化脓性颞下颌关节炎的治疗

A Clinical Study on Septic Arthritis of Temporomandibular Joint:Treatment

目的探讨化脓性颞下颌关节炎的治疗方法及其疗效。方法对我科近5年就诊的30例化脓性颞下颌关节炎患者,关节局部进行单针低压灌洗、双针低压灌洗、关节腔灌洗结合颞下间隙切排及关节内镜手术等4种方式治疗;治疗效果通过关节腔穿刺、张口度、颌疼痛和颌功能等方面的检查来评判;随访观察后遗症的发生情况。结果治疗的总有效率为100%(30/30);单针低压灌洗、双针低压灌洗、关节腔灌洗结合颞下间隙切排和关节内镜手术的有效率分别为14/20、9/13、1/1和4/4;后遗症主要为骨关节病。结论化脓性颞下颌关节炎急性期的治疗要素是适当的关节腔低压灌洗、减轻关节负荷及全身配合应用抗生素;对伴有颞下间隙脓肿的患者,在进行关节腔灌洗的同时,还可行下颌下切口的颞下间隙引流;对一些灌洗治疗无效或有后遗症的患者,关节内镜手术有优异的疗效。

Objective To investigate the procedure and effect on treating septic arthritis of temporomandibular joint(TMJ).Methods30patients were treated by antibiotic therapy,resting of the jaw,and local therapies.The local therapies included arthrocentesis with single needle in20joints,arthrocentesis with double needles in13,arthrocentesis accompanied by submandibular drainage of the infratemporal space abscess in1,and arthroscopy in4.The therapeutic effects were judged by joint cavity puncture,mouth opening,jaw pain,and jaw function,and so on.Sequelae were evaluated.Results The overall success rate of the treatment was100%(30/30).The success rates of the4different management were:14/20in arthrocentesis with single needle,9/13in arthrocentesis with double needles,1/1in arthrocentesis combined with submandibular drainage,and4/4in arthroscopy,respectively.The sequelae were mild,and most of the cases had only postinfectious osteoarthritis.Conclusions Low pressure arthrocentesis,antibiotic therapy and resting of the jaw were important components of treatment in acute septic arthritis.If infratemporal space abscess was found,submandibular drainage should be done.Arthroscopy could be recommended to those who haven' t got good results by arthrocentesis or those who have already had some sequelae,such as TMJ fibrous ankylosis.