关节镜在颞下颌关节滑膜软骨瘤病治疗中的临床应用体会

doi:10.13591/j.cnki.kqyx.2026.03.007

摘要/Abstract

摘要：

目的总结关节镜对颞下颌关节滑膜软骨瘤病(temporomandibular joint synovial chondromatosis, TMJ SC)诊治的临床意义。方法本研究回顾性分析北京大学口腔医院2020年9月至2024年9月收治的17例经磁共振检查初步诊断为TMJ SC的病例,所有患者均经关节镜手术治疗,并对其术前检查、术后随访的最大张口度、视觉模拟疼痛评分进行分析总结。结果经关节镜治疗的TMJ SC患者17例,与术后病理诊断相符,术后磁共振复查显示,关节腔病灶基本消失;术后随访期间未见复发者,且临床症状均有不同程度改善。结论对于TMJ SC,采用关节镜手术治疗的方式,具有创伤小、并发症少等优点,可有效缓解临床症状,改善颞下颌功能,减少术后相关并发症的发生。

关键词: 颞下颌关节, 滑膜软骨瘤病, 关节镜手术

Abstract:

Objective To summarize the clinical significance of arthroscopy in the diagnosis and treatment of temporomandibular joint synovial chondromatosis(TMJ SC). Methods Seventeen cases with TMJ SC who were surgically treated by arthroscopy from September 2020 to September 2024 in The Peking University Stomatological Hospital were retrospectively analyzed. Data including preoperative examination, maximum incisal opening(MIO), and visual analog pain score(VAS) were analyzed and summarized. Results All the 17 TMJ SC cases were treated by arthroscopy, consistent with the postoperative pathological diagnosis. Postoperative review by MRI showed that joint cavity lesions disappeared. No recurrence was observed during postoperative follow-up, and clinical symptoms were improved to varying degrees. Conclusion For TMJ SC, arthroscopic surgery has advantages such as minimal trauma and wide indications, which can effectively alleviate clinical symptoms, improve temporomandibular function, and reduce the occurrence of postoperative complications.

Key words: temporomandibular joint, synovial chondromatosis, arthroscopic surgery

中图分类号:

R782.6

任晓旭, 董浩然, 贺洋, 郭刚, 张君伟. 关节镜在颞下颌关节滑膜软骨瘤病治疗中的临床应用体会[J]. 口腔医学, 2026, 46(3): 201-205.

REN Xiaoxu, DONG Haoran, HE Yang, GUO Gang, ZHANG Junwei. Clinical application experience of arthroscopy in the treatment of temporomandibular joint synovial chondromatosis[J]. Stomatology, 2026, 46(3): 201-205.

