中国口腔颌面外科杂志

中国口腔颌面外科杂志 ›› 2019, Vol. 17 ›› Issue (4): 352-355.doi: 10.19438/j.cjoms.2019.04.015

• 论著 • 上一篇    下一篇

45例复发性颞下颌关节前脱位的分类及治疗探讨

宋昊天, 杨驰   

  1. 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,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,上海市口腔医学研究所,上海200011
  • 收稿日期:2018-04-28 修回日期:2019-05-28 出版日期:2019-07-20 发布日期:2019-08-12
  • 通讯作者: 杨驰, E-mail：yangchi63@hotmail.com
  • 作者简介:宋昊天（1992-）,男,硕士研究生,E-mail：songhaotian1992@126.com
  • 基金资助:
    上海市科学技术委员会科研基金（18DZ2291100）

Classification and treatment for recurrent anterior dislocation of temporomandibular joint on 45 cases

SONG Hao-tian, YANG Chi   

  1. Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai 200011, China;
  • Received:2018-04-28 Revised:2019-05-28 Online:2019-07-20 Published:2019-08-12

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摘要： 目的 介绍一种基于MRI上关节盘与髁突相对位置的颞下颌关节复发性前脱位分类方法,以及针对不同类型采用不同手术方法治疗的经验。方法 选择2003年5月—2016年5月治疗的45例颞下颌关节复发性前脱位患者。依据MRI分为Ⅰ型（关节盘无移位）、Ⅱ型（关节盘移位）、Ⅲ型（骨关节病）及Ⅳ型（存在精神或神经功能障碍）,依据分类选择不同的手术治疗方法。结果 Ⅰ型28例（62.2%）,Ⅱ型12例（26.7%）,Ⅲ型2例（4.4%）,Ⅳ型3例（6.7%）。Ⅰ型患者采用关节结节增高术或关节镜下硬化剂注射术;Ⅱ型患者采用颞下颌关节盘复位固定术（锚固）及关节镜下关节盘复位固定术,辅助关节结节增高术;Ⅲ型患者根据临床症状进行手术;Ⅳ型患者均采用关节结节凿平术。随访期间未发现开口受限、开口疼痛、脱位复发。结论 基于MRI影像学特点对颞下颌关节脱位进行分类,对术者选择合适的治疗方案具有指导意义。

关键词: 颞下颌关节, 复发性前脱位, 分类, 磁共振

Abstract: PURPOSE: To introduce a classification of recurrent anterior dislocation of temporomandibular joint(TMJ) based on MRI by analyzing relative position of TMJ disc and condylar; and summarize the experience of different therapeutic methods. Methods: MRI data of 45 patients who suffered from recurrent anterior dislocation of TMJ treated in our hospital during May 2003 to May 2016 were collected. On the basis of MRI findings, four categories were proposed, namely type Ⅰ: proper disc position, type Ⅱ: anterior disc displacement,type Ⅲ: osteoarthritis and type Ⅳ with mental disorders. Different treatments were conducted for different types of lesions. Results: TypeⅠ included 28 cases(62.2%), type Ⅱ included 12 cases(26.7%), type Ⅲ included 2 cases(4.4%) and type Ⅳ included 3 cases(6.7%). Type I was treated for either articular tubercle augmentation or arthroscopic sclerotherapy. Type Ⅱ was treated with TMJ disc reduction and fixation (anchoring), and arthroscopic disc reduction and fixation, assisted with TMJ tubercle enhancement. Type Ⅲ was treated according to clinical symptoms of patients. Type Ⅳ was treated using chiseling of the eminence. During the follow-up period, mouth opening limitation, pain, and dislocation recurrence were not present. Conclusions: The classification of TMJ dislocation based on the features of MRI imaging is instructive for surgeons to make appropriate treatment plan.

Key words: Temporomandibular joint, Recurrent anterior dislocation, Classification, MRI

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