颞下颌关节盘锚固术中脂肪组织瓣转归的实验研究

Experimental research of outcomes of free fat flap in temporomandibular joint disc anchor in minipigs

目的:探讨颞下颌关节(temporomandibular joint,TMJ)盘锚固术中游离脂肪瓣的影像学变化及组织学转归。方法:选取3个月龄小型猪6只,术前拍摄TMJ MRI,将左侧作为实验组,对其进行关节盘前附着松解,并切取耳前区脂肪瓣,移植到TMJ松解后的间隙内。右侧作为对照组,只进行关节盘前附着松解。术后即刻、3、6个月分别拍摄TMJ MRI,观察脂肪组织的影像学变化。术后3、6个月各处死动物3只,取脂肪标本,测量脂肪组织的体积,并进行HE染色,观察其组织学变化。结果:MRI示移植的脂肪组织在术后3个月、6个月信号逐渐减弱,脂肪瓣体积在术后3个月减少到67.7%,术后6个月减少为42.6%。HE染色示术后3个月脂肪组织呈现慢性炎症反应,术后6个月可见新的脂肪小叶形成,小叶间纤维组织增生明显。结论:游离脂肪瓣移植6个月后,脂肪瓣部分存活,体积稳定,为TMJ外科临床应用游离脂肪瓣提供了理论支持。

PURPOSE： To observe the imaging changes and histological outcomes of free fat flap grafts in temporomandibular joint （TMJ） disc anchor in minipigs. METHODS： Six three-month-old minipigs were included in the study. Magnetic resonance images （MRI） were taken on the animals before operation. The left joints were as experimental sides in which the anterior attachment were released and free fat flap from the front of ear lobe was grafted in the gap. The right joints were as control group in which only the anterior attachment was released. MRIs were taken right after operation, 3 and 6 months after operation in order to observe the imaging changes of free fat flap. Fat specimens were excised three and six months after operation. The volume of fat was measured and haematoxylin and eosin （HE） staining was performed to observe the histological outcome. RESULTS： MRIs showed the signals of grafted fat were gradually decreased 3 and 6 months after operation. The volume of fat was deduced to 67.7% 3 months after operation and 42.6% 6 months after operation. HE staining showed chronic inflammation in the grafted fat 3 months after operation and new fat lobule was formed 6 months after operation accompanied with obvious fibrosis among lobules. CONCLUSION： Free fat flap can survive steadily 6 months after operation with the surviving volume about 42.6%. The free fat flap graft was feasible in TMJ surgery. Supported by Natural Science Foundation of Shanghai Municipality （10ZR1418200）and Shanghai Pujiang Talent Plan in 2011.