青少年颞下颌关节盘前移位及髁突吸收的序列诊疗指南——外科治疗策略

doi:10.19438/j.cjoms.2026.04.003

中国口腔颌面外科杂志 ›› 2026, Vol. 24 ›› Issue (4): 331-339.doi: 10.19438/j.cjoms.2026.04.003

青少年颞下颌关节盘前移位及髁突吸收的序列诊疗指南——外科治疗策略

杨驰¹, 沈佩¹, 胡敏², 陈敏洁¹, 焦子先¹, 陆海霞³, 傅开元⁴, 房兵⁵, 周青⁶, 张清彬⁷, 朱耀旻⁸, 焦国良⁹, 田磊¹⁰, 李煌¹¹, 李志勇¹², 李云鹏¹³, 买买提吐逊·吐尔地¹⁴, 柳新华¹⁵, 何冬梅¹, 张善勇¹, 方一鸣¹⁶, 郭泾¹⁷, 江凌勇¹⁸, 贺红¹⁹, 陈莉莉²⁰, 张益²¹, 贺洋²¹, 焦凯²², 殷治国²³, 龙星²⁴, 江银华²⁵, 马志贵¹, 谢千阳¹, 戈旌¹, 郑吉驷¹, 白果¹, 刘小涵¹, 张大河¹, 曲冠霖¹, 罗怡¹

1.上海交通大学医学院附属第九人民医院口腔外科,上海交通大学口腔医学院,国家口腔医学中心,口腔疾病国家临床医学研究中心,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;
2.中国人民解放军总医院口腔科,北京 100039;
3.上海交通大学医学院附属第九人民医院口腔预防科,上海 200011;
4.北京大学口腔医院颞下颌关节病及口颌面疼痛诊治中心,北京 100081;
5.上海交通大学医学院附属第九人民医院口腔正畸科,上海 200011;
6.中国医科大学附属口腔医院口腔颌面外科,辽宁沈阳 110002;
7.广州医科大学附属口腔医院颞下颌关节科,广东广州 510080;
8.深圳市口腔医院口腔颌面外科,广东深圳 518001;
9.中国人民解放军联勤保障部队第九八医院口腔科,河北石家庄 050082;
10.空军军医大学口腔医院颌面创伤与正颌外科,陕西西安 710032;
11.南京市口腔医院口腔正畸科,江苏南京 210008;
12.浙江大学附属口腔医院口腔颌面外科,浙江杭州 310006;
13.空军军医大学口腔医院颅颌面整形与美容外科,陕西西安 710032;
14.新疆医科大学第一附属医院颌面外科,新疆乌鲁木齐 830054;
15.晋中市第一人民医院口腔科,山西晋中 030600;
16.温州医科大学附属第一医院口腔科,浙江温州 325000;
17.宁波口腔医院口腔正畸科,浙江宁波 315010;
18.上海交通大学医学院附属第九人民医院口腔颅颌面科,上海 200011;
19.武汉大学口腔医院口腔正畸科,湖北武汉 430079;
20.中山大学光华口腔医学院·附属口腔医院口腔正畸科,广东广州 510055;
21.北京大学口腔医院口腔颌面外科,北京 100081;
22.空军军医大学唐都医院口腔科,陕西西安 710038;
23.无锡市人民医院口腔科,江苏无锡 214043;
24.武汉大学口腔医院口腔颌面外科,湖北武汉 430079;
25.丽水市人民医院口腔颌面外科,浙江丽水 323000

收稿日期:2026-03-10 修回日期:2026-04-12 发布日期:2026-08-05
通讯作者: 杨驰,E-mail: yangchi63@hotmail.com
作者简介:杨驰（1963—）,男,博士,教授、主任医师
基金资助:
国家重点研发计划项目（2023YFC2509100）; 上海交通大学医学院附属第九人民医院RCT研究专项基金（2025RCTA02）

Guidelines for sequential diagnosis and treatment of temporomandibular joint anterior disc displacement and condylar resorption in adolescents: surgical treatment strategies

