应用牵引成骨技术治疗颞下颌关节强直

Distraction osteogenesis for treatment of temporomandibular joint ankylosis

目的 探讨应用牵引成骨技术治疗骨性颞下颌关节强直的方法。方法 应用内置式颌骨牵引器 ,治疗 11例 (13侧 )颞下颌关节骨性强直患者。 9例为单侧 ,2例为双侧。患者年龄 9～ 5 1岁 ,平均年龄 2 0 .9岁。手术首先在强直关节区形成 15～ 2 0mm的骨间隙 ,然后在残留升支后缘行“L”型截骨 ,形成一长约 2cm ,宽约 1cm的可移动骨段 ,然后安置骨牵引器 ,术后第 4～ 8天开始牵引 ,牵引速度 0 .2 5mm/次。每天 4次。直到可移动骨段顶端接近术中制备的假关节窝 (保留 3～ 4mm间隙 )。术后即行开口训练。稳定期为 3～ 4个月。结果 11例 (13侧 )患者经牵引成骨关节成形术治疗后 ,开口度可以达到正常 (33～ 4 5mm)。牵引间隙内成骨良好。新形成的髁状突经改建变得圆钝 ,形态接近正常髁状突 ,无感染及成骨不良等并发症发生。结论 牵引成骨关节成形可有效治愈颞下颌关节强直 ,与传统治疗方法相比风险小 。

Objective To study the application of distraction osteogenesis in temporomandibular joint (TMJ) ankylosis patients. Methods 11 temporomandibular joint ankylosis patients (13 sides of TMJ) were treated by this technique. After removal of bony mass on the ankylosis area, a L shape osteotomy of the ramus was performed to create the distraction transport disc which connected the mandible by distractor. Distractions were started on the 4～8th postoperative day. The distraction rhythm and rate were 0.25 mm 4 times a day. Distraction was stopped when contact was made between the transport disc and glenoid fossa. The patients underwent active mouth opening postoperatively. Distractor was kept in place for 3～4 months after completion of distraction and then removed under local anesthesia. Results Postoperatively, the range of mouth opening of the 11 patients (13 sides) was increased to normal (33～45 mm), bone formation in the gaps were perfect and the neocondyle was remodeling and approximated normal shape. No complications were found. Conclusion Distraction osteogenesis for arthroplasty has many advantages compared with traditional methods. It is valuable in clinical practice as a new method for treatment of TMJ ankylosis.