青少年进展期髁突特发性吸收的多学科联合治疗  

Multidisciplinary approach to adolescent idiopathic condylar resorption at progressing stage

作　　者：张丹[1] 刘欢叶[1] 周青[2] 

机构地区：[1]中国医科大学口腔医学院颞下颌关节联合治疗中心正畸教研室 [2]中国医科大学口腔医学院颞下颌关节联合治疗中心口腔颌面外科教研室,辽宁省口腔医学研究所,辽宁省口腔疾病转化医学研究中心,辽宁沈阳110002

出　　处：《中国实用口腔科杂志》2017年第6期330-334,共5页Chinese Journal of Practical Stomatology

基　　金：辽宁省自然科学基金(20170541010)

摘　　要：髁突特发性吸收(idiopathic condylar resorption,ICR)是一种罕见的以髁突骨吸收为主要临床表现的关节退行性病变,表现为以髁突骨关节面破坏为主的一系列炎症反应,严重影响口颌面美观及功能,是口腔临床治疗的难点和重点。文章从ICR的病因入手,探讨其可能的致病因素,并结合青少年进展期ICR的临床特点,深入阐述以关节腔注射-稳定性咬合板治疗-正畸治疗-关节盘复位术-下颌牵张成骨-正颌外科手术为主要治疗手段的多学科联合治疗。对于早期关节腔炎症反应明显、髁突形态未遭到严重破坏的患者,采取关节腔注射结合稳定性咬合板治疗的可逆性保守治疗;在上述治疗基础上,对于关节腔炎症反应基本得到控制、髁突骨皮质连续性逐渐恢复、髁突高度基本维持的患者,采取以MEAW技术髁突减压为代表的正畸非可逆性保守治疗;对于髁突形态遭到严重破坏的患者,采取牵张成骨术、正颌外科手术、全关节置换等方法恢复颜面美观及口颌面系统的正常生理功能。以期在该疾病的快速进展期,切实有效地控制关节腔的炎症反应,最大限度恢复髁突骨皮质的连续性,保留髁突的正常形态和功能,避免形成严重的骨性畸形。Idiopathic condylar resorption （ICR） is a rare degenerative osteoarthropathy characterized by condyle resorption of unknown origin.The clinical manifestation of ICR is a series of inflammatory reaction of the condyle,which destroys the normal structure of the condyle.Patients with ICR have a classic facial morphology,including retruded mandible,high occlusal plane,and tendency for a class Ⅱ open bite that worsens with time.So far,the etiology and pathogenesis of ICR remains unclear.This article will start with the causes and the clinical characters of this disease.This article goes deeply into the treatment plan of adolescent ICR.A multidisciplinary approach of intra-articular injection combined with stability splint and orthodontic treatment,as well as oral surgery is recommended in this article.The purpose of the multidisciplinary approach is to control the intra-articular inflammation reaction,in order to protect the condyle from further resorption.

关 键 词：髁突特发性吸收 关节腔注射 稳定性咬合板 富血小板血浆 

分 类 号：R78[医药卫生—口腔医学]