中国口腔颌面外科杂志

中国口腔颌面外科杂志 ›› 2017, Vol. 15 ›› Issue (1): 20-25.doi: 10.19438/j.cjoms.2017.01.005

• 论著 • 上一篇    下一篇

人工颞下颌关节治疗关节强直的效果分析

何冬梅, 胡逸晖*, 杨驰, 陈敏洁, 张善勇, 李辉, 白果, 张露珠, 陆川, 黄栋   

  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,上海市口腔医学重点实验室,上海 200011
  • 出版日期:2017-01-20 发布日期:2017-02-27
  • 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;胡逸晖（1993-）,男,硕士,住院医师,E-mail：376378566@qq.com。*并列第一作者
  • 基金资助:
    国家自然科学基金（81472117）; 上海市自然科学基金（13ZR1423500,14ZR1424300）; 上海市科学技术委员会实验动物专项基金（15140902500）; 上海交通大学医工交叉基金（YG2014MS05）

Effect of total joint TMJ prosthesis in the treatment of temporomandibular joint ankylosis

HE Dong-mei, HU Yi-hui, YANG Chi, CHEN Min-jie, ZHANG Shan-yong, LI Hui, BAI Guo, ZHANG Lu-zhu, LU Chuan, HUANG Dong   

  1. 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
  • Online:2017-01-20 Published:2017-02-27

被引次数

3

摘要： 目的 应用并评价Biomet标准型人工颞下颌关节假体治疗关节强直的效果。方法 回顾2013—2015年收治的颞下颌关节强直患者,采用计算机辅助设计和制作技术,设计并制作强直骨球切除和Biomet标准型人工颞下颌关节假体安放导板,术中应用下颌下切口取出的皮下游离脂肪移植于髁突假体周围,预防异位成骨。对于合并严重颌骨畸形的患者,采用人工关节假体延长前徙下颌支及Le Fort I型截骨术,数字化板辅助固定的方法同期矫正颌骨畸形。术后进行1年以上的临床和CT随访,评价开口度、咬合稳定性,以及假体周围有无异位成骨和假体与骨的结合情况。结果 11例患者15侧关节纳入研究,其中4例患者行下颌骨延长及颏后缩畸形纠正术。术后平均随访22.9个月（12~31个月）,无假体感染、断裂和松动。患者开口度显著改善（术前平均5.5 mm,术后31.5 mm,P<0.05）。4例患者气道显著增宽。CT显示假体固定螺钉周围无骨吸收,人工髁突头周围无异位成骨。结论 人工颞下颌关节假体是治疗关节强直,特别是复发性强直的可靠方法,可同时纠正颌骨畸形,效果稳定。

关键词: 人工颞下颌关节, 关节强直, 效果分析

Abstract: PURPOSE: The aim of the study was to apply and evaluate the effect of total TMJ prosthesis in the treatment of temporomandibular joint(TMJ) ankylosis. METHODS: Patients treated from 2013 to 2015 were reviewed. Computer-aided design and manufacture (CAD/CAM) technique was used to guide bony mass removal and locate the TMJ prosthesis (Biomet, USA). Free fat harvested from the mandibular incision subcutaneously was grafted around the artificial condylar head to prevent ectopic bone formation. For cases with severe mandibular deficiency, the mandibular ramus was elongated by the prosthesis and combined with Le Fort I osteotomy under the guide of digital occlusal splint. At least 1 year follow-up was completed after operation to evaluate mouth opening, occlusal stability, bone resorption around screws and ectopic bone formation around artifical condylar head. RESULTS: Eleven patients with 15 joints were included. In 4 patients with severe mandibular deficiencies, their mandibular ramus was elongated by TMJ prostheses combined with Le Fort I osteotomy guided by digital templates. There was no prosthesis loosening, breakage, or infection leading to removal during a mean follow-up period of 22.9 months (12-31 months) after operation. Mouth opening was significantly improved from 5.5 mm preoperatively to 31.5 mm postoperatively (P<0.05). No ectopic bone formation was found around the artificial condyles, and no bone resorption was detected around the screws on CT scans. CONCLUSIONS: TMJ prosthesis is a reliable treatment option for ankylosis, especially in recurrent cases. It can correct jaw bone deformities simultaneously with stable results.

Key words: Total TMJ prosthesis, Temporomandibular joint ankylosis, Effect analysis

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