游离冠突与肋骨移植治疗颞下颌关节强直的疗效分析

中国口腔颌面外科杂志 ›› 2016, Vol. 14 ›› Issue (1): 33-38.

游离冠突与肋骨移植治疗颞下颌关节强直的疗效分析

黄栋，何冬梅^*，杨驰^*，陆川，白果

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:2015-04-05 出版日期:2016-01-20 发布日期:2016-02-01
通讯作者: 杨驰,E-mail：yangchi63@hotmail.com;何冬梅,E-mail：lucyhe119@163.com。*共同通信作者
作者简介:黄栋（1986-）,男,硕士,住院医师,E-mail: pociman@126.com
基金资助:
国家自然科学基金(81472117); 上海市卫计委青年项目（20154Y0189）; 上海交通大学医工交叉面上项目（YG2014MS05）; 上海交通大学医工交叉基金青年项目（YG2015QN04）

Comparison of temporomandibular joint reconstruction with free coronoid process graft and costochondral graft in the treatment of temporomandibular joint ankylosis

HUANG Dong, HE Dong-mei, YANG Chi, LU Chuan, BAI Guo

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

Received:2015-04-05 Online:2016-01-20 Published:2016-02-01

摘要/Abstract

摘要： 目的比较游离冠突移植（free coronoid process graft, CPG）与肋骨移植（costochondral graft, CCG）治疗颞下颌关节强直的疗效。方法回顾2011—2014年我科收治的采用CPG和CCG治疗的10例（15侧）颞下颌关节强直患者,对手术后CT及至少6个月以上随访期的CT进行三维重建,采用Proplan CMF 1.4软件（Materialize, 比利时）测量植骨块的高度,比较不同方法移植骨的吸收情况,同时对随访期患者的开口度和咬合关系进行比较。采用SPSS19.0软件包中的配对t检验比较2种方法移植骨的吸收量,评价2种方法的效果。结果 5例（7侧）CPG患者术后平均随访16.8个月（6~22个月）,冠突平均吸收5.41 mm,占移植骨高度的21.9%,冠突顶部圆钝改建。随访期末最大开口度平均为31.6 mm,较术前显著增加(P<0.05);4例出现前牙开,1例关节强直复发;5例（8侧）CCG患者术后平均随访14.4个月（6~30个月）,肋骨平均吸收2.44 mm,占移植骨高度的6.2%;随访期末最大开口度平均为33.6 mm,较术前显著增加(P<0.05);4例咬合关系稳定,1例出现开,无关节强直复发。结论颞下颌关节强直的治疗中,游离冠突移植比肋骨移植的骨吸收率高,易引起咬合关系改变。

关键词: 颞下颌关节强直, 游离冠突移植, 游离肋骨移植, 颞下颌关节重建

Abstract: PURPOSE : To compare the effect of free coronoid process graft (CPG) and costochondral graft (CCG) in the treatment of temporomandibular joint ankylosis (TMJA). METHODS : Ten TMJA patients (15 joints) treated with CPG or CCG in our department from 2011 to 2014 were included in this study. All patients were followed up for more than 6 months after operation. Post operative CT scan data within 1 week after operation and during follow up were imported into the Proplan CMF 1.4 software (Materialize, Belgium) for 3 dimensional reconstruction and measurement. Bone absorption was measured and compared between the 2 METHODS using paired t test with SPSS 19.0 software package. Maximum mouth opening (MMO) and occlusion were also evaluated and compared before and after operation. RESULTS : In CPG group, the average follow-up duration was 16.8 months (ranged from 6-22 months). The average bone absorption was 5.41 mm (21.9% of the initial height). Tip of the grafted bone was reformed to be round. The average MMO was 31.6mm, which had significant difference between the preoperative values (P<0.05). Four of 5 patients developed open bite, one patient had TMJA recurrence. In CCG group, the average follow-up duration was 14.4 months (ranged from 6~30 months). The average bone absorption was 2.44 mm (6.2% of the initial height). The average MMO was 33.6 mm, which had a significant difference between the preoperative values (P<0.05). One of 5 patients developed open bite, the other 4 patients had stable occlusion. No patient had recurrence. CONCLUSIONS : In the treatment of TMJA, bony absorption rate in CPG patients was higher than that in CCG patients, which was easy to cause occlusion changes.

