急性创伤性关节盘前移位的诊断和治疗：附42例临床分析  

Diagnosis and treatment of acute traumatic temporomandibular joint disc displacement in 42 consecutive patients

作　　者：何冬梅[1] 杨秀娟[1] 杨驰[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5期425-429,共5页China Journal of Oral and Maxillofacial Surgery

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计划项目(14DZ2294300)

摘　　要：目的 :探讨创伤性关节盘前移位的诊断、治疗效果和后遗症的处理。方法 :收集我科2010—2015年收治的创伤性关节盘前移位病例,根据临床和影像学特点分为3期,即急性期、亚急性期和慢性期。比较不同方法治疗后髁突骨质的变化及开口度情况。采用SPSS软件包对数据进行t检验。结果:42例59侧关节纳入研究,其中急性期和亚急性期患者(18例27侧)髁突骨质破坏的发生率为18.5%,而慢性期(24例32侧)高达75%。22例30侧保守治疗的关节中,髁突骨质退变者占90%(平均随访8.8个月);31例47侧关节在伤后和保守治疗后接受手术治疗,其中23例34侧关节选择手术复位关节盘,髁突骨质吸收占4.5%,盘复位有效率达95.5%(15例22侧,平均随访22个月)。8例13侧晚期关节接受髁突切除关节置换。手术治疗组术后开口度比术前和保守治疗组显著增大(P<0.01)。结论:创伤性关节盘前移位发病隐匿,易引起骨关节病和关节强直等后遗症,早期关节盘复位手术可以显著降低骨关节炎和关节强直的发生率,晚期需要关节置换治疗。PURPOSE： To explore the diagnosis, treatment results and sequela of traumatic temporomandibular joint disc displacement （ATDD） in 42 consecutive patients. METHODS： Patients diagnosed of ATDD and treated from 2010 to 2015 were recruited. Their clinical and radiologic characters were analyzed based on 3 stages： acute phase, subacute phase and chronic phase. Conservative and surgical treatment results were evaluated and compared with SPSS software package. RESULTS： Forty-two patients with 59 joints were included in the study. Among the acute and sub-acute phases patients （18 cases with 27 joints）, 18.5% of the joints had condylar surface bone destruction, whereas 75% in the chronic phase （24 cases with 32 joints）. Twenty-two cases with 30 joints accepted conservative treatment; among them, 90% developed osteoarthritis after a mean follow-up period of 8.8 months. Thirty-one cases with 47 joints accepted surgical treatment after injury or conservative treatment. Among them, 23 cases with 34 joints had disc reposition, 95.5% were effective （15 cases with 22 joints, mean follow-up period of 22 months）. Eight cases with 13 end-stage joints accepted condylar resection and joint replacement. Their maximal incisor opening after surgery was significantly increased compared with that before surgery and conservative treatment （P〈0.01）. CONCLUSIONS： ATDD is easy to lead to osteoarthritis and ankylosis, disc reposition in the acute and sub-acute phases can significantly reduce the occurrence of above sequel; however, in the chronic phase, joint replacement may be necessary in selected patients.

关 键 词：颞下颌关节 创伤性关节盘前移位 关节强直 

分 类 号：R782.6[医药卫生—口腔医学]