急性创伤性关节盘前移位的诊断和治疗：附42例临床分析

中国口腔颌面外科杂志 ›› 2016, Vol. 14 ›› Issue (5): 425-429.

急性创伤性关节盘前移位的诊断和治疗：附42例临床分析

何冬梅^*, 杨秀娟^*, 杨驰

上海交通大学医学院附属第九人民医院·口腔医学院口腔外科, 上海市口腔医学重点实验室,上海 200011

收稿日期:2016-01-13 出版日期:2016-09-20 发布日期:2016-10-14
通讯作者: 杨驰,E-mail:yangchi63@hotmail.com
作者简介:何冬梅（1972-）,女,博士,主任医师,E-mail:lucyhe119@163.com; 杨秀娟（1983-）,女,在读博士研究生,主治医师。*并列第一作者
基金资助:
国家自然科学基金（81472117）; 上海交通大学医工交叉基金（YG2014MS05）; 上海市科学技术委员会科研计划项目（14DZ2294300）

Diagnosis and treatment of acute traumatic temporomandibular joint disc displacement in 42 consecutive patients

HE Dong-mei, YANG Xiu-juan, YANG Chi

Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology. Shanghai 200011, China

Received:2016-01-13 Online:2016-09-20 Published:2016-10-14

摘要/Abstract

摘要： 目的: 探讨创伤性关节盘前移位的诊断、治疗效果和后遗症的处理。方法: 收集我科2010—2015年收治的创伤性关节盘前移位病例,根据临床和影像学特点分为3期,即急性期、亚急性期和慢性期。比较不同方法治疗后髁突骨质的变化及开口度情况。采用SPSS软件包对数据进行t检验。结果: 42例59侧关节纳入研究,其中急性期和亚急性期患者（18例27侧）髁突骨质破坏的发生率为18.5%,而慢性期（24例32侧）高达75%。22例30侧保守治疗的关节中,髁突骨质退变者占90%（平均随访8.8个月）;31例47侧关节在伤后和保守治疗后接受手术治疗,其中23例34侧关节选择手术复位关节盘,髁突骨质吸收占4.5%,盘复位有效率达95.5%（15例22侧,平均随访22个月）。8例13侧晚期关节接受髁突切除关节置换。手术治疗组术后开口度比术前和保守治疗组显著增大（P<0.01）。结论: 创伤性关节盘前移位发病隐匿,易引起骨关节病和关节强直等后遗症,早期关节盘复位手术可以显著降低骨关节炎和关节强直的发生率,晚期需要关节置换治疗。

关键词: 颞下颌关节, 创伤性关节盘前移位, 关节强直

Abstract: PURPOSE: To explore the diagnosis, treatment results and sequela of traumatic temporomandibular joint disc displacement (ATDD) in 42 consecutive patients. METHODS: Patients diagnosed of ATDD and treated from 2010 to 2015 were recruited. Their clinical and radiologic characters were analyzed based on 3 stages: acute phase, subacute phase and chronic phase. Conservative and surgical treatment results were evaluated and compared with SPSS software package. RESULTS: Forty-two patients with 59 joints were included in the study. Among the acute and sub-acute phases patients (18 cases with 27 joints), 18.5% of the joints had condylar surface bone destruction, whereas 75% in the chronic phase (24 cases with 32 joints). Twenty-two cases with 30 joints accepted conservative treatment; among them, 90% developed osteoarthritis after a mean follow-up period of 8.8 months. Thirty-one cases with 47 joints accepted surgical treatment after injury or conservative treatment. Among them, 23 cases with 34 joints had disc reposition, 95.5% were effective (15 cases with 22 joints, mean follow-up period of 22 months). Eight cases with 13 end-stage joints accepted condylar resection and joint replacement. Their maximal incisor opening after surgery was significantly increased compared with that before surgery and conservative treatment (P<0.01). CONCLUSIONS: ATDD is easy to lead to osteoarthritis and ankylosis, disc reposition in the acute and sub-acute phases can significantly reduce the occurrence of above sequel; however, in the chronic phase, joint replacement may be necessary in selected patients.

Key words: Temporomandibular joint, Acute traumatic disc displacement, Joint ankylosis

中图分类号:

R782.6

何冬梅, 杨秀娟, 杨驰. 急性创伤性关节盘前移位的诊断和治疗：附42例临床分析[J]. 中国口腔颌面外科杂志, 2016, 14(5): 425-429.

HE Dong-mei, YANG Xiu-juan, YANG Chi. Diagnosis and treatment of acute traumatic temporomandibular joint disc displacement in 42 consecutive patients[J]. China J Oral Maxillofac Surg, 2016, 14(5): 425-429.

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