自体肋软骨和自体喙突移植在成人单侧颞颌关节强直治疗中的临床效果比较

Retrospective study of autogenous cosotochondral graft and coronoid process graft in the cases of unilateral ankylosis of the temporomandibular joint in adults

目的:比较成人单侧颞颌关节强直髁突重建中自体喙突移植和肋软骨移植的临床效果。方法:选取32例自体喙突移植和28例自体肋软骨移植重建髁突的颞下颌关节强直病例,对其术前和术后的饮食分数、最大张口度、侧向运动、开口型偏斜、CT扫描影像学等方面进行评价。结果:两组患者的关节强直治疗均取得满意效果。在饮食分数、张口度、侧向运动、开口型偏斜和复发率等术前及术后的测量值中,两组间差异无统计学意义(P>0.05),但两组病例中术后张口度、侧向运动及饮食分数均较术前有显著改善。肋软骨移植术中有3例患者出现了胸膜撕裂,6例患者出现了移植骨供区的暂时性疼痛。肋软骨移植及喙突移植术后分别有5例和3例患者的面神经颞支受到了损伤,3-6月内康复。喙突移植组中无关节强直复发,肋软骨移植组中有1例复发。结论:在颞下颌关节强直矫治中,自体喙突移植是一种较好的髁突重建骨移植材料。

Objective：To compare the clinical outcomes of autogenous cosotochondral graft and coronoid process graft in the cases of unilateral ankylosis of the temporomandibular joint in adults. Method：32 patients underwent autogenous coronoid process graft and 28 patients underwent cosotochondral graft. Diet scores,CBCT,maximal interincisal opening,lateral excursion,and mandibular deviation on opening the mouth preoperatively and postoperatively were used to evaluate the clinical effects. Result：The clinical outcomes in both groups were satisfactory. There were no significant differences between the 2 groups in the parameters before and after the operation with respect to diet scores,interincisal opening,lateral excursion,mandibular deviation or recurrence rate,but in both the postoperative interincisal opening,lateral excursion,and diet scores had improved significantly. After costochondral graft 3 patients had intraoperative plural tears,and 6 had temporary pain at the donor site. The frontal branch of the facial nerve was temporarily affected in 5 patients after costochondral graft and 3 after coronoid process grafts,all of which recovered in 3 ~6 months. There was no recurrence after coronoid process grafting,and one after costochondral grafting. Conclusion：Autogenous coronoid process may be a good resource for condylar reconstruction in patients with TMJ ankylosis.