导致颞下颌关节强直的成人髁突骨折类型分析

中国口腔颌面外科杂志 ›› 2014, Vol. 12 ›› Issue (1): 39-44.

导致颞下颌关节强直的成人髁突骨折类型分析

蔡怡华, 陆川, 何冬梅*, 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:2013-06-20 修回日期:2013-07-20 出版日期:2014-02-10 发布日期:2014-02-10
作者简介:蔡怡华(1988-),女,硕士,住院医师,E-mail：ines13m_blk@hotmail.com *并列通信作者
基金资助:
上海市科学技术委员会资助项目(08DZ2271100,13XD1402300); 上海高校创新团队发展计划; 教育部留学回国人员科研启动基金; 卫生行业公益基金(201002017)

Analysis of the mandibular condylar fracture type leading to temporomandibular joint ankylosis in adults

CAI Yi-hua, LU Chuan, HE Dong-mei, YANG Chi

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

Received:2013-06-20 Revised:2013-07-20 Online:2014-02-10 Published:2014-02-10
Supported by:
Supported by Research Fund of Science and Technology Committee of Shanghai Municipality (08DZ2271100,13XD1402300), Program for Innovative Research Team of Shanghai Municipal Education Commission, Scientific Research Foundation of Ministry of Education for Returned Overseas Scholars and Research Fund of the Ministry of Health of China (201002017).

摘要/Abstract

摘要： 目的: 回顾分析导致颞下颌关节强直的成人髁突骨折类型。方法：回顾口腔外科关节组2010—2012年收治的由髁突骨折保守治疗导致颞下颌关节强直,从损伤到发生强直有完整CT资料的成人病例,按照下颌支残端与关节窝的位置关系,将髁突骨折分为3级,0级为下颌支残端位于关节窝内,与之无接触；1级为下颌支残端位于关节窝内,与之有接触；2级为下颌支残端外上方脱位出关节窝。结合髁突骨折类型、骨折块移位程度和关节盘的位置、下颌骨其他部位骨折情况等,分析关节强直形成的原因。结果：13例(24侧)导致关节强直病例的髁突骨折有完整的CT资料,导致关节强直的髁突骨折类型均为囊内骨折,其中B型占70%。下颌支残端与关节窝的位置关系中,0级0侧；1级10侧,占41.7%；2级14侧,占58.3%。0级和1级的关节盘均伴髁突骨折块移位,后外侧带断裂。形成关节强直的髁突骨折中,77%伴颏部骨折,导致牙弓增宽。结论：下颌支残端与关节窝的位置关系对于预后判断有重要作用,其中0级不易引起关节强直；1级较容易引起关节强直,是手术的相对适应证；2级最容易引起关节强直,是手术的绝对适应证。其他危险因素还有髁突囊内B型骨折和合并牙弓增宽的下颌骨骨折。

关键词: 髁突骨折, 颞下颌关节强直, 骨折类型

Abstract: PURPOSE：To analyze the mandibular condylar fracture type leading to temporomandibular joint ankylosis in adults. METHODS: Patients diagnosed with ankylosis caused by condylar fracture who had CT scans from injury to ankylosis in our department from 2010 to 2012 were reviewed. According to the relationship between the mandibular stump of the ramus and TMJ fossa, the condylar fractures were divided into 3 grades. Grade 0: the stump of the ramus was in the fossa without contact to it; Grade 1: the stump of the ramus was in the fossa with contact to it; Grade 2: the stump of the ramus was superolaterally displaced out of the fossa. The type of condylar fracture, the degree of fracture fragment displacement, the position of the disc and other fractures of the mandible were also analyzed for ankylosis development. RESULTS: Thirteen patients with 24 joints had completed CT scans diagnosed with TMJ ankylosis caused by condylar fracture were included in the study. The types of the condylar fracture caused to ankylosis were all intracapsular fractures with type B fracture accounting for 70%. Among the relationship between the stump of the ramus and TMJ fossa, grade 0 in 0 joint; grade 1 in 10 joints, accounting for 41.7%; grade 2 in 14 joints, accounting for 58.3%. The discs were all displaced with the fracture fragment and ruptured in the posterior band in grades 1 and 2. There were 77% of the condylar fractures had combined symphysis fracture which caused widening of the mandibular arch. CONCLUSION: The relationship between the ramus stump and TMJ fossa plays an important role in the prognosis of condylar fracture. Grade 0 is less easy to cause ankylosis; grade 1 is easy to cause ankylosis and is the relative indication for surgery; grade 2 is most likely to cause ankylosis and is the absolute indication for surgery. Other risk factors are type B intracapsular condylar fracture and combined mandibular fracture with arch widening.

