颞下颌关节强直不同截骨方法的比较研究

Comparison of different osteotomies in the operation for temporomandibular joint ankylosis treatment

目的：比较颢下颌关节强直手术中不同截骨方法的手术效果。方法：随访武汉大学口腔医学院1997～2002年颞下颌关节强直手术患者78例，其中55例采用2种手术方法：裂隙关节成形术和保留关节盘的关节成形术，这2种术式均存在2种截骨：传统截骨法和改良的保留髁突法。用随访时开口度与术前开口度之差即开口度改善作为手术疗效评价的主要指标，然后分别统计分析。结果：平均随访3．19年，保留关节盘的2种截骨法t检验，t=1．22，P=0．24，无统计学差异；裂隙关节成形术2种截骨法的秩和检验P=0．59，无统计学差异。结论：改良截骨法虽然对手术效果的改善不明显，但在恢复关节结构、面形及[牙合]关系方面有重要意义。

Objective：To compare the effect of TMJ arthroplasty between modified and traditional osteotomy. Metbods：A clinical retrospective evaluation of 55 patients treated for temporomandibular joint ankylosis during 1997-2002. Traditional and modified osteotomy were performed respectively in gap arthroplasty or arthroplasty with retaining disc. The follow-up examination was done and the improvement of mouth opening was used as the guideline of effect evaluation. Independent-sample t test and rank sum （Mann-Whitney） test were applied for statistic analysis. Results：The average follow-up time was 3. 19 years. Ankylosis recurrence was found in 10 out of the 26 cases with gap arthroplasty and not in the 29 with arthroplasty with retaining dise, mouth opening（cm） was increased by 1.47 ± 1.47 in the cases with gap arthroplasty and 2.78 ± 0.69 with arthroplasty with retaining disc. Traditional osteotomy and modified osteotomy resulted in similar effects in both gap arthroplasty group and arthroplasty with retaining disc group （ P 〉 0.05 ）. Conclusion： Modified osteotomy can not improve operative effect.