内镜辅助肋骨-软骨移植重建髁突与同期正颌手术的临床研究

One-staged orthognathic surgery and arthoscope-assisted condylar reconstruction with costochondral graft

目的探讨内镜辅助肋骨-软骨移植重建髁突与同期正颌手术治疗严重颞下颌关节病变及牙颌面畸形的效果。方法于术前对患者进行临床检查和治疗设计，术中行LeFortI型截骨术、下颁支矢状骨劈开术、髁突等关节区病变的处理、内镜辅助下肋骨-软骨移植和颏成形术，术后进行随访。结果2003年9月至2005年12月，于临床应用15例，所有患者同期手术均顺利完成，术中、术后均无严重出血、神经损伤、受区感染等严重并发症发生。术后随访29～52个月，平均31．8个月，所有患者面容均显著改善，关节功能良好，且无关节区疼痛等主观症状，患者对手术疗效满意。术后张口度平均为33．6mm，侧向运动度为0～6mm。结论选择合适的适应证、设计合理的手术方案，内镜辅助髁突重建同期正颌手术效果较好。

Objective To investigate one-staged orthognathic surgery and arthoscope-assisted condylar reconstruction with costochondral graft for temporomandibular diseases combined with dental-maxillofacial deformities. Methods The preoperative measurement and model surgery was performed. The patients underwent arthoscope-assisted condylar reconstruction with costochondral graft combined with bimaxillary surgery or mandibular surgery. Results From Sept. 2003 to Dec. 2005, 15 cases were treated successfully with no bleeding, nerve injury and infection. The patients were followed up for 29 to 52 months（ mean, 31.8 months）. The appearance was markedly improved. TMJ function was good with no pain. The average maximum intefincisal opening was 33.6mm. Conclusion Compared with traditional operation, one-staged orthognathic surgery and arthoscope-assisted condylar reconstruction with costochondral graft has its advantages. Indication selection and preoperative design are very important.