自体耳廓软骨瓣置换或重建颞下颌关节盘——临床疗效评价

AUTOGENOUS AURICULAR CARTILAGE GRAFT FOR DISC REPLACEMENT OR RECONSTRUCTION OF THE TEMPOROMANDIBULAR JOINT. A CLINICAL STUDY

目的 为了对己严重病变的关节盘进行置换及对关节强直进行重建关节盘 ,本文报道耳廓软骨移植的手术方法和临床疗效 ,并结合文献报道中的有关资料进行讨论。方法 对 4侧结构紊乱、4侧骨关节病、2侧滑膜软骨瘤病及 3侧关节强直 ,共 13侧颞下颌关节 ,用自体耳廓软骨瓣置换或重建关节盘 ,其中 ,6例合并应用关节刨削术 ,2侧用颞深筋膜瓣重建关节外侧囊 ,1侧耳廓软骨瓣复合颞深筋膜修复关节盘以获得足够的厚度。结果 随访期 1～ 13月 ,所有软骨瓣无感染 ,均成活 ,临床疗效满意 ,供区无或轻微变形。结论 在形态和厚度方面 ,人类的耳廓软骨瓣与关节盘较相似 。

Objective The clinical effect of the autogenous auricular cartilage graft that replaces or reconstructs the articular disc of the temporomandibular joint(TMJ) was evaluated.Methods The 13 discs of the 13 joints with 4 joints of internal derangement, 4 osteoarthrosis, 2 synovial chondromatosis, and 3 ankylosis were replaced or reconstructed with autogenous auricular cartilage grafts. Of them, shaving was performed in the 5 joints, temporalis fascia flaps were used to repair the lateral capsule in 2, and, auricular cartilage graft with tempralis fascia flap were used to get enough thickness in 1.Results At an average follow up of 6.5 months, clinical symptoms were improved in all patients. Maximal active opening was increased from 2.3cm to 3.3cm in ID, from 0.8cm to 2.7cm in ankylosis, and from 3.5cm to 3.9cm in synovial chondromatosis. Pain was releaved from 5-6 to 0-2(VAS) in OA, and from 7-8 to 0-1 in synovial chondromatosis. All grafts survived. There were no or slight deformities in the donors. Conclusions The autogenous auricular cartilage graft resembles the articular disc in the form and the thickness, and is a good material for replacing or reconstructing the articular disc of the temporomandibular joint.