耳屏小切口在颞下颌关节盘锚固术中应用效果评价  

Application effect of a minimal tragus incision for anchoring the temporomandibular joint disc

作　　者：牛强 李云鹏 张浚睿 郭维维 周善洛 刘富伟 李治冶 吕曜光 NIUQiang;LI Yun-peng;ZHANG Jun-rui;GUO Wei-wei;ZHOU Shan-luo;LIU Fu-wei;LI Zhi-ye;LYU Yao-guang(State Key Laboratory of Oral&Maxillofacial Reconstruction and Regeneration,National Clinical Research Center for Oral Diseases,Shaanxi International Joint Research Center for Oral Diseases,Departement of Oral and Maxillofacial Surgery,College of Stomatology,the Air Force Military Medical University,Xi'an 710032,China)

机构地区：[1]口颌系统重建与再生全国重点实验室,国家口腔疾病临床医学研究中心,陕西省口腔疾病临床医学研究中心,空军军医大学口腔医院颌面外科,陕西西安710032

出　　处：《中国实用口腔科杂志》2025年第2期183-187,194,共6页Chinese Journal of Practical Stomatology

基　　金：国家口腔疾病临床医学研究中心课题(LCB202205);陕西省重点研发计划项目(S2023-YF-GHZD-0108)。

摘　　要：目的 评价应用耳屏小切口行颞下颌关节盘锚固术的治疗效果。方法 选取2023年1—12月于空军军医大学口腔医院颌面外科就诊并应用耳屏小切口行颞下颌关节盘锚固术治疗的21例颞下颌关节盘不可复性前移位患者(27侧术区)的临床和影像学资料行回顾性分析。比较患者术前及术后6个月的最大张口度、前伸运动度、左侧方运动度、右侧方运动度、视觉模拟评分量表(VAS)疼痛评分、Friction颞下颌关节紊乱指数[包括下颌运动(MM)、关节杂音(JN)、关节触压诊(JP)、肌肉压诊(MP)、功能障碍指数(DI)、肌肉压痛指数(PI)和关节紊乱指数(CMI)]、关节盘长度及髁突高度,并评价关节盘复位效果。结果 21例患者术后6个月最大张口度、前伸运动度、左侧方运动度、右侧方运动度依次为(41.33±3.06)、(9.09±0.89)、(10.09±1.09)、(9.95±1.20)mm,分别较术前[(32.05±6.29)、(6.90±1.81)、(7.95±2.36)、(7.57±2.27)mm]明显增加,差异均有统计学意义(均P <0.05);与术前相比,术后6个月VAS疼痛评分、Friction颞下颌关节紊乱指数(除JN外)均降低,差异均有统计学意义(均P <0.05)。MRI检查结果显示,85.2%(23/27)的关节盘复位效果为优,14.8%(4/27)的关节盘复位效果为良。术后6个月关节盘长度为(9.29±1.35)mm,较术前[(7.62±1.44)mm]明显增加,差异有统计学意义(t=-7.293,P <0.001);术前与术后6个月髁突高度比较,差异无统计学意义(t=-1.468,P=0.154)。结论应用耳屏小切口行颞下颌关节盘锚固术治疗颞下颌关节盘不可复性前移位可有效复位关节盘,改善患者颞下颌关节运动情况与功能,并可缓解疼痛。Objective To evaluate the therapeutic effect of minimal tragus incision applied in temporomandibular joint disc anchorage(TMJ-DA).Methods The clinical and imaging data of 21 patients(27 sides)with anterior disc displacement without reduction(ADDWoR)who underwent TMJ-DA with a minimal tragus incision were retrospectively analyzed.The maximal mouth opening(MMO),maximal protrusive movement(PM),lef/right maximal lateral movement(LLM/RLM),visual analogue scale(VAS)pain score,disc length,condylar height and the Fricton indexes[including mandibular movement(MM),joint noise(JN),joint palpation(JP),muscle palpation(MP),dysfunction index(DI),palpation index(PI)and craniomandibular index(CMI)] were compared preoperatively and at six months postoperatively.Additionally,the efficacy of disc reposition was evaluated.ResultsTwenty-one patients exhibited significant improvements in MMO,PM,LLM and RLM at six months after surgery[being(41.33±3.06)mm,(9.09±0.89)mm,(10.09±1.09)mm,and(9.95±1.20)mm] compared with those before operation[being(32.05±6.29)mm,(6.90±1.81)mm,(7.95±2.36)mm,and(7.57±2.27)mm ](all P<0.05).Additionally,compared to preoperative levels,the VAS pain score and Friction indexes(excluding JN)showed a significant decrease at six months after surgery(all P<0.05).MRI examination results indicated that 85.2%(23/27)of the disc reposition effects were rated as excellent,while 14.8%(4/27)were rated as good.The disc's length at six months after surgery was significantly increased[post-operation:(9.29±1.35)mm;pre-operation:(7.62±1.44)mm)](t=-7.293,P<0.001),while there was no significant difference in condylar height between before surgery and at six months after surgery(t=-1.468,P=0.154).Conclusion TMJ-DA can be performed through the minimal tragus incision,and it is an effective method for reposition of temporomandibular joint disc,which improves MMO,relieves pain and restores the TMJ function.

关 键 词：颞下颌关节 关节盘不可复性前移位 颞下颌关节盘锚固术 耳屏小切口 

分 类 号：R78[医药卫生—口腔医学]