Yang Chi¹, Shen Pei¹, Hu Min², Chen Minjie¹, Jiao Zixian¹, Lu Haixia³, Fu Kaiyuan⁴, Fang Bing⁵, Zhou Qing⁶, Zhang Qingbin⁷, Zhu Yaomin⁸, Jiao Guoliang⁹, Tian Lei¹⁰, Li Huang¹¹, Li Zhiyong¹², Li Yunpeng¹³, Maimaitituxun Tuerdi¹⁴, Liu Xinhua¹⁵, He Dongmei¹, Zhang Shanyong¹, Fang Yiming¹⁶, Guo Jing¹⁷, Jiang Lingyong¹⁸, He Hong¹⁹, Chen Lili²⁰, Zhang Yi²¹, He Yang²¹, Jiao Kai²², Yin Zhiguo²³, Long Xing²⁴, Jiang Yinhua²⁵, Ma Zhigui¹, Xie Qianyang¹, Ge Jing¹, Zheng Jisi¹, Bai Guo¹, Liu Xiaohan¹, Zhang Dahe¹, Qu Guanlin¹, Luo Yi¹

1. Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine;College of Stomatology, Shanghai Jiao Tong University;National Center for Stomatology;National Clinical Research Center for Oral Diseases;Shanghai Key Laboratory of Stomatology;Shanghai Research Institute of Stomatology. Shanghai 200011;
2. Department of Stomatology, the First Medical Center of PLA General Hospital. Beijing 100039;
3. Department of Oral Prevention, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011;
4. Center for Temporomandibular Disorders & Orofacial Pain, Peking University School and Hospital of Stomatology. Beijing 100081;
5. Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011;
6. Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, China Medical University. Shenyang 110002, Liaoning Province;
7. Department of Temporomandibular Joint, School and Hospital of Stomatology, Guangzhou Medical University. Guangzhou 510080, Guangdong Province;
8. Department of Oral and Maxillofacial Surgery, Shenzhen Stomatological Hospital, Shenzhen University. Shenzhen 518001, Guangdong Province;
9. Department of Stomatology, Bethune International Peace Hospital. Shijiazhuang 050082, Hebei Province;
10. Department of Maxillofacial Trauma and Orthognathic Surgery, School of Stomatology, The Fourth Military Medical University. Xi'an 710032, Shaanxi Province;
11. Department of Orthodontics, Nanjing Stomatological Hospital. Nanjing 210008, Jiangsu Province;
12. Department of Oral and Maxillofacial Surgery, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine. Hangzhou 310006, Zhejiang Province;
13. Department of Craniofacial Plastic and Aesthetic Surgery, School of Stomatology, Air Force Military Medical University. Xi'an 710005, Shaanxi Province;
14. Department of Maxillofacial Surgery, The First Affiliated Hospital of Xinjiang Medical University. Urumqi 830054, Xinjiang Uygur Autonomous Region;
15. Department of Stomatology, The First People's Hospital of Jinzhong. Jinzhong 030600, Shanxi Province;
16. Department of Stomatology, The First Affiliated Hospital of Wenzhou Medical University. Wenzhou 325000, Zhejiang Province;
17. Department of Orthodontics, Ningbo Stomatological Hospital. Ningbo 315010, Zhejiang Province;
18. Department of Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011;
19. Department of Orthodontics, Hospital of Stomatology, Wuhan University. Wuhan 430079, Hubei Province;
20. Department of Orthodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University. Guangzhou 510055, Guangdong Province;
21. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology. Beijing 100081;
22. Department of Stomatology, Tangdu Hospital, School of Stomatology, Air Force Military Medical University. Xi'an 710038, Shaanxi Province;
23. Department of Stomatology, Wuxi People's Hospital. Wuxi 214043, Jiangsu Province;
24. Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Wuhan University. Wuhan 430079, Hubei Province;
25. Department of Oral and Maxillofacial Surgery, Lishui City People's Hospital. Lishui 323000, Zhejiang Province