图/表 6

图1

图2

图3

图4

表1

表2

参考文献 20

[1]	Lee DH, Jeong TW. Uncommon primary synovial chondromatosis involving only the infrapatellar fat padin an elderly patient[J]. Knee Surg Relat Res, 2016, 28(1): 79-82. doi: 10.5792/ksrr.2016.28.1.79
[2]	Barwell R. Clinical lectures on movable bodies in joints[J]. Br Med J, 1876, 1(796): 403-405.
[3]	Sembronio S, Raccampo L, Tel A, et al. The role of temporomandibular joint arthroscopy for diagnosis and surgical management of synovial chondromatosis[J]. Diagnostics(Basel), 2023, 13(17): 2837.
[4]	Petito AR, Bennett J, Assael LA, et al. Synovial chondromatosis of the temporomandibular joint: Varying presentation in 4 cases[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2000, 90(6): 758-764. doi: 10.1067/moe.2000.107533
[5]	Brabyn PJ, Capote A, Muñoz-Guerra MF, et al. Arthroscopic management of synovial chondromatosis of the temporomandibular joint. Case series and systematic review[J]. J Maxillofac Oral Surg, 2018, 17(4): 401-409. doi: 10.1007/s12663-018-1102-7
[6]	Mccain JP, de la Rua H. Arthroscopic observation and treatment of synovial chondromatosis of the temporomandibular joint. Report of a case and review of the literature[J]. Int J Oral Maxillofac Surg, 1989, 18(4): 233-236. doi: 10.1016/S0901-5027(89)80060-8
[7]	García LD, Medina BG, Rico MS. Synovial chondromatosis of the temporomandibular joint. Technical details of arthroscopic management[J]. Br J Oral Maxillofac Surg, 2021, 59(9):1102-1103. doi: 10.1016/j.bjoms.2020.12.005
[8]	贺倩芸, 佟大可, 纪方. 生物多糖冲洗胶液在踝关节骨折手术后粘连预防中的临床应用价值[J]. 天津药学, 2015, 27(5):34-36.
[9]	Milgram JW. Synovial osteochondromatosis[J]. J Bone Jt Surg, 1977, 59(6): 792-801. doi: 10.2106/00004623-197759060-00013
[10]	Leite PCC, Tolentino ES, Yamashita AL, et al. Surgical treatment of synovial chondromatosis in the inferior compartment of the temporomandibular joint with articular disc involvement[J]. J Craniofac Surg, 2018, 29(2): e199-e203. doi: 10.1097/SCS.0000000000004262
[11]	Ardekian L, Faquin W, Troulis MJ, et al. Synovial chondromatosis of the temporomandibular joint: Report and analysis of eleven cases[J]. J Oral Maxillofac Surg, 2005, 63(7): 941-947. doi: 10.1016/j.joms.2005.03.009
[12]	Koyama J, Ito J, Hayashi T, et al. Synovial chondromatosis in the temporomandibular joint complicated by displacement and calcification of the articular disk: Report of two cases[J]. AJNR Am J Neuroradiol, 2001, 22(6): 1203-1206.
[13]	Testaverde L, Perrone A, Caporali L, et al. CT and MR findings in synovial chondromatosis of the temporo-mandibular joint: Our experience and review of literature[J]. Eur J Radiol, 2011, 78(3): 414-418. doi: 10.1016/j.ejrad.2009.11.015 pmid: 19969436
[14]	Jia M, Xu Y, Shao B, et al. Diagnostic magnetic resonance imaging in synovial chondromatosis of the temporomandibular joint[J]. Br J Oral Maxillofac Surg, 2022, 60(2): 140-144. doi: 10.1016/j.bjoms.2021.02.024
[15]	Wang P, Tian Z, Yang J, et al. Synovial chondromatosis of the temporomandibular joint: MRI findings with pathological comparison[J]. Dentomaxillofac Radiol, 2012, 41(2): 110-116. doi: 10.1259/dmfr/36144602
[16]	Cai XY, Yang C, Chen MJ, et al. Arthroscopic management for synovial chondromatosis of the temporomandibular joint: A retrospective review of 33 cases[J]. J Oral Maxillofac Surg, 2012, 70(9): 2106-2113. doi: 10.1016/j.joms.2011.09.043
[17]	Khanna JN, Ramaswami R. Synovial chondromatosis of the temporomandibular joint with intracranial extension-report of two cases[J]. Int J Oral Maxillofac Surg, 2017, 46(12): 1579-1583. doi: 10.1016/j.ijom.2017.05.018
[18]	Satyanarayan P, Roy ID, Issar Y, et al. Comparative evaluation of success in cases of synovial chondromatosis of temporomandibular joint treated with temporomandibular joint arthroscopy: A case series[J]. J Maxillofac Oral Surg, 2022, 21(4): 1227-1232. doi: 10.1007/s12663-021-01640-y
[19]	Jacinto FS, Salvatore S. Temporomandibular joint arthroscopic surgical techniques: Electrocoagulation and myotomy indications[J]. Atlas Oral Maxillofac Surg Clin North Am, 2022, 30(2): 165-173. doi: 10.1016/j.cxom.2022.06.009 pmid: 36116875
[20]	徐保华, 史宗道. 下颌髁突原发肿瘤: 附12例报告[J]. 实用口腔医学杂志, 2001, 17(3): 249-250.

病例	性别	年龄/岁	受累关节	手术时间	MIO/mm		VAS
病例	性别	年龄/岁	受累关节	手术时间	术前	术后6个月	术前	术后6个月
1	女	38	右侧	2020年	27	33	8	4
2	男	29	左侧	2020年	28	32	7	2
3	女	24	左侧	2021年	25	29	8	3
4	女	47	左侧	2021年	30	41	6	3
5	女	51	右侧	2021年	20	23	8	2
6	男	36	左侧	2022年	26	36	6	0
7	女	30	右侧	2022年	25	38	8	3
8	女	56	右侧	2023年	27	41	7	2
9	女	26	左侧	2023年	31	40	6	1
10	男	28	右侧	2023年	38	43	7	2
11	男	33	左侧	2023年	36	45	6	0
12	女	53	右侧	2024年	23	31	8	4
13	女	44	左侧	2024年	30	37	7	3
14	男	35	左侧	2024年	31	42	7	2
15	男	32	左侧	2024年	27	35	8	3
16	女	48	左侧	2024年	35	42	6	2
17	女	29	右侧	2024年	29	39	8	3

项目	手术前	手术后	t	P
MIO/mm	28.7±4.6	36.9±5.8	10.6	<0.000 1
VAS	7.1±0.8	2.3±1.2	24.6	<0.000 1