颞下颌关节强直的手术方法与复发

The Operation Methods and Recurrence of Temporomandibular Joint Ankylosis

目的:通过比较颞下颌关节强直四种手术方法的复发率,探讨手术方法的改进对减少复发的作用。方法: 回顾1988-2002年间我院收治的颞下颌关节强直手术病人140例,其中采用耳前切口101例,包括裂隙关节成形 术55例,间置物关节成形术17例,保留关节盘的关节成形术29例;主要采用耳前加颌下切口的关节重建术39例。 此期间复发20例。结果:总复发率约14.3％,裂隙关节成形术的复发率约16.4％,间置物关节成形术的复发率约 23.5％,关节重建术总的复发率为15.4％,而保留关节盘组复发率仅3.4％。结论:手术方法的改进可减少复发: 对创伤性颞下颌关节强直,保留关节盘的关节成形术可有效降低复发率;而其它手术方法均有不同程度的复发,它 们之间的疗效比较还需要进一步随访观察。

Objective: The purpose of this study was to discuss the effect of decreasing recurrence by comparing the recurrence rate of four kinds operation methods of temporomandibular joint (TMJ) ankylosis. Methods: A clinical retrospective evaluation of 140 patients treated for this disorder during 1988 -2002. According to the techniques we used, patients were divided into four groups. Three groups were treated by means of preauricular incision for 101 cases, gap arthroplasty 55 cases , interpositional arthroplasty 17 cases, arthroplasty of retaining disc 29 cases, and in the fourth group TMJ reconstruction were mainly performed with preauricular and submandibular incision for 39 cases. There were 20 recurrence cases during these patients. Results: Total recurrence rate was 14. 3% , including the recurrence rate of gap arthroplasty was 16. 4% ; interpositional arthroplasty was 23.5% ; TMJ reconstruction was 15.4% ; but arthroplasty of retaining disc was only 3.4%. Conclusion: Improving methods can reduce recurrence. For traumatic TMJ ankylosis, arthroplasty of retaining the disc can lessen recurrence rate effectively, comparing with other operation methods, but effect comparison between these methods need more follow up.