Received:2026-03-10 Revised:2026-04-12 Published:2026-08-05

摘要/Abstract

摘要： 青少年颞下颌关节盘前移位发生率高,隐匿性强,危害大,可导致髁突吸收,影响颅颌面肌骨发育,严重者可继发下颌后缩等牙颌面畸形。青少年关节盘前移位及髁突吸收的序列诊疗是以“关节-颌骨-咬合”综合诊治理念为指导,在“关节-颌骨-咬合-气道”综合评价的基础上,以恢复正确盘-髁关系、促进关节及颌面部肌骨健康生长为主要目标,通过关节及颌面综合检查及多学科协作,以外科治疗为主要手段,辅以咬合、正畸等干预,旨在治疗关节疾病的同时,预防或纠正关节源性牙颌面畸形。本指南主要包括青少年颞下颌关节盘前移位的危害、评价体系、序列治疗和成功标准等4个方面,旨在为该病的临床诊疗提供科学依据和指导。

关键词: 青少年, 颞下颌关节盘前移位, 髁突吸收, 关节源性牙颌面畸形, 序列治疗, 临床指南

Abstract: The incidence of temporomandibular joint (TMJ) anterior disc displacement (ADD) in adolescents is high, with strong concealment and significant risks, potentially leading to condylar resorption and affecting the growth of the craniofacial musculoskeletal system. The sequential diagnosis and treatment of TMJ ADD in adolescents refer to a comprehensive diagnosis and treatment based on the concept of “joint-jaw-occlusion” with the primary goal of restoring the correct disc-condylar relationship and promoting healthy growth of the joint and craniofacial musculoskeletal system. This is accomplished via comprehensive joint and craniofacial examinations, in conjunction with multidisciplinary collaboration. Surgical treatment serves as the principal approach, complemented by occlusal and orthodontic interventions. It aims to treat joint diseases while preventing or correcting craniofacial deformities caused by joint problems. This guideline mainly included four aspects: the hazards of TMJ ADD in adolescents, the evaluation system, sequential treatments, and the criteria for success, aiming to provide a scientific basis and guidance for the clinical diagnosis and treatment of this disease.

Key words: Adolescents, Temporomandibular joint anterior disc displacement, Condylar resorption, Temporomandibular joint-originated dentofacial deformity, Sequential treatment, Clinical guideline

中图分类号:

R782.6

杨驰, 沈佩, 胡敏, 陈敏洁, 焦子先, 陆海霞, 傅开元, 房兵, 周青, 张清彬, 朱耀旻, 焦国良, 田磊, 李煌, 李志勇, 李云鹏, 买买提吐逊·吐尔地, 柳新华, 何冬梅, 张善勇, 方一鸣, 郭泾, 江凌勇, 贺红, 陈莉莉, 张益, 贺洋, 焦凯, 殷治国, 龙星, 江银华, 马志贵, 谢千阳, 戈旌, 郑吉驷, 白果, 刘小涵, 张大河, 曲冠霖, 罗怡. 青少年颞下颌关节盘前移位及髁突吸收的序列诊疗指南——外科治疗策略[J]. 中国口腔颌面外科杂志, 2026, 24(4): 331-339.

Yang Chi, Shen Pei, Hu Min, Chen Minjie, Jiao Zixian, Lu Haixia, Fu Kaiyuan, Fang Bing, Zhou Qing, Zhang Qingbin, Zhu Yaomin, Jiao Guoliang, Tian Lei, Li Huang, Li Zhiyong, Li Yunpeng, Maimaitituxun Tuerdi, Liu Xinhua, He Dongmei, Zhang Shanyong, Fang Yiming, Guo Jing, Jiang Lingyong, He Hong, Chen Lili, Zhang Yi, He Yang, Jiao Kai, Yin Zhiguo, Long Xing, Jiang Yinhua, Ma Zhigui, Xie Qianyang, Ge Jing, Zheng Jisi, Bai Guo, Liu Xiaohan, Zhang Dahe, Qu Guanlin, Luo Yi. Guidelines for sequential diagnosis and treatment of temporomandibular joint anterior disc displacement and condylar resorption in adolescents: surgical treatment strategies[J]. China J Oral Maxillofac Surg, 2026, 24(4): 331-339.

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青少年颞下颌关节盘前移位及髁突吸收的序列诊疗指南——外科治疗策略

Guidelines for sequential diagnosis and treatment of temporomandibular joint anterior disc displacement and condylar resorption in adolescents: surgical treatment strategies

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