期刊导航

论文摘要

改良关节盘锚固术在颞下颌关节盘穿孔、破裂治疗中的应用

Application of modified articular disc anchorage in treating the perforation and rupture of temporomandibular joint disc

作者:王铁彪, 周五超, 肖寅, 程家龙, 欧阳洲城, 程晨, 习伟宏

Author:Wang Tiebiao, Zhou Wuchao, Xiao Yin, Cheng Jialong, Ouyang Zhoucheng, Cheng Chen, Xi Weihong.

收稿日期:2022-12-24          年卷(期)页码:2023,41(4):434-434-442

期刊名称:华西口腔医学杂志

Journal Name:West China Journal of Stomatology

关键字:颞下颌关节,关节盘前移位,关节盘穿孔,改良关节盘锚固术,手术治疗,

Key words:temporomandibular joint,anterior disc displacement,disc perforation,modified articular disc anchorage,surgical treatment,

基金项目:江西省重点研发计划(20203BBG73048)

中文摘要

目的 应用改良关节盘锚固术治疗陈旧性不可复性颞下颌关节盘移位伴穿孔、破裂,探讨其应用疗效。 方法 收集2018年1月—2021年12月于南昌大学附属口腔医院行手术治疗的颞下颌关节盘穿孔患者31例(34侧),穿孔47处。根据穿孔部位,将关节盘穿孔分为Ⅰ型(关节盘后份穿孔)、Ⅱ型(关节盘前份穿孔)、Ⅲ型(关节盘外侧穿孔)、复合型穿孔和损毁型穿孔5类。根据穿孔部位选择改良关节盘锚固术手术方式。Ⅰ型、Ⅲ型穿孔采用后锚定方式,于髁突颈部后外侧植入锚固钉,用锚固线在后份穿孔前缘或外侧穿孔内侧行水平褥式缝合,固定关节盘在锚固钉上。Ⅱ型及合并Ⅱ型穿孔的复合型穿孔采用前后双锚定方式,其中前锚定是在髁突颈部前缘置入锚固钉或制备贯通的孔,用锚固线在前份穿孔后缘行水平褥式缝合,固定关节盘在锚固钉或孔洞上,后锚定方法同前。损毁型穿孔不采用锚固术修复。采用配对t检验分析术前及术后1、3、6个月患者的疼痛视觉模拟评分(VAS)、最大张口度(MIO)、颞下颌关节紊乱指数(CMI),分析术后磁共振成像(MRI)影像中关节盘复位情况及患者术后生活质量。 结果 34侧穿孔中,Ⅰ型穿孔14侧(41.2%),Ⅱ型穿孔4侧(11.8%),Ⅲ型穿孔3侧(8.8%),复合型穿孔10侧(29.4%),损毁型穿孔3侧(8.8%)。改良关节盘锚固术后3、6个月患者的VAS、MIO、CMI明显改善,与术前相比差异均有统计学意义(P<0.05)。关节盘有效复位率为96.77%(30/31)。术后6个月患者生活质量评分为47.22±2.13,评价为优者占96.4%(27/28)。 结论 改良关节盘锚固术治疗颞下颌关节盘穿孔、破裂具有良好的效果,是治疗关节盘穿孔、破裂的一种有效方法,其远期效果需进一步观察。

英文摘要

ObjectiveThis study aimed to use modified articular disc anchorage in treating old irreducible temporomandibular joint (TMJ) disc displacement with perforation and rupture, as well as to explore its efficacy.MethodsA total of 31 patients (34 sides) with 47 TMJ disc perforations who underwent surgical treatment in the Affiliated Stomatolo-gical Hospital of Nanchang University from January 2018 to December 2021 were selected. According to the location of disc perforation, it has five types: posterior disc perforation (typeⅠ), anterior disc perforation (typeⅡ), lateral disc perforation (type Ⅲ), composite disc perforation, and destruction disc perforation. The modified methods of disc anchoring were divided into two types according to the location of the perforation. TypesⅠandⅢ disc perforation were trea-ted by posterior anchoring method. For posterior ancho-ring, a screw was implanted into the posterolateral side of the condylar neck, and the disc was fixed on the screw by horizontal mattress suture. TypeⅡdisc perforation and compo-site disc perforation combined typeⅡperforation were treated by anterior and posterior double-anchoring method. For anterior anchoring, anchor screws or holes were placed at the anterior edge of the condylar neck, and horizontal mattress suture was performed at the posterior edge of the anterior perforation with an anchor wire. The articular disc was then fixed on the anchor screws or holes. For the posterior anchoring method, it was the same as the previous one. Pairedttest was used to analyze the visual analog scale (VAS), maximum interincisal opening (MIO), and TMJ disorder index (CMI) of the patient before surgery and 1, 3, and 6 months after surgery. Disk-condyle position relationship by magnetic resonance imaging and postoperative quality of life in postoperative were analyzed.ResultsThe incidence of perforation was 41.2% (14/34) in typeⅠ, 11.8% (4/34) in typeⅡ, 8.8% (3/34) in typeⅢ, 29.4% (10/34) in composite type, and 8.8% (3/34) in destruction type. The VAS, MIO, and CMI at 3, 6 months after operation significantly improved compared with those before operation (P<0 .05). the effective reduction rate of disc was 96.77% (30/31). the quality of life at 6 months after surgery was 47.22±2.13, and the rate of excellent evaluation was 96.4% (27/28).ConclusionModified articular disc anchorage achieves a good curative effect for treating temporomandibular joint disc perforation and rupture. Nevertheless, its long-term effect requires further observation.

下一条:颏部形态对正畸治疗影响的研究

关闭

Copyright © 2020四川大学期刊社 版权所有.

地址:成都市一环路南一段24号

邮编:610065