成人颞下颌关节强直及其继发畸形的分类与治疗  

Classification for treatment of adult temporomandibular joint ankylosis and its secondary malformations

作　　者：王瑞宇 姜楠[1] 曹品银 刘尧[1] 祝颂松[1] 毕瑞野[1] WANG Ruiyu;JIANG Nan;CAO Pinyin;LIU Yao;ZHU Songsong;BI Ruiye(State Key Laboratory of Oral Diseases&National Clinical Research Center for Oral Diseases&Department of Orthognathic and TMJ Surgery,West China Hospital of Stomatology,Sichuan University,Chengdu 610041,China)

机构地区：[1]口腔疾病研究国家重点实验室,国家口腔疾病临床医学研究中心,四川大学华西口腔医院正颌及关节外科,四川成都610041

出　　处：《口腔疾病防治》2022年第10期712-717,共6页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：国家自然科学基金项目(81771097、81801003);四川大学创新研究项目(2022SCUH0022)。

摘　　要：目的建立成人颞下颌关节强直分类新体系,指导不同临床特点的成人颞下颌关节强直(temporo-mandibular joint ankylosis,TMJA)患者治疗方案的制定。方法提出基于成人颞下颌关节功能重建的“CD”强直分类法,即髁突残留情况(C)、牙颌面畸形程度(D)分类法。选取2016年1月至2020年4月就诊于四川大学华西口腔医院正颌及关节外科的TMJA患者共56例(73侧强直关节),采用“CD”分类法将患者分为4个亚类,分别为内侧髁突头部分残留且无明显骨性错颌(C+D-)、内侧无髁突头残留且无明显骨性错颌(C-D-)、内侧髁突头部分残留且伴骨性错颌(C+D+)、内侧无髁突头残留且伴骨性错颌(C-D+)。对不同亚类患者采取不同的颞下颌关节重建治疗策略并进行随诊。“C+”:采取关节外侧成形术(lateral arthroplasty,LAP),在解除强直的同时保留内侧残留髁突;“C-”:强直骨球较小,升支高度丧失不明显,行关节间隙成形解除强直;强直骨球较大,升支高度降低明显,解除强直后行关节重建;“D+”:同期或分期采用外科手段矫治继发牙颌面畸形;“D-”:术后进行正畸治疗改善咬合关系,口腔疾病对症治疗。结果根据“CD”分类法采取不同颞下颌关节强直手术治疗策略后,56例患者共73侧关节强直全部解除,平均开口度由(3.6±3.2)mm提升至(32.8±5.4)mm(P<0.001)。术后随访12~48个月,未见关节强直复发。结论“CD”分类法对高效指导成人关节强直患者临床方案的制定有积极指导意义,也有利于将颞下颌关节功能重建的理念在更多单位进行推广。Objective To generate a new classification for adult temporomandibular joint ankylosis(TMJA),which could effectively guide treatment strategies for adult TMJA patients with various clinical features.Methods We developed a new"CD"classification system according to the preservation of the condyle(C)and the severity of dentofacial bone deformity(D).From January 2016 to April 2020,56 TMJ patients(with 73 ankylosed joints)in our department were classified into 4 subgroups by‘CD’classification:condylar head preservation but no dentofacial deformities(C+D-),no condylar head preservation and no dentofacial deformities(C-D-),condylar head preservation and dentofacial deformities(C+D+),and no condylar head preservation but dentofacial deformities(C-D+).Different strategies were used according to the clinical features of each subgroup.The clinical outcomes of these patients were analyzed.Different treatment strategies of temporomandibular joint reconstruction were adopted for different subclasses of patients and were followed."C+":lateral arthroplasty(LAP)was used to remove the rigidity and preserve the medial residual condyle."C-":if the ankylosing bone ball is small and the loss of ascending branch height is not obvious,arthroplasty should be performed to relieve ankylosis;however,if the ankylosing bone ball is large and the ascending branch height decreases significantly,joint reconstruction should be carried out after the ankylosis is relieved."D+":surgical treatment of secondary dental and maxillofacial malformations at the same time or over stages."D-":orthodontic treatment after operation to improve occlusal relationship and symptomatic treatment of oral diseases.Results After treatment,all 73 ankylosed joints were completely released,and the average maximal interincisal opening increased from(3.6±3.2)to(32.8±5.4)mm(P<0.001),with no recurrence of ankylosis found during the 12-48 month follow-up period.Conclusion The generation and elaboration of a‘CD’classification system is intended to help as a TMJA recon

关 键 词：成人颞下颌关节强直 分类方法 牙颌面畸形 颞下颌关节重建 关节外侧成形术 正颌手术 关节间隙成形术 正畸治疗 

分 类 号：R78[医药卫生—口腔医学]