Key words: Temporomandibular joint ankylosis, Mandibular condyle fracture, Fracture type

蔡怡华, 陆川, 何冬梅*, 杨驰*. 导致颞下颌关节强直的成人髁突骨折类型分析[J]. 中国口腔颌面外科杂志, 2014, 12(1): 39-44.

CAI Yi-hua, LU Chuan, HE Dong-mei, YANG Chi. Analysis of the mandibular condylar fracture type leading to temporomandibular joint ankylosis in adults[J]. China J Oral Maxillofac Surg, 2014, 12(1): 39-44.

参考文献

[1] Ellis E 3rd, Moos KF, el-Attar A. Ten years of mandibular fractures: an analysis of 2,137 cases[J]. Oral Surg Oral Med Oral Pathol, 1985, 59(2): 120-129.
[2] He D, Yang C, Chen M, et al. Intracapsular condylar fracture of the mandibular: our classification and open treatment experience[J]. J Oral Maxillofac Surg, 2009; 67(8): 1672-1679.
[3] He D, Yang C, Chen M, et al. Traumatic temporomandibular joint ankylosis: our classification and treatment experience[J]. J Oral Maxillofac Surg, 2011, 69(6): 1600-1607.
[4] He D, Yang C, Chen M, et al. Surgical treatment of traumatic temporomandibular joint ankylosis with medially displaced residual condyle: surgical METHODS and long-term results[J]. J Oral Maxillofac Surg, 2011, 69(9): 2412-2418.
[5] He D, Edward E 3rd, Zhang Y. Etiology of temporomandibular joint ankylosis secondary to condylar fractures: the role of concomitant mandibular fractures[J]. J Oral Maxillofac Surg, 2008, 66(1): 77-84.
[6] Bos RR, Ward Booth RP, de Bont LG. Mandibular condyle fractures: a consensus[J]. Br J Oral Maxillofac Surg, 1999, 37(2): 87-89.
[7] Ellis E 3rd. Complications of mandibular condyle fractures[J]. Int J Oral Maxillofac Surg, 1988, 27(4): 255-257.
[8] Feng Z, Li L, He D, et al. Role of retention of the condylar cartilage in open treatment of intracapsular condylar fractures in growing goats: three-dimensional computed tomographic analysis[J]. Br J Oral Maxillofac Surg, 2012, 50(6): 523-527.
[9] Yan YB, Zhang Y, Gan YH, et al. Surgical induction of TMJ bony ankylosis in growing sheep and the role of injury severity of the glenoid fossa on the development of bony ankylosis[J]. J Craniomaxillofac Surg, 2013, 41(6): 476-486.
[10] Duan DH, Zhang Y. A clinical investigation on disc displacement in sagittal fracture of the mandibular condyle and its association with TMJ ankylosis development[J]. Int J Oral Maxillofac Surg, 2011, 40(2): 134-138.
[11] Miyamoto H, Kurita K, Ogi N, et al. The role of the disk in sheep temporomandibular joint ankylosis[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1999, 88(2): 151-158.
[12] Arakeri G, Kusanale A, Zaki GA, et al. Pathogenesis of post-traumatic ankylosis of the temporomandibular joint: a critical review[J]. Br J Oral Maxillofac Surg, 2012, 50(1): 8-12.
[13] Chen M, Yang C, He D, et al. Soft tissue reduction during open treatment of intracapsular condylar fracture of the temporomandibular joint: our institution's experience[J]. J Oral Maxillofac Surg, 2010, 68(9): 2189-2195.
[14] 王化, 王霄英, 张益, 等. 颞下颌关节损伤的MRI表现[J]. 实用放射学杂志, 2008, 24(3): 306-308, 319.
[15] Wang P, Yang J, Yu Q. MR imaging assessment of temporomandibular joint soft tissue injuries in dislocated and nondislocated mandibular condylar fractures[J]. AJNR Am J Neuroradiol, 2009, 30(1): 59-63.
[16] Zhang Y, He DM. Clinical investigation of early post-traumatic temporomandibular joint ankylosis and the role of repositioning discs in treatment[J]. Int J Oral Maxillofac Surg, 2006, 35(12): 1096-1101.
[17] Ferretti C, Bryant R, Becker P, et al. Temporomandibular joint morphology following post-traumatic ankylosis in 26 patients[J]. Int J Oral Maxillofac Surg, 2005, 34(4): 376-381.