游离冠突与肋骨移植治疗颞下颌关节强直的疗效分析

摘要/Abstract

摘要： 目的比较游离冠突移植（free coronoid process graft, CPG）与肋骨移植（costochondral graft, CCG）治疗颞下颌关节强直的疗效。方法回顾2011—2014年我科收治的采用CPG和CCG治疗的10例（15侧）颞下颌关节强直患者,对手术后CT及至少6个月以上随访期的CT进行三维重建,采用Proplan CMF 1.4软件（Materialize, 比利时）测量植骨块的高度,比较不同方法移植骨的吸收情况,同时对随访期患者的开口度和咬合关系进行比较。采用SPSS19.0软件包中的配对t检验比较2种方法移植骨的吸收量,评价2种方法的效果。结果 5例（7侧）CPG患者术后平均随访16.8个月（6~22个月）,冠突平均吸收5.41 mm,占移植骨高度的21.9%,冠突顶部圆钝改建。随访期末最大开口度平均为31.6 mm,较术前显著增加(P<0.05);4例出现前牙开,1例关节强直复发;5例（8侧）CCG患者术后平均随访14.4个月（6~30个月）,肋骨平均吸收2.44 mm,占移植骨高度的6.2%;随访期末最大开口度平均为33.6 mm,较术前显著增加(P<0.05);4例咬合关系稳定,1例出现开,无关节强直复发。结论颞下颌关节强直的治疗中,游离冠突移植比肋骨移植的骨吸收率高,易引起咬合关系改变。

关键词: 颞下颌关节强直, 游离冠突移植, 游离肋骨移植, 颞下颌关节重建

Abstract: PURPOSE : To compare the effect of free coronoid process graft (CPG) and costochondral graft (CCG) in the treatment of temporomandibular joint ankylosis (TMJA). METHODS : Ten TMJA patients (15 joints) treated with CPG or CCG in our department from 2011 to 2014 were included in this study. All patients were followed up for more than 6 months after operation. Post operative CT scan data within 1 week after operation and during follow up were imported into the Proplan CMF 1.4 software (Materialize, Belgium) for 3 dimensional reconstruction and measurement. Bone absorption was measured and compared between the 2 METHODS using paired t test with SPSS 19.0 software package. Maximum mouth opening (MMO) and occlusion were also evaluated and compared before and after operation. RESULTS : In CPG group, the average follow-up duration was 16.8 months (ranged from 6-22 months). The average bone absorption was 5.41 mm (21.9% of the initial height). Tip of the grafted bone was reformed to be round. The average MMO was 31.6mm, which had significant difference between the preoperative values (P<0.05). Four of 5 patients developed open bite, one patient had TMJA recurrence. In CCG group, the average follow-up duration was 14.4 months (ranged from 6~30 months). The average bone absorption was 2.44 mm (6.2% of the initial height). The average MMO was 33.6 mm, which had a significant difference between the preoperative values (P<0.05). One of 5 patients developed open bite, the other 4 patients had stable occlusion. No patient had recurrence. CONCLUSIONS : In the treatment of TMJA, bony absorption rate in CPG patients was higher than that in CCG patients, which was easy to cause occlusion changes.

Key words: Temporomandibular joint ankylosis, Free coronoid process graft, Costochondral graft, Joint reconstruction

中图分类号:

R782.6

黄栋，何冬梅，杨驰，陆川，白果. 游离冠突与肋骨移植治疗颞下颌关节强直的疗效分析[J]. 中国口腔颌面外科杂志, 2016, 14(1): 33-38.

HUANG Dong, HE Dong-mei, YANG Chi, LU Chuan, BAI Guo. Comparison of temporomandibular joint reconstruction with free coronoid process graft and costochondral graft in the treatment of temporomandibular joint ankylosis[J]. China J Oral Maxillofac Surg, 2016, 14(1): 33-38.

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