45例复发性颞下颌关节前脱位的分类及治疗探讨

Classification and treatment for recurrent anterior dislocation of temporomandibular joint on 45 cases

目的:介绍一种基于MRI上关节盘与髁突相对位置的颞下颌关节复发性前脱位分类方法,以及针对不同类型采用不同手术方法治疗的经验。方法:选择2003年5月-2016年5月治疗的45例颞下颌关节复发性前脱位患者。依据MRI分为Ⅰ型(关节盘无移位)、Ⅱ型(关节盘移位)、Ⅲ型(骨关节病)及Ⅳ型(存在精神或神经功能障碍),依据分类选择不同的手术治疗方法。结果:Ⅰ型28例(62.2%),Ⅱ型12例(26.7%),Ⅲ型2例(4.4%),Ⅳ型3例(6.7%)。Ⅰ型患者采用关节结节增高术或关节镜下硬化剂注射术;Ⅱ型患者采用颞下颌关节盘复位固定术(锚固)及关节镜下关节盘复位固定术,辅助关节结节增高术;Ⅲ型患者根据临床症状进行手术;Ⅳ型患者均采用关节结节凿平术。随访期间未发现开口受限、开口疼痛、脱位复发。结论:基于MRI影像学特点对颞下颌关节脱位进行分类,对术者选择合适的治疗方案具有指导意义。

PURPOSE:To introduce a classification of recurrent anterior dislocation of temporomandibular joint(TMJ)based on MRI by analyzing relative position of TMJ disc and condylar;and summarize the experience of different therapeutic methods.METHODS:MRI data of 45 patients who suffered from recurrent anterior dislocation of TMJ treated in our hospital during May 2003 to May 2016 were collected.On the basis of MRI findings,four categories were proposed,namely typeⅠ:proper disc position,typeⅡ:anterior disc displacement,typeⅢ:osteoarthritis and typeⅣwith mental disorders.Different treatments were conducted for different types of lesions.RESULTS:TypeⅠincluded 28 cases(62.2%),typeⅡincluded 12 cases(26.7%),typeⅢincluded 2 cases(4.4%)and typeⅣincluded 3 cases(6.7%).Type I was treated for either articular tubercle augmentation or arthroscopic sclerotherapy.TypeⅡwas treated with TMJ disc reduction and fixation(anchoring),and arthroscopic disc reduction and fixation,assisted with TMJ tubercle enhancement.TypeⅢwas treated according to clinical symptoms of patients.TypeⅣwas treated using chiseling of the eminence.During the follow-up period,mouth opening limitation,pain,and dislocation recurrence were not present.CONCLUSIONS:The classification of TMJ dislocation based on the features of MRI imaging is instructive for surgeons to make appropriate treatment plan.