE： Arthroscopy facilitated open surgery was carried out for the treatment of synovial chondromatosis of temporomandibular joint（TMJ）, its indications and effects were discussed. METHODS： Patients with synovial chondromatosis of TMJ who were hospitalized from September 2010 to February 2015 were included in this study. Clinical and medical imaging examinations were conducted prior to surgery in order to confirm the diagnosis and range of the tumor. For those with tumors in their upper articular cavities and medial groove expansion of the joint capsule still in between medial crest of the condylar head and inferior temporal gap, shown by their coronal MRI reconstructions,arthroscopy was chosen to assist the open surgery procedure in resecting free substances and performing a thorough cleanup of TMJ capsule and synovium. Post-operative joint-jaw-occlusion relationship examinations and long-term imaging follow-ups were conducted to evaluate the clinical effect of this treatment. RESULTS： Free substances were found in the resected TMJ capsules of 36 patients by open surgery. Further examinations with arthroscopy indicated that more free substances were contained in the medial groove or the anterior and posterior recessus of 14 patients, which were all removed using a cup-shaped clamp. A finishing touch of a thorough clean-up of the joint capsule and synovium was applied with arthroscopy; pathologic examinations proved the diagnosis of synovial chondromatosis. After treatment, all patients experienced good recoveries of their TMJ functions and achieved stable occlusions and face shapes. MRI scans in an average of 33.3 months after surgery indicated no recurrence of the tumor. CONCLUSIONS： Arthroscopy can be a great facilitating tool in open surgery to detect the articular cavity from multiple perspectives. Utilization of this technique has benefits in a complete elimination of the diseased tissues with minimal osteotomy required and reductions of the wounded area and surgical time. Thus, arthroscopy c

关 键 词：颞下颌关节 滑膜软骨瘤病 内镜 开放性手术 

分 类 号：R739.8[医药卫生—肿瘤]