关节镜用于颞下颌关节滑膜软骨瘤病诊治的临床分析

Clinical analysis of arthroscopy used in the diagnosis and treatment of synovial chondromatosis of the temporomandibular joint

目的评估关节镜对颞下颌关节滑膜软骨瘤病(TMJSC)的诊治的临床意义。方法本研究回顾性分析2011年7月至2018年12月收治的16例经磁共振检查(MRI)初步诊断为TMJSC的病例,若经关节镜检查明确诊断者,即行开放手术,对确诊病例的术前MRI、关节镜、开放手术情况、术后病理诊断、术后MRI进行分析,并进行临床随访,评价其诊治效果;对其术前、随访的开口度、视觉模拟疼痛评分(VAS)进行差异性t检验。结果经关节镜诊断为TMJSC者14例,与术后病理诊断相符,关节镜的诊断正确率100%。术后MRI复查,关节腔病灶基本消失;10例TMJSC患者随访(随访率71.4%)期为6个月~7年8个月,平均随访时间17.6个月,未见复发者,且临床症状均有不同程度改善。术前和随访时,开口度差异性t检验结果为t=7.757、P<0.05;VAS的t检验结果为t=-3.274、P<0.05。结论关节镜对TMJSC的术前确诊是必要的,在开放手术中有重要的辅助诊疗的作用。

Objective To evaluate the value of arthroscopy in the diagnosis and treatment of synovial chondromatosis of the temporomandibular joint(TMJSC).Methods The cases of 16 patients preliminarily diagnosed with TMJSC by magnetic resonance imaging(MRI)from July 2011 to December 2018 were analyzed retrospectively.If the diagnosis was confirmed by arthroscopy,the opening operation was performed.The preoperative MRI,arthroscopy and opening operation,postoperative pathology and postoperative MRI of confirmed cases were analyzed,and clinical follow-up was performed to evaluate the curative effect of open surgery.The degree of mouth opening and visual analogue scale(VAS)scores for pain pre-operation and during follow-up of the confirmed cases were analyzed by t-test.Results Fourteen cases of TMJSC were diagnosed by arthroscopy,consistent with the postoperative pathological diagnosis.Postoperative MRI examination showed that articular cavity lesions basically disappeared.Ten patients with synovial chondromatosis were followed-up(follow-up rate,71.4%)from 6 months to 7 years and 8 months(average follow-up time,17.6 months);no recurrence was found,and clinical symptoms improved by varying degrees.Before operation and at follow-up,t-test results of opening degree difference were t=7.757,P<0.05;t-test results of VAS were t=-3.274,P<0.05.Conclusion Arthroscopy is essential in the diagnosis and treatment of TMJ synovial chondromatosis.