牵张成骨联合正颌正畸技术治疗颞下颌关节强直的效果分析

Distraction Osteogenesis plus Orthodontic and Orthognathic Method for Ankylosis of Temporo-mandibular Joint

目的:探讨联合采用牵张成骨以及正颌正畸技术治疗颞下颌关节强直的效果。方法:选取我院收治的50例颞下颌关节强直继发小下颌畸形患者,根据不同的手术方式将其分为观察组以及对照组,对照组仅采取正颌正畸治疗,观察组一期通过关节成形术解除关节强直,完成正畸治疗后,二期采用牵张成骨以及颏成形术矫治小下颌畸形伴随OSAHS,术后进行8-35月的随访,评价治疗效果。结果:观察组的牵张距离、颏前移距离以及术后张口度均明显大于对照组,且最大张口度均大于20 mm,平均最大张口度由术前的3.2 mm增加至术后的36.7 mm,P<0.05,观察组术后能够恢复正常咬合关系和咀嚼功能,两组患者术后的平均睡眠紊乱指数(AH1)、LAST、后气道间隙(PAS)以及SNB角度比较有统计学差异,P<0.05,观察组术后患者的OSAHS症状均得到显著的改善,未出现OSAHS复发情况。结论:牵张成骨联合正颌正畸技术治疗颞下颌关节强直可以获得满意的效果,可以很好的矫治牙额面畸形,且能够有效改善伴发的OSAHS症状。

Objective： To study the effect of distraction osteogenesis plus orthodontic and orthognathic method in the treatment of patients with ankylosis of temporo-mandibular joint. Methods： A total of 50 patients with temporo-mandibular joint ankylosis were selected from People＇s Hospital of Wuxi City Affiliated to Nanjing Medical University and divided into observation group （n=25） and control group （n=25） according to the different surgical methods. The control group was given only orthodontic and orthognathic treatment, while the observation group, arthroplasty treatment in the first stage to relieve joints stiffness and distraction osteogenesis and genioplasty in the second stage to correct small chin deformity and OSAHS. After the surgery, 8-35 months of follow up were given to the patients of the two groups; the effects of the treatment were evaluated. Results： The stretching distance, chin forward distance and postoperative mouth degrees of observation group were significantly greater than those of control group, and the biggest mouth degrees were greater than 20 mm, the average maximum mouth degree increased from 3.2 mm preoperative to 36.7 mm after operation（P〈0.05）. The observation group could restore normal occlusal and chewing function. There were statistically significant difference in the mean sleep disorder index, the LAST, posterior airway space （PAS） and the SNB angle between two groups postoperative （P〈0.05）. The OSAHS symptoms were significantly improved in the observation group after operation, the OSAHS recurrence was not found. Conclusion： Distraction osteogenesis plus orthodontic and orthognathic method has a good effect in the treatment of patients with temporo-mandibular joint ankylosis, which can correct the tooth facies frontalis deformity and effectively improve the OSAHS symptom.