MRI评价颞下颌关节镜盘复位固定术的短期疗效

MRI Evaluation on Arthroscopic Temporomandibular Joint Disc Repositioning and Suturing

目的:用MRI评价颞下颌关节(temporomandibular joint,TMJ)镜关节盘复位固定术的短期疗效。方法:2004- 08—2007-03期间,共对639例(764侧关节)Ⅱ～Ⅴ期TMJ结构紊乱(internal derangement,ID)患者进行了关节镜治疗,所有患者手术前及术后1～7 d进行MRI检查。根据我们制定的成功标准,在髁突矢状位上选用内、中、外3个不同的层面进行手术前后关节盘的位置比较,从而评价手术疗效。标准制定如下:若3个层面完全复位,则疗效定为"优";2个层面完全复位,则疗效定为"良";仅1个层面或完全未复位则疗效定为"差"。将"优"和"良"定为有效(注:若术前仅有1个或2个1/3层面移位者,要求均被复位才算有效)。结果:764侧关节中,术后MRI显示729侧关节为"优",占95.42%;24侧关节为"良",占3.14%;11侧关节为"差",约1.44%,对评价为"差"的关节进行了二次关节镜手术或开放性手术。结论:经手术前后MRI对比验证,颞下颌关节镜关节盘复位固定术能有效地将关节盘复位,但其稳定性尚需进一步评价。

Objective： To evaluate the efficiency of arthroscopic suturing technique for stabilizing anteriorly displaced discs on patients with internal derangement （ID） of temporomandibular joint （TMJ） by MRI. Methods： 639 patients （764 joints） diagnosed as Ⅱ to Ⅴ stages of ID were carried out arthroscopic disc repositioning and suturing from Aug 2004 to Mar 2007. Consecutive MRIs were used to evaluate ID before operation and during 1-7 days after operation for all 639 patients. The disc position of TMJ was judged according to our success criteria which included three different sagittal planes （lateral, central and medial）. Operation efficiency of those patients, whose disc of TMJ was affirmed to be in normal position in all 3 planes, were evaluated to be excellent. Those patients, whose disc were in normal position in 2 planes, were evaluated to be good. The others were evaluated to be poor. Cases evaluated as ＂excellence＂ and ＂good＂, were calculated as success cases （if the disc displaced only in one or two planes before operation, the efficiency of operation would be evaluated to be success, only if the whole disc was in normal position）. Results： Postoperative consecutive MRI for all 764 joints confirmed that 95.42% joints was excellent; 3.14% was good, and only 1.44% was poor. Arthroscopic surgery or open surgery was carried out once more for the joints which evaluated as poor. Conclusion： This study indicates that TMJ arthroscopic suturing technique is effective in repositioning the TMJ disc confirmed by MRI examination, but long-term follow-up is necessary.