颞下颌关节滑膜软骨瘤病术后功能及骨质改建研究  

A study on postoperative function and bone remodeling of temporomandibular joint synovial chondromatosis

作　　者：张宁[1] 陈稳 高润涛[1] 常世民[1] 王振 汤若薇 张熙东[3] 姜欣梅 黄晓峰[1] ZHANG Ning;CHEN Wen;GAO Runtao;CHANG Shimin;WANG Zhen;TANG Ruowei;ZHANG Xidong;JIANG Xinmei;HUANG Xiaofeng(Department of Stomatology,Beijing Friendship Hospital,Capital Medical University,Beijing 100032)

机构地区：[1]首都医科大学附属北京友谊医院口腔科,100032 [2]首都医科大学附属北京友谊医院放射科,100032 [3]河北医科大学第四医院药学部

出　　处：《现代口腔医学杂志》2024年第6期408-413,共6页Journal of Modern Stomatology

基　　金：北京市医院管理中心临床技术创新项目(XMLX202132);北京市博士后工作经费资助项目(2023-ZZ-022);国家自然科学基金青年项目(82302282);首都医科大学校培育项目(PYZ23075);四川省自然科学基金青年科学基金项目(2022NSFSC1525/2022NSFSC1455);河北省青年科技课题(20220167)。

摘　　要：目的探究颞下颌关节滑膜软骨瘤病(temporomandibular joint synovial chondromatosis,TMJ SC)的术后颞下颌关节功能、髁突-关节窝骨质改建情况。方法回顾首都医科大学附属北京友谊医院自2017年3月至2023年8月收治的TMJ SC患者,分析患者手术前后下颌功能运动、疼痛、骨质破坏评分改变情况,同时分析TMJ SC合并盘后区穿孔患者预后情况。结果本研究共筛查到病理结果确诊为TMJ SC患者7例。与术前相比,患者术后6个月随访时最大开口度(P=0.023)、前伸运动(P=0.027)、右侧侧方运动(P=0.022)、左侧侧方运动(P=0.032)和疼痛(P=0.019)均得到显著改善。术后随访中,髁突(5/7)、关节窝(6/7)骨质破坏比例较术前无变化。但是髁突骨质破坏评分较术前显著改善(P=0.026),而关节窝骨质破坏评分未见显著改善(P=0.078)。TMJ SC合并盘后区穿孔患者,术中同期行颞肌筋膜瓣转移修复,术后最大开口度和髁突骨质破坏评分均得到改善。结论TMJ SC手术治疗可显著地改善颞下颌关节功能和髁突骨质破坏。伴有盘后区穿孔时,颞肌筋膜瓣转移修复术是一种有效的治疗方案。Objective To explore the postoperative function of the temporomandibular joint synovial chondromatosis(TMJ SC)and the bone remodeling of the condylar-glenoid.Methods The patients with TMJ SC admitted to Beijing Friendship Hospital Capital Medical University from March 2017 to August 2023 were reviewed.The changes in mandibular function,pain,and bone destruction scores before and after surgery were analyzed.Besides,the prognosis of TMJ SC patients with posterior disc perforation was studied.Results In this study,7 patients with pathologically confirmed TMJ SC.The maximum mouth opening(P=0.023),mandibular distal extension(P=0.027),the right side mandibular lateral extension(P=0.022),the left side mandibular lateral extension(P=0.032),and pain(P=0.019)were significantly improved after 6 months of follow-up.Postoperative condylar bone destruction significantly improved compared to preoperative(P=0.026).However,there was no significant change in bone destruction of the joint fossa.After the temporalis myofascial flap was used for TMJ SC patients with posterior disc perforation,there was significant improvement in maximum mouth opening and destruction of condylar bone.Conclusion Clinical symptoms and condylar bone destruction were significantly improved after surgical treatment.Temporalis myofascial flap was an effective treatment for TMJ SC with perforation.

关 键 词：颞下颌关节 滑膜软骨瘤病 手术治疗 颞下颌关节功能 骨质改建 

分 类 号：R782.6[医药卫生—口腔医学]