颞下颌关节镜盘复位固定术

Arthroscopic disc repositioning and suturing technique for internal derangement of the temporomandibular joint:technical note

目的:介绍一种颞下颌关节镜下盘复位固定新技术及其临床应用的初步效果。方法:选取门诊就诊的颞下颌关节疾病患者进行临床检查,在初步诊断为结构紊乱后进行MRI检查,以获取评价关节盘情况的影像学依据,并按照Wilkes-Bronstein分期标准进行分期,将处于Ⅱ～Ⅴ期的患者纳入治疗范围,进行关节镜下盘复位固定手术,主要操作要点为前附着松解和关节盘的水平褥式牵引缝合。术后连续对2004年8月—2007年3月期间接受关节镜下关节盘复位固定术的639例(764侧)患者进行随访观察。术后再次进行MRI检查,并根据自定的MRI评价标准,评价关节盘复位的效果。优为3个层面完全复位;良为2个层面完全复位;差为仅1个层面复位或完全未复位。将"优"和"良"定为有效,对复位"差"者再次进行手术、或改为开放性锚固术。结果:764侧关节中,术后MRI显示729侧为"优",占95.42%(729/764);24侧为"良",占3.14%(24/764);11侧为"差",约1.44%(11/764)。结论:颞下颌关节镜盘复位固定术是一种能将关节盘复位的有效术式,但其长期的稳定性尚需进一步评价。

PURPOSE：The purpose of this study was to introduce a new arthroscopic disc suturing for treating internal derangement of the temporomandibular joint.METHODS：Arthroscopic disc repositioning and suturing surgery including anterior release and disc repositioning was performed on patients who visited the TMJ clinic at the Ninth People＇s Hospital,Shanghai JiaoTong University School of Medicine,between August 2004 and March 2007 with TMJ ID stages Ⅱ-Ⅴ.The patients＇ ID stages were based on the criteria of Wilkes Bronstein＇s classification.Consecutive MRIs were used to evaluate ID before operation and after operation for all 639 patients.The disc position 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 discs were in normal position in 2 planes,were evaluated to be good.The others were evaluated to be poor.Cases evaluated as ＂excellent＂ and ＂good＂ were used for calculation of success case（if the disc is displaced in only one or two planes,we thought it was success,when the whole disc was in normal position）.Arthroscopic surgery or open surgery was carried out once more for the joints evaluated as poor.RESULTS：Postoperative consecutive MRIs for all 764 joints confirmed that 95.42%（729/764） joints was excellent,3.14%（24/764） was good,and only 1.44%（11/764） was poor.CONCLUSION：TMJ arthroscopic suturing is an effective,minimally invasive surgery in repositioning the TMJ disc,but long-term follow-up is necessary for its stability.