对创伤性颞下颌关节强直发生与分类治疗的几点认识  

Management of traumatic temporomandibular joint ankylosis:a perspective

作　　者：张益[1] 贺洋[1] Zhang Yi;He Yang(Department of Oral and Maxillofacial Surgery,Peking University School and Hospital of Stomatology&National Center for Stomatology&National Clinical Research Center for Oral Diseases&National Engineering Research Center of Oral Biomaterials and Digital Medical Devices&Beijing Key Laboratory of Digital Stomatology,Beijing 100081,China)

机构地区：[1]北京大学口腔医学院·口腔医院口腔颌面外科,国家口腔医学中心,国家口腔疾病临床医学研究中心,口腔生物材料和数字诊疗装备国家工程研究中心,口腔数字医学北京市重点实验室,北京100081

出　　处：《中华口腔医学杂志》2023年第10期985-990,共6页Chinese Journal of Stomatology

摘　　要：关节创伤约占颞下颌关节强直病因的85%以上,髁突矢状骨折是最易导致关节强直的“危险类型”骨折。关节盘移位是关节强直形成的必要条件,但不是唯一条件,上下关节面重度损伤及彼此间紧密接触也是关节强直发生的重要条件。关节强直的发生及形成机制类似于肥大性骨不连,强直骨球内透射带的持续存在主导了强直进程。Ⅰ型强直要求复位关节盘、Ⅱ型强直要求保留假关节,是创伤性关节强直的治疗特点。目前关节强直术后的复发率依然没有得到有效控制,儿童、双侧强直和喙突移植重建髁突患者的术后复发率较高。Traumatic injury to the temporomandibular joint(TMJ)was the most common cause of TMJ ankylosis(85%),while sagittal fracture of the mandibular condyle was identified as the high risk fracture pattern.TMJ disc displacement is one of the prerequisite factors of TMJ ankylosis.The severe damage and close contacts of both the articular surface of glenoid fossa and condyle were also crucial pathogenic factors in the development of TMJ ankylosis.The mechanism and development of TMJ ankylosis may be similar to hypertrophic non-union,and the persistence of radiolucent zone within the ankylotic callus governs the clinical and pathological process of TMJ ankylosis.In typeⅠtraumatic TMJ ankylosis,repositioning of the displaced disk is required,while the preservation of pseudo-joint is essential in the management of the typeⅡtraumatic TMJ ankylosis.Nevertheless,the rate of TMJ reankylosis still remains high.Higher rate of TMJ reankylosis was observed in paediatric population,bilateral involvement of TMJ ankylosis,and in cases with reconstruction of mandibular condyle with coronoid process.

关 键 词：颞下颌关节 关节强直 髁突骨折 临床分类治疗 

分 类 号：R782.6[医药卫生—口腔医学]