Key words: Temporomandibular joint ankylosis, Free coronoid process graft, Costochondral graft, Joint reconstruction

中图分类号:

R782.6

黄栋，何冬梅，杨驰，陆川，白果. 游离冠突与肋骨移植治疗颞下颌关节强直的疗效分析[J]. 中国口腔颌面外科杂志, 2016, 14(1): 33-38.

HUANG Dong, HE Dong-mei, YANG Chi, LU Chuan, BAI Guo. Comparison of temporomandibular joint reconstruction with free coronoid process graft and costochondral graft in the treatment of temporomandibular joint ankylosis[J]. China J Oral Maxillofac Surg, 2016, 14(1): 33-38.

参考文献

[1] Gundlach KK. Ankylosis of the temporomandibular joint [J]. J Craniomaxillofac Surg, 2010, 38(2): 122-130.
[2] He D, Cai Y, Yang C. Analysis of temporomandibular joint ankylosis caused by condylar fracture in adults [J]. J Oral Maxillofac Surg, 2014, 72(4): 763.e1-e9.
[3] Erol B, Tanrikulu R, Görgün B. A clinical study on ankylosis of the temporomandibular joint [J]. J Craniomaxillofac Surg, 2006, 34(2):100-106.
[4] Zhang X, Chen M, Wu Y, et al. Management of temporomandibular joint ankylosis associated with mandibular asymmetry in infancy [J]. J Craniofac Surg, 2011, 22(4): 1316-1319.
[5] 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.
[6] Khadka A, Hu J. Autogenous grafts for condylar reconstruction in treatment of TMJ ankylosis: current concepts and considerations for the future[J]. Int J Oral Maxillofac Surg, 2012, 41(1): 94-102.
[7] Shen P, Zhang S, Yang C, et al. The mandibular symmetry evaluation of total temporomandibular joint replacement on developing sheep [J]. J Craniomaxillofac Surg, 2014, 42(3): 201-205.
[8] Wolford LM, Dingwerth DJ, Talwar RM, et al. Comparison of 2 temporomandibular joint total joint prosthesis systems [J]. J Oral Maxillofac Surg, 2003, 61(6): 685-690.
[9] Pearce CS, Cooper C, Speculand B. One stage management of ankylosis of the temporomandibular joint with custom-made total joint replacement system [J]. Br J Oral Maxillofac Surg, 2009, 47(7): 530-534.
[10] Manemi RV, Fasanmade A, Revington PJ. Bilateral ankylosis of the jaw treated with total alloplastic replacement using the TMJ concepts system in a patient with ankylosing spondylitis [J]. Br J Oral Maxillofac Surg, 2009, 47(2): 159-161.
[11] Mercuri LG. Alloplastic temporomandibular joint reconstruction [J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1998, 85(6): 631-637.
[12] Poswillo DE. Biological reconstruction of the mandibular condyle [J]. Br J Oral Maxillofac Surg, 1987, 25(2): 100-104.
[13] Zhu SS, Hu J, Li J, et al. Free grafting of autogenous coronoid process for condylar reconstruction in patients with temporomandibular joint ankylosis [J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2008, 106(5): 662-667.
[14] Hong YL, Gu XM, Feng XH, et al. Modified coronoid process grafts combined with sagittal split osteotomy for treatment of bilateral temporomandibular joint ankylosis [J]. J Oral Maxillofac Surg, 2002, 60(1): 11-18.
[15] He D, Yang C, Chen M, et al. Modified preauricular approach and rigid internal fixation for intracapsular condyle fracture of the mandible [J]. J Oral Maxillofac Surg, 2010, 68(7): 1578-1584.
[16] Qiu YT, Yang C, Chen MJ. Endoscopically assisted reconstruction of the mandibular condyle with a costochondral graft through a modified preauricular approach [J]. Br J Oral Maxillofac Surg, 2010, 48(6): 443-447.
