双侧陈旧性颞下颌关节脱位诊疗经验总结  

The experience in diagnosis and treatment of bilateral chronic protracted mandibular dislocation

作　　者：邹姣姣 侯笑茹 王淋 李立峰 李彦秋 虎小毅[1,2,3] 邢晓涛 ZOU Jiaojiao;HOU Xiao-ru;WANG Lin;LI Li-feng;LI Yan-qiu;HU Xiao-yi;XING Xiao-tao(Key laboratory of Shaanxi Province for Craniofacial Precision Medicine Research,College of Stomatology,Xi’an Jiaotong University,Shaanxi Xi’an 710000,China;Laboratory Center of Stomatology,College of Stomatology,Xi’an Jiaotong University,Shaanxi Xi’an 710000,China;Department of Cranio-Maxillofacial Trauma and Plastic Surgery,College of Stomatology,Xi’an Jiaotong University,Shaanxi Xi’an 710000,China)

机构地区：[1]西安交通大学口腔医院陕西省颅颌面精准医学研究重点实验室,陕西西安710000 [2]陕西省牙颌疾病临床研究中心,陕西西安710000 [3]西安交通大学口腔医院创伤整形外科,陕西西安710000

出　　处：《临床口腔医学杂志》2024年第4期200-204,共5页Journal of Clinical Stomatology

基　　金：国家自然科学基金项目(32300981);西安交通大学口腔医院院设科研项目(00694)。

摘　　要：目的:探讨并总结我院收治的双侧陈旧性颞下颌关节脱位(chronic protracted mandibular dislocation,CPMD)的病例特征、治疗方案及预后,为陈旧性颞下颌关节脱位的防治提供临床参考。方法:回顾性分析2019年12月~2023年5月于我院住院治疗的9例CPMD病例,总结并分析CPMD患者的基本资料、脱位类型、脱位时间及临床症状;发病时所伴随的其他系统疾病及意识状态;复位方法、复位用时、住院天数及并发症;出院随访张口度、咬合关系及复发情况。结果:9例CPMD患者平均年龄(67±11.3)岁,女性占比88.9%;脱位类型均为双侧前脱位,脱位平均时间(2.1±1.4)个月。神经系统损伤是CPMD发病联系最密切的危险因素,发病时意识不清的患者占77.8%,仅22.2%的患者在初期感知脱位症状;约88.9%的CPMD病例发病与医疗活动存在密切联系。8例患者在麻醉下手法复位,手法复位率达88.9%,平均时间(24.3±10.9)min,1例患者行手术复位。复位后均给予弹性牵引及后期张口功能训练。除手术复位患者存在轻微张口受限及面神经损伤外,其他患者随访期间咬合关系及张口度正常,无复发及并发症。结论:CPMD主要继发于意识丧失的颅脑损伤性疾病;全麻下手法复位配合牵引钉+橡皮圈弹性牵引是治疗CPMD的首选及有效方法,但必要时仍需手术复位。Objective:To explore and summarize the characteristics,therapeutic regimens,and prognosis of chronic protracted mandibular dislocation(CPMD)in our hospital in order to provide the clinical references for prevention and treatment of CPMD.Methods:Retrospective analysis of 9 clinic cases diagnosed with CPMD hospitalized in our hospital from December 2019 to May 2023.To analyze and summarize the basic data,dislocation type,dislocation duration,clinical representations,risk factors,patients’conscious state,reduction method,reduction time,hospital stays,and complications.The mouth opening,occlusion,and joint stability in followed-up period were also analyzed.Results:The average age of 9 patients was(67±11.3)years,and 88.9%were females.All the patients been diagnosed with bilateral anterior dislocation whose duration of dislocation was(2.1±1.4)months.Nervous system injuries were the most closely related risk factor for CPMD.About 77.8%cases shown unconscious during CPMD onset,only 22.2%patients had the immediate perception of dislocation.About 88.9%cases of CPMD were closely related to medical activities.Manual reduction was performed in 8 cases under anesthesia with an average time of(24.3±10.9)minutes and the manual reduction rate was 88.9%,besides 1 case were treated with surgery method.All the patients received elastic intermaxillary traction after reduction,normal occlusion and mouth opening,no re-dislocation and complications were found in manual reduction,besides the condition of slight limitation and facial nerve injury in surgery case.Conclusion:CPMD is mainly secondary to nervous system injuries with unconsciousness.Manual reduction under general anesthesia combined with elastic traction using traction nail is the preferred and effective treatment of CPMD,but surgery reduction is still available if necessary.

关 键 词：陈旧性颞下颌关节脱位 手法复位 弹性颌间牵引 手术复位 

分 类 号：R782.6[医药卫生—口腔医学]