关节盘锚固定术治疗颞下颌关节盘前移位的临床应用

›› 2015, Vol. 35 ›› Issue (8): 658-661.

关节盘锚固定术治疗颞下颌关节盘前移位的临床应用

刘登峰¹,孙仁义²,肖进²,胡孙强¹,刘捷凡¹

1. 温州医科大学附属口腔医院
2. 温州医学院附属口腔医院

收稿日期:2013-12-18 修回日期:2014-03-14 出版日期:2015-08-28 发布日期:2015-08-14
通讯作者: 刘登峰 E-mail:liudf21@sina.com

Application of disc anchorage in the treatment of anterior disc displacement without reduction

Received:2013-12-18 Revised:2014-03-14 Online:2015-08-28 Published:2015-08-14
Contact: Deng-Feng LIU E-mail:liudf21@sina.com

摘要/Abstract

摘要： 目的通过对不可复性盘前移位的患者行关节盘复位锚固定术，探讨关节盘锚固定术治疗不可复性盘前移位的疗效。方法对根据临床症状及磁共振成像诊断为不可复性盘前移位的患者15例（20侧关节）行关节盘锚固定术。结果 15例20侧关节接受关节盘复位固定术，手术后MRI显示12例16侧达到优，2例3侧达到良，有效率为95%，仅有1侧为“差”，占5%。所有不可复性盘前移位患者术后3、6、12个月较术前的疼痛改善依次为90%、95%、90%，下颌最大侧向运动改善依次为0.4、3.2、5.9 mm，最大张口度改善依次为8.6、16.2、22 mm。结论关节盘锚固定术治疗不可复性盘前移位具有显著疗效。

关键词: 颞下颌关节盘, 关节盘锚固定术, 不可复性关节盘前移位

Abstract: Objective To investigate the clinical effect of Disc Anchorage for anterior disc displacement without reduction according to MRI.Methods Disc Anchorages were applied on 15 patients (20 sides) of Anterior disc displacement without reduction according to clinical symptoms and MRI.Results Postoperative MRI showed that among the 15 cases(20 sides) of Disc Anchorage,12 cases(16 sides) achieved excellent result,2 cases(3 sides) achieved good result,and the effective rate was 95%.Only 1 side was “poor pressing”,accounting for 5 %,which had longer course,serious deformation of TMJ disc morphology,and shortened length of disc.A clinical followup of all patients was carried out 3 months,6 months and 12 months after surgery,to compare the pain,mouth opening,degree of lateral movement changes before and after surgery.Conclusions Disc Anchorage has a significant effect on anterior disc displacement without reduction.

Key words: temporomandibular joint disc, disc anchorage, anterior disc displacement without reduction

中图分类号:

R782.6

刘登峰孙仁义肖进胡孙强刘捷凡. 关节盘锚固定术治疗颞下颌关节盘前移位的临床应用[J]. 口腔医学, 2015, 35(8): 658-661.

参考文献

[1]马绪臣.颞下颌关节病的基础与临床［M］.2版，北京：人民卫生出版社，2004：184,195.
[2]邱蔚六，张震康.口腔颌面外科学［M］.5版.北京:人民卫生出版社,2004:304.
[3]Israel HA.Technique for placement of a discal traction suture during temporomandibular joint arthroscopy[J].J Oral Maxillofac Surg,1989,47(3):311-313
[4]Tarro AW.Arthroscopic treatment of anterior disc displacement:a preliminary report[J].J Oral Maxillofac Surg,1989,47(4):353-358
[5]Ohnishi M.Arthroscopic surgery for hypermobility and recurrent mandibular dislocation[J].Oral Maxillofac Surg Clin North Am,1989,1(2):153-156
[6]McCain JP,Podrasky AE,Zabiegalski NA.Arthroscopic disc repositioning and suturing:a preliminary report[J].J Oral Maxillofac Surg,1992,50(6):568-579
[7]Drace JE,Enzmann DR.Defining the normal temporomandibular joint:closed,partially open,and openmouth MR imaging of asymptomatic subjects［J］.Radiology,1990,177(1)∶67-71.
[8]张善勇，杨驰，蔡协艺，等.MRI评价颞下颌关节镜盘复位固定术的短期疗效[J].口腔颌面外杂志,2008,18(2):31-34
[9]Emshoff R,Innerhofer K,Rudisch A,et al.Clinical versus magnetic resonance imaging findings with internal derangement of the temporomandibular joint:an evaluation of anterior disc displacement without reduction[J].J Oral Maxillofac Surg,2002,60(1):36-41
[10]Sato S,Goto S,Nasu F,et al.Natural course of disc displacement with reduction of the temporomandibular joint:changes in clinical signs and symptoms[J].J Oral Maxillofac Surg,2003,61(1):32-34
[11]Emshoff R,Brandlmaier I,Bodner G,et al.Condylar erosion and disc displacement:detection with highresolution ultrasonography[J].J Oral Maxillofac Surg,2003,61(8):877-881
[12]Annandale T.On displacement of the interarticular cartilage of the lower jaw and its treatment by operation[J].Lancet,1887,1:411-412
[13]Wilkes CH.Arthrography of the temporomandibular joint in patientswith the TMJ paindysfunction syndrome[J].Minn Med,1978,61(11):645-652
[14]Mehra P,Wolford LM.The Mitek mini anchor for TMJ disc repositioning:surgical technique and results[J].Int J Oral Maxillofac Surg,2001,30(6):497-503
[15]张善勇，陈敏洁，姜滨，等.关节盘锚固定术治疗中晚期TMJ 结构紊乱的临床效果[J].中国口腔颌面外科杂志,2008,6(11):415-420
[16]VázquezDelgado E,ValmasedaCastellón E,VázquezRodríguez E,et al.Longterm results of functional open surgery for the treatment of internal derangement of the temporomandibular joint[J].Br J Oral Maxillofac Surg,2004,42(2):142-148