[17] Gillies HD, Pilcher LS. Plastic surgery of the face [J]. Ann Surg, 1920, 72(6): 766.
[18] Daniels S, Ellis 3rd E, Carlson DS. Histologic analysis of costochondral and sternoclavicular grafts in the TMJ of the juvenile monkey [J]. J Oral Maxillofac Surg, 1987, 45(8): 675-683.
[19] Peltomäki T. Histologic structure of human costochondral junction [J]. Plast Reconstr Surg, 1994, 94(5): 585-588.
[20] Ko EW, Huang CS, Chen YR. Temporomandibular joint reconstruction in children using costochondral grafts [J]. J Oral Maxillofac Surg, 1999, 57(7): 789-798.
[21] Kaban LB, Bouchard C, Troulis MJ. A protocol of management of temporomandibular joint ankylosis in children [J]. J Oral Maxillofac Surg, 2009, 67(9): 1966-1978.
[22] Kaban LB, Perrott DH, Fisher K. A protocol for management of temporomandibular joint ankylosis [J]. J Oral Maxillofac Surg, 1990, 48(11): 1145-1151.
[23] Qudah MA, Qudeimat MA, Al-Maaita J. Treatment of TMJ ankylosis in Jordanian children - a comparison of two surgical techniques [J]. J Craniomaxillofac Surg, 2005, 33(1): 30-36.
[24] Politis C, Fossion E, Bossuyt M. The use of costochondral grafts in arthroplasty of the temporomandibular joint [J]. J Craniomaxillofac Surg, 1987, 15(6): 345-354.
[25] Elgazzar RF, Abdelhady AI, Saad KA, et al. Treatment modalities of TMJ ankylosis: experience in Delta Nile, Egypt [J]. Int J Oral Maxillofac Surg, 2010, 39(4): 333-342.
[26] Tabchouri N, Kadlub N, Diner PA, et al. Unusual costochondral bone graft complication [J]. Int J Oral Maxillofac Surg, 2013, 42(11): 1427-1430.
[27] Medra AM. Follow up of mandibular costochondral grafts after release of ankylosis of the temporomandibular joints [J]. Br J Oral Maxillofac Surg, 2005, 43(2): 118-122.
[28] El -Sayed KM. Temporomandibular joint reconstruction with costochondral graft using modified approach [J]. Int J Oral Maxillofac Surg, 2008, 37(10): 897-902.
[29] Peltomäki T, Vähätalo K, Rönning O. The effect of a unilateral costochondral graft on the growth of the marmoset mandible [J]. J Oral Maxillofac Surg, 2002, 60(11): 1307-1314.
[30] Youmans RD, Russell EA Jr. The coronoid process: a new donor source for autogenous bone grafts [J]. Oral Surg Oral Med Oral Pathol, 1969, 27(3): 422-428.
[31] 洪民, 李永海, 黄继贤. 喙突移植治疗颞颌关节强直 [J]. 中国人民解放军军医进修学院学报, 1980, 1(1): 54-58.
[32] 杨明达. 用喙突移植治疗真性颞颌关节强直 [J]. 浙江医学, 1980, 2(1): 17-19.
[33] Liu YM, Li JH, Hu J, et al. Autogenous coronoid process pedicled on temporal muscle grafts for reconstruction of the mandible condylar in patients with temporomandibular joint ankylosis [J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2010, 109(2): 203-210.
[34] 邰振星,洪民,王忠良. 喙突移植术治疗颞下颌关节强直临床和组织病理学观察 [J]. 中华口腔医学杂志, 1987, 22(2): 94-96.
[35] 祝颂松,李娜,胡静,等.自体喙突移植重建下颌髁突的实验研究 [J]. 实用口腔医学杂志, 2006, 22(3): 321-324.
[36] 满城,祝颂松,张碧,等. 自体喙突移植重建下颌髁突对下颌骨生长发育的影响 [J]. 北京口腔医学, 2009, 17(2): 65-68.
[37] Zhang W, Gu B, Hu J, et al. Retrospective comparison of autogenous costochondral graft and coronoid process graft in the management of unilateral ankylosis of the temporomandibular joint in adults [J]. Br J Oral Maxillofac Surg, 2014, 52(10): 928-933.