外伤性颞下颌关节强直的病因学研究

An Etiology Study on Post-traumatic Ankylosis of Temporomandibular Joint(TMJ)

目的：探讨外伤性颞下颌关节强直与髁突骨折的关系。方法：92例外伤性颞下颌关节强直和342例髁突骨折病例。分析颞下颌关节强直患者临床及影像学资料并与髁突骨折患者进行对比研究。结果：颞下颌关节强直患者26例伤后明确诊断为髁突骨折,根据强直就诊时X线,还有43例存在髁突骨折痕迹,髁突骨折共计69例（69/92,75.0%）。颞下颌关节强直大多是0-10岁（56例,占60.9%）时的外伤所致,就诊大多在11-20岁（51例,占55.4%）,而髁突骨折的病例以成年人（≥21岁）多见（230例,占67.3%）,差异有统计学意义（X^2=113.79,X^2=45.25,P〈0.01）。髁突骨折以男性多见（232/342,67.8%）,而颞下颌关节强直患者中女性多见（48/92,52.2%）,差异有统计学意义（X^2=12.54,P〈0.01）。髁突骨折病人受伤时伴有身体其他部位外伤的有103例（103/342,30.1%）,与颞下颌关节强直（35/92,38.0%）相比差异有统计学意义（X^2=4.14,P〈0.05）。结论：虽然髁突骨折是导致外伤性颞下颌关节强直最主要原因,但髁突骨折早期不及时、不正确的诊疗对颞下颌关节强直的发生有着很大的影响。是否处在生长发育期、创伤严重程度与颞下颌关节强直发生密切相关。

Objective： To study the correlation between ankylosis of TMJ and condylar fracture. Method ： This study was based on 92 cases of post - traumatic TMJ ankylosis and 342 cases of condylar fracture. The clinical and radiographic data of TMJ ankylosis and condylar fracture patients were reviewed and analyzed. Result： 26 patients of 92 TMJ ankylosis were diagnosed as condylar fracture after trauma, and the signs of condylar fracture were determinated in other 43 ankylosis patients by the preoperatively radiographic views. So the history of condylar fracture could be identified at least 75.0% cases （ 69/92 ） of ankylosis. The ankylosis cases mostly were caused by the trauma suffered in the period of 0 - 10 years old （56/92, 60. 9% ）, hospitalized in the period of 11 -20 years old [51/92, 55.4% ）. Those ages were significantly different from the ages of eondylar fracture patients whose ages were mostly in the period of over 21 years old （230/342, 67.8% ） ,X^2= 113.79,X^2 = 45.25, P 〈 0.01. The most patients of ankylosis were female and condylar fracture were male, which was significantly different （X^2 = 12.54, P 〈0.01 ）. The percents of associated trauma in ankylosis （ 35/92, 38.0% ） and in condylar fracture （ 103/342, 30.1% ） patients were significantly different （ X^2 =4.14, P 〈 0.05 ）. Conclusion： The most vital cause of post - traumatic TMJ ankylosis is condylar fracture, and delaying or inaccurate diagnosis and therapy of condylar fracture could resuit in TMJ ankylosis. There are close relationship between the age and severity of trauma and TMJ ankylosis.