颞下颌关节上腔囊内粘连的关节镜检查

Arthroscopic Diagnosis for Intraarticular Adhesion of Temporomandibular Joint

目的探讨囊内粘连与颞下颌关节内错乱(ID)分期以及与患者年龄、张口受限时间及术前张口度之间的关系.方法选择患有颞下颌关节ID的251例患者的280侧关节进行关节镜检查,观察颞下颌关节囊内粘连的形态及部位,按颞下颌关节上腔九分法分区记录粘连情况,计算各区粘连所占比例和不同粘连级别与ID分期的关系.将Ⅲ～Ⅴ期患者按关节镜检查结果分为粘连组和无粘连组,比较两组患者年龄、张口受限时间和术前张口度的差异.结果280侧受检关节中,有157侧发生粘连,约占56.07%,其中1级粘连占44.59%,2级粘连占32.48%,3级粘连占7.64%,4级粘连占15.29%.粘连关节在不同ID分期的构成比分别为:处于ID Ⅱ期的37侧关节有4侧发生粘连,占10.81%;处于ID Ⅲ期的121侧关节有59侧发生粘连,占48.76%;处于ID Ⅳ期的41侧关节有31侧发生粘连,占75.61%;处于ID Ⅴ期的81侧关节有63侧发生粘连,占77.78%.ID分期为Ⅲ～Ⅴ期的患者共223例(243侧),其中粘连组为136例(153侧),无粘连组为87例(90侧),两组患者的年龄、张口受限时间和术前张口度均有统计学差异(P＜0.001).结论颞下颌关节上腔囊内粘连发生率较高,多发生于张口受限时间长、张口度小及年龄较大的患者,且内错乱分期愈高,粘连级别愈高.

Objective To demonstrate the incidence ratio of intraarticular adhesion （ID）, arthroscopic findings of adhesions were evaluated by means of its shape, location and degree. To evaluate the correlation between intraarticluar adhesion and the following index, including patients＇ age, locking duration and intefincisal opening preoperatively. Methods 280 consecutive arthroscopically examined joints in 251 patients were evaluated. Two surgeons discussed and recorded the shape, location and degree of adhesion nine parts of the temporomandibular joint （TMJ） upper compartment on the chart. The adhesion ratio in different regions and the relation between different grades and ID stages of adhesions were calculated. The patients with ID stage Ⅲ,Ⅳ,Ⅴ, were divided into two groups, one with adhesion, and the other without. Interineisal opening, locking duration and age were compared between two groups using t-test. Results Of all 280 joints , 157 joints had adhesions, which accounted for 56 . 07 % . The adhesion of grade 1 accounted for 44.59%, grade 2 for 32.48%, grade 3 for 7.64%, and grade 4 for 15.29%. The proportiom of different grades in different stage were as follows. The joints with adhesion in Stage Ⅱ accounted for 10.81%, Stage Ⅲ for 48.76%, Stage Ⅳ for 75.61%, and Stage Ⅴ for 77.78%. There were 223 patients who suffered from ID Ⅲ-Ⅴ. All of 223 patients were divided into the group with adhesion （136 patients） and the other group without adhesion（87 patients）. The patients＇age, interineisal opening and locking duration between two groups were statistically significant difference（ P 〈 0.001）. Conclusion Arthroscopic findings confirmed that the incidence ratio of adhesion was high, mainly occurred in the older patients with longer locking duration and less interineisal opening. With the higher stage of ID, the adhesion＇ grades rise.