正颌术中髁突定位技术的研究进展

Progress on intraoperative condylar positioning techniques in orthognathic surgery

正颌手术后髁突移位可导致患者复发以及出现颞下颌关节症状。为减少术后髁突移位,众多髁突定位技术运用于临床中。旨探讨髁突定位技术预防术后出现关节症状及复发的有效性,本文回顾近20年内国内外正颌术中髁突定位技术的相关文献,经文献归纳发现,定位技术以稳定术前髁突位置为最终目的,可分为非计算机辅助和计算机辅助定位技术。目前计算机辅助设计与制造髁突定位装置(computer⁃aided de⁃sign/computer⁃aided manufacturing condylar positioning devices,CAD/CAM CPDs)定位效果最佳,由牙支持式与骨支持式导板组成。其余各技术定位效果由高到低排序:CAD/CAM钛板定位>手法定位>计算机辅助导航系统>影像定位系统。各定位技术的精准度可达到与髁突术前位置相差1~2 mm与1°~2°,有效预防术后复发以及关节症状,为不同级别的外科医生和不同难度的病例提供临床参考。该领域仍缺乏大样本和长时间随访的随机对照试验。未来需进一步研究,以优化现今髁突定位技术,提升其临床实际效用及开拓新型定位技术。

Condylar displacement can lead to temporomandibular joint(TMJ)symptoms and relapse after orthogna⁃thic surgery.To minimize condylar displacement,numerous condylar positioning techniques have been applied in clini⁃cal practice.To verify the effectiveness of condylar positioning techniques in preventing postoperative TMJ symptoms and relapse,we reviewed the literature related to all types of intraoperative condylar positioning techniques in the past 20 years.According to a literature review,positioning techniques aim to seat the condyles at a preoperative position dur⁃ing surgery and are divided into noncomputer⁃aided and computer⁃aided condyle positioning methods.At present,com⁃puter⁃aided design/computer⁃aided manufacturing condylar positioning devices(CAD/CAM CPDs)are the most superior positioning methods and are composed of teeth⁃supported and bone⁃supported guidance.The sequence of the remaining technology positioning effect from high to low is as follows:CAD/CAM titanium plate positioning>manual positioning>computer⁃aided navigation system>image positioning system.Different techniques reach considerable accuracy within 1⁃2 mm and 1°⁃2°in locating the preoperative condylar position and preventing TMJ symptoms or disorders and surgical relapse to provide a clinical reference for different levels of surgeons and cases.However,this study lacks randomized controlled trials with large samples and long⁃term follow⁃up.Future studies should upgrade the current methods,im⁃prove the clinical utility,and develop new positioning techniques.