正颌外科治疗对颞下颌关节功能影响的研究

The effect of orthognathic surgery on temporomandibular joint function

目的 观察正颌手术后颞下颌关节病各种症状及体征的变化 ,比较不同固定方式及手术方式对于颞下颌关节的影响。方法 正颌手术矫治的连贯患者 46例 ,术前 1周内及术后 1年记录患者的颞下颌关节情况。结果 全组Helkimo主诉症状指数 (Ai) ,临床指数 (Di)的差异无显著性 ,术后最大开口度与下颌前伸度皆减小 ,但只有 1%差别 ,无明显临床意义。单双颌手术及升支的 3种术式之间比较 ,各项症状与体征的变化差异无显著性。结论 正颌外科治疗对颞下颌关节的影响不大 。

Objective To prospectively investigate the signs and symptoms of TMJ in patients undergoing different orthognathic operations with rigid or non rigid internal fixation. Methods The Helkimo index was used to analyze the anamnestic (Ai) and clinical (Di) data of 46 one year postoperative cases being performed mandibular ramus osteotomies combined with other operations, and compared with preoperative data to analysis the changes of TMJ symptoms. Results The changes of the Ai and Di data were not significant. Postoperative in the four clinical indices, only the joint tenderness indice was significantly different from preoperative. Despite there were decreases of maximal opening of mouth, maximal protrusion, they were only 1% lower than preoperative data and had no clinical significance. The percentage of TMJ to develop after bimaxillary operation was not different from only mandibular operation. There was no significant difference as compared between different operations and fixation methods. Conclusions The change of TMJ symptoms and signs after orthognathic surgery was not significant. Compared with each other the various surgical procedures (bimaxillary or only mandibular, BSSRO or BIVRO, RF or NRF) were not found any difference about the effect on the TMJ.