颞下颌关节盘不可复性前移位行锚固术后的临床疗效及影像学分析

Clinical effect and imaging analysis of disc anchor surgery for anterior disc displacement without reduction

目的探讨颞下颌关节盘锚固术(disc anchor surgery,DA)在颞下颌关节盘不可复性前移位(anterior disc displacement without reduction,ADDWR)治疗中的临床疗效及影像学分析。方法选择2014年1月—2018年12月在宁波市医疗中心李惠利医院行DA的195例ADDWR患者(220侧关节),分别于术前和术后1、3、6个月对患者的开口度、关节疼痛视觉模拟评分(VAS)及MRI表现进行分析,并进行长期随访,定期复查MRI以评估关节盘的位置及髁突骨质的变化。结果开口度术前为(17.63±3.31)mm,术后1个月为(37.63±2.30)mm,3个月为(38.03±2.65)mm,6个月为(38.23±2.20)mm;术前VAS评分值为31.26(12.91,49.61),术后1个月为7.72(0.81,14.63),3个月为6.69(1.08,12.31),6个月为5.65(0.13,11.17),开口度及VAS值与治疗前比较差异均有统计学意义(均P<0.05)。术后1个月MRI显示所有移位关节盘均复位,经12~72个月(平均30.12个月)的随访,MRI显示95.91%(211/220)的关节盘位置良好,而4.09%(9/220)的关节盘前移复发。76.82%(169/220)的髁突有新骨形成,20.00%(44/220)的髁突无骨质变化,3.18%(7/220)的髁突发生骨吸收。结论 DA能有效治疗ADDWR,复位后的关节盘位置稳定,能显著改善开口度、缓解疼痛及刺激髁突骨再生。

Objective To investigate the clinical effect and imaging analysis of disc anchor surgery(DA)in the treatment of anterior disc displacement without reduction(ADDWR).Methods Total 195 patients(220 lateral joints)with ADDWR were selected in our hospital from January 2014 to December 2018.Opening degree,visual analogue scale(VAS)and MRI findings were analyzed,and performed a long-term follow-up.MRI was reviewed regularly to assess the location of the joint disc and changes in the condylar bone.Results The average opening degree before surgery was(17.63±3.31)mm and(37.63±2.30)mm one month after surgery,3 months post-surgery mean opening degree was(38.03±2.65)mm and 6 months was(38.23±2.20)mm.VAS before surgery was 31.26(12.91,49.61),and 7.72(0.81,14.63)one month after surgery,6.69(1.08,12.31)three months after surgery,and 5.65(0.13,11.17)in six months post-surgery,there was significant difference of opening degree and the VAS between preoperative and post treatment(all P<0.05).One month after surgery,MRI showed all displaced discs were reset,and after a follow-up of 12-72 months(30.12 months on average),MRI showed that 95.91%(211/220)of the discs were in good position,compared with 4.09%(9/220)of the anterior discs.Some condyles bone had new bone formation[76.82%(169/220)],20.00%(44/220)had no bone changes,and 3.18%(7/220)had bone resorption.Conclusion DA can effectively treat the ADDWR and the articular disc position after surgery set stable,can significantly improve the opening degree,relieve pain and stimulate condylar bone regeneration.