单侧颞下颌关节强直伴小颌畸形同期牵引成骨治疗的临床研究

Clinical study of simultaneous correction of unilateral temporomandibular joint ankylosis and mandibular micrognathia with internal distraction osteogenesis

目的：观察应用内置式颌骨牵引器对单侧颞下颌关节（temporomandibular joint，TMJ）强直伴小颌畸形患者进行同期的牵引成骨治疗的临床疗效。方法：应用内置式颌骨牵引器，对7例单侧TMJ强直伴小颌畸形的成人患者进行同期的牵引成骨关节成形及下颌骨体（13侧）的牵引成骨治疗。术前经睡眠多导图仪（polysomnography，PSG）检查，7例患者均患有阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea and hypopnea syndrome，OSAHS），其中3例为重度OSAHS，另4例为轻、中度OSAHS。6例患者行双侧下颌骨体延长，1例患者行单侧下颌骨体延长。7例患者的TMJ强直均行牵引成骨关节成形术。手术包括两个术式：TMJ强直的牵引成骨关节成形术和小颌畸形的牵引成骨治疗。术后间歇期5—7天，牵引速度1mm／d，分4次进行。稳定期为3—5个月。术后即行开口训练。每一患者术前、术后均行x线头影测量及PSG检查。结果：所有患者术后OSAHS症状均减轻或消失。除1例术前重度者术后诊断为轻度外，其余6例患者术后PSG检查结果显示均已达到治愈标准。7侧关节强直经牵引成骨关节成形术矫治后，开口度均恢复正常。牵引间隙内成骨良好，未见感染及成骨不良等并发症发生。术后随访复查18—51个月，平均随访复查时间34．3个月。无小颌畸形及关节强直复发。结论：同期的牵引成骨治疗可有效矫治成人单侧TMJ强直伴小颌畸形及OSAHS.手术方法简便、风险小，能有效缩短治疗疗程，减少手术次数。术后开口训练对牵引间隙内的骨形成无不利影响。

Objective：To observe the clinical results in correction of unilateral temporomandibular joint （TMJ） ankylosis accompanying with mandibular micrognathia using internal distraction osteogenesis sim- uhaneously. Methods： Seven adult patients of unilateral TMJ ankylosis accompanying with mandibular micrognathia （13 sides of mandibular body） were treated simultaneously with internal distraction osteogenesis. Obstructive sleep apnea and hypopnea syndrome（OSAHS） was diagnosed in all patients preoperatively. The treatment includs distraction osteogenesis of mandibular body and transport distraction osteogenesis for TMJ arthroplasty at the same time. Distraction was started on the 6th to 8th day after operation. The distraction rhythmand rate was one mm a day operated in 4 separate times. The patients underwent active mouth opening postoperatively. Distractors were kept in place for 3 -5 months after completion of distraction and then removed. Mean distraction distance of the 13 sides of mandibular body was 17. 1mm（ranged from 14 to 20 mm） and that of the 7 sides of TMJ was 16.4mm（ranged from 15 to 20mm）. Results：After treatment, micrognathia of the 7 patients was corrected. OSAHS was cured in 6 patients. The mean range of mouth opening was increased from 8.1 mm to 39.9 mm and bone formation in the distraction gaps was observed. The mean following - up period was 34.3 months（ ranged from 18 to 51 months）. No recurrence of TMJ ankylosis or micrognathia was occurred. Conclusion：Unilateral TMJ ankylosis accompanying with micrognathia and OSAHS can be treated effectively by distraction osteogenesis simultaneously. The operation is simple with low risk. The course of treatment can be simplified and the operation times can be reduced.