利用夹板治疗髁状突纵形骨折突、盘的组织学变化

Histological observation of the effects of occlusal splint on mandibular condyle and disc after sagittal condyle fracture in miniature pigs

目的：观察髁状突纵形骨折后及牙合夹板治疗时髁状突、关节盘的改变。探讨牙合夹板治疗机制。方法：实用小型猪１８头，随机分为髁状突纵形骨折后未治疗组，牙合夹板治疗组及对照组各６头。实验后３、６、１２周取材，光镜扫描电镜观察。结果：牙合板治疗髁状突纵形骨折１２周，骨折愈合，无盘突粘连。生发层细胞和表层纤维连续，其下是新生软骨细胞和大量软骨内化骨现象。未治疗组３周关节盘轻度变形，１２周关节盘与髁状突、颞下凹粘连，呈双髁突畸形。电镜下牙合夹板治疗组骨折侧髁突表面凝胶样物质尚存，细胶原纤维暴露。未治疗组骨折侧髁突表面凝胶状物质消失，有的部位胶原纤维粗大，有的部位细小。结论：髁状突纵形骨折未治疗后果为盘突粘连，双髁突畸形。牙合夹板具有防止盘突粘连，使髁状突恢复正常生长发育的作用。

Objective:To observe the histological changes of mandibular condyle and disc after sagittal condyle fracture treated with occlusal splint and to explore the mechanism of occlusal splint treatment. Method:Sagittal fractures of mandibular condyle were made in 18 miniature pigs and then the pigs were divided into 3 groups:untreated,occlusal splint treated and control. Light and electron microscopes were used to observe the histological changes of the condyles and discs 3, 6 and 12 weeks after operation.Results:12 weeks after operation, there was no adhesion within TMJ in the pigs trealed with the occlusal splint. The fractured bone was healed and partial cartilages regenerated;the disc deformed,bifid condyle formed and serious adhesions occured between the disc and condyle in the untreated pigs. Conclusion:For the treatment of sagittal condyle fracture occlusal splint can prevent adhesion within TMJ,restore the normal growth and developement of the condyle and disc.