髁突置换治疗创伤性颞下颌关节强直五例

Prosthetic replacement of condylar head for management of traumatic temporomandibular joint ankylosis

目的总结用人工髁突置换治疗创伤性颞下颌关节强直（temporomandibular joint ankylosis，TMJA）的临床效果。方法2006年8月至2008年4月北京大学口腔医学院·口腔医院口腔颌面外科共5例创伤性TMJA患者接受人工髁突置换手术，患者均为男性。术前行CT检查后，用快速成形技术制作三维头模，在头模上模拟切除关节骨球、关节成形、选择适宜的人工髁突，术中依术前设计安放并固定人工髁突。术后1周和复查时评价手术效果。结果5例共植人6侧人工髁突（1例为双侧）。3例复查时间为术后8～30个月，另外2例失访。复查时张口度平均为30mm，2例咬合关系良好，1例前牙区有约1mm的开骀。结论人工髁突置换可以作为创伤性TMJA手术治疗的方法之一，其临床效果还需进一步验证。

Objective To preliminarily evaluate the method of using titanium condylar protheses in management of traumatic temporomandibular joint ankylosis. Methods Between August 2006 and April 2008, titanium condylar replacement was performed in 5 male patients. Preoperative CT datum of patient was obtained and a resin model was then produced and used as a reference to select a suitable titanium condyle for reconstruction of the joint. In the operation, the bony ankylosis was removed. According to the preoperation planning, the selected prosthesis was inserted and fixed to the distal mandibular segment. The results were assessed by means of examinations and measurements postoperatively and during follow-up. Results The 5 patients received alloplastic replacement of 6 condyles. Three patients were under follow-up and follow-up time ranged from 8 months to 2 years and 6 months. The mean mouth opening was 30 mm. Two patients had good occlusion and one patient developed a slight open bite. Conclusions Prosthetic condylar replacement can provide a choice for management of traumatic temporomandibular joint ankylosis.