带蒂颞深筋膜脂肪瓣在颞下颌关节重建中的应用：135例临床分析

doi:10.19438/j.cjoms.2020.05.006

中国口腔颌面外科杂志 ›› 2020, Vol. 18 ›› Issue (5): 412-416.doi: 10.19438/j.cjoms.2020.05.006

带蒂颞深筋膜脂肪瓣在颞下颌关节重建中的应用：135例临床分析

陈光灿, 陈敏洁, 杨驰, 魏文斌, 王轶雯, 刘芷扬

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:2019-11-29 修回日期:2020-03-19 出版日期:2020-09-20 发布日期:2020-10-28
通讯作者: 陈敏洁,E-mail:chenminjie00@126.com
作者简介:陈光灿（1995-）,男,硕士研究生,E-mail:chenguangcan0811@hotmail.com
基金资助:
上海市科委生物医药重点项目（16411953300）; 上海交通大学医工交叉项目（YG2016QN06）; 上海交通大学医学院附属第九人民医院临床研究型MDT项目（201701018）

Application of pedicled deep temporal fascial fat flap in temporomandibular joint reconstruction: clinical analysis of 135 consecutive cases

CHEN Guang-can, CHEN Min-jie, YANG Chi, WEI Wen-bin, WANG Yi-wen, LIU Zhi-yang

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. Shanghai200011, China

Received:2019-11-29 Revised:2020-03-19 Online:2020-09-20 Published:2020-10-28

摘要/Abstract

摘要： 目的：探讨以颞中血管为蒂的颞深筋膜脂肪瓣在颞下颌关节重建中的应用效果。方法：收集2012年1月—2017年12月间于上海交通大学医学院附属第九人民医院口腔外科手术治疗的颞下颌关节病患者135例（170侧）。所有患者在手术过程中均应用以颞中血管为蒂的颞深筋膜脂肪瓣,术后定期随访,至少1年以上的影像学资料齐全。根据术前诊断、手术方法等对患者进行分类,并通过影像学检查,评估该组织瓣的位置和长期稳定性。结果：135例患者中,因晚期颞下颌关节内紊乱或骨关节病,应用颞深筋膜脂肪瓣置换关节盘8例;因颞下颌关节强直,术中置入颞深筋膜脂肪瓣作为间隔物28例;因颞下颌关节-颅底区肿瘤性病变,术中置入颞深筋膜脂肪瓣作为间隔物31例;因各类疾病行关节置换后置入颞深筋膜脂肪瓣作为间隔物68例。术后即刻与术后1年以上的影像学检查均可见髁突或移植骨与关节窝之间有混杂信号影,将两者分隔开。在20~86个月的随访期内,未见组织瓣坏死、感染、供区脱发或凹陷等并发症。结论：以颞中血管为蒂的颞深筋膜脂肪瓣可用于多种颞下颌关节疾病的外科治疗,即刻位置满意且术后保持长期稳定。

关键词: 颞下颌关节, 颞深筋膜瓣, 颞中动脉, 颞中静脉

Abstract: PURPOSE: To review the data of application of deep temporal fascial flap pedicled with middle temporal artery in temporomandibular joint reconstruction. METHODS: One hundred and thirty-five patients with various temporomandibular joint diseases from January, 2012 to December, 2017 were included in this study. All patients were treated surgically and a deep temporal fascial flap pedicled with middle temporal artery was harvested during surgery with different purposes. The patients were followed up regularly for at least one year, and classified with diagnosis and surgical methods. Radiological examinations were taken regularly to evaluate the position and long-term stability of the flap. RESULTS: Among 135 cases, eight underwent disc replacement with the pedicled deep temporal fascial flap due to terminal stage of internal derangement or osteoarthropathy. Twenty-eight underwent interposition with the flap due to temporomandibular joint ankylosis, while 31 underwent interposition due to space occupying disease of the temporomandibular joint - skull base region. Sixty-eight underwent joint replacement with autologous bone grafts and aforementioned flap interposition. Postoperative radiological examinations showed that the condyle or bone graft and the glenoid fossa were separated completely by a mixed-signal material. No severe complications such as flap necrosis, infection, alopecia or temporal hollowing were found during the follow-up period ranging from 20 months to 86 months. CONCLUSIONS: Pedicled deep temporal fascial flap can be widely used in reconstruction of temporomandibular joint.

Key words: Temporomandibular joint, Deep temporal fascial flap, Middle temporal artery, Middle temporal vein

中图分类号:

R782.6

陈光灿, 陈敏洁, 杨驰, 魏文斌, 王轶雯, 刘芷扬. 带蒂颞深筋膜脂肪瓣在颞下颌关节重建中的应用：135例临床分析[J]. 中国口腔颌面外科杂志, 2020, 18(5): 412-416.

CHEN Guang-can, CHEN Min-jie, YANG Chi, WEI Wen-bin, WANG Yi-wen, LIU Zhi-yang. Application of pedicled deep temporal fascial fat flap in temporomandibular joint reconstruction: clinical analysis of 135 consecutive cases[J]. China J Oral Maxillofac Surg, 2020, 18(5): 412-416.

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带蒂颞深筋膜脂肪瓣在颞下颌关节重建中的应用：135例临床分析

Application of pedicled deep temporal fascial fat flap in temporomandibular joint reconstruction: clinical analysis of 135 consecutive cases

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