手术治疗单侧不可复性关节盘前移位的疗效观察

doi:10.3877/cma.j.issn.1674-1366.2015.01.009

中华口腔医学研究杂志(电子版) ›› 2015, Vol. 09 ›› Issue (01) : 57 -62. doi: 10.3877/cma.j.issn.1674-1366.2015.01.009

所属专题：文献；

临床研究

手术治疗单侧不可复性关节盘前移位的疗效观察

李锐¹^,^†(

), 张睿², 付坤¹, 高宁¹, 乔永明¹

^1. 450000　郑州大学第一附属医院口腔科
^2. 450000　郑州市口腔医院口腔颌面外科

收稿日期:2015-01-01 出版日期:2015-02-01
通信作者: 李锐
基金资助:
国家自然科学基金(81300843); 河南省科技厅开放合作项目(142106000183)

A study of surgical treatment for unilateral anterior disc displacement without reduction

Rui Li¹^,^†(), Rui Zhang², Kun Fu¹, Ning Gao¹, Yongming Qiao¹

^1. Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
^2. Department of Oral and Maxillofacial Surgery, Zhengzhou Stomatologic Hospital, Zhengzhou 450000, China

Received:2015-01-01 Published:2015-02-01
Corresponding author: Rui Li
About author:
Corresponding author: Li Rui, Email: liruisichuan@163.com

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目的

探讨手术治疗单侧颞下颌关节不可复性关节盘前移位的临床效果。

方法

选择2012年10月至2013年10月单侧不可复性关节盘前移位患者54例，均经磁共振成像（MRI）确诊，保守治疗效果不佳，进行关节盘复位手术，按发病病程分为以下三组：6个月以内组（15例）；6~12个月组（22例）；12个月以上组（17例）。治疗后1、6和12个月对患者进行复诊，并对三组的疗效进行比较。

结果

术后1、6和12个月复诊时，三组病例术后张口度改善情况和疼痛缓解情况均较术前有明显改善（P < 0.05）。术后12个月时，6个月以内组和6~12个月组张口度改善情况优于12个月以上组（P < 0.05）；而这两组仅在术后1个月复查时有明显差异（P < 0.05），在其他复查时间点该两组无明显差异。6~12个月组术后张口度改善情况均优于12个月以上组（P < 0.05）。6个月以内组和6~12个月组疼痛缓解程度均优于12个月以上组（P < 0.05）；而6个月以内组和6~12个月组未发现明显差异。

结论

在保守治疗效果不佳的前提下，手术是治疗不可复性关节盘前移位的有效方法，尤其对于发病时间在12个月以内的病例的治疗效果明显优于病程较长者，早期治疗对于预后十分重要。

关键词: 颞下颌关节紊乱病, 不可复性关节盘前移位, 关节盘复位术

Objective

To preliminarily evaluate the surgical treatment for anterior disc displacement without reduction (ADDwR) .

Methods

Fifty-four patients with ADDwR received disc repositioning and fixation via open anchorage surgery from October 2012 to October 2013 were enrolled. They were distributed into three groups according to the course of disease: < 6 months (15 cases) ; 6-12 months (22 cases) and > 12 months (17 cases) . The follow-up time was 1-12 months and the clinical effects of each group were compared.

Results

The postoperative clinical effect was significantly improved, such as maximum interincisal opening (MIO) and pain release (P < 0.05) . Twelve months after operation, the improvement of MIO in Group <6 m and 6-12 m were better than that of the Group > 12 m (P < 0.05) , and there was no significant difference between Group < 6 months and Group 6-12 m, except at one month after operation. The improvement of MIO of Group 6-12 m was always better than that of Group > 12 m (P < 0.05) .

Conclusions

With the accurate diagnosis and appropriate selection of indications, disc repositioning and fixation via open anchorage surgery should be an effective procedure for ADDwR, especially in the cases treated within 12 months. Earlier treatment means better prognosis.

Key words: Temporomandibular disorders, Anterior disc displacement without reduction, Disc anchorage

表1 三个治疗组手术前后最大张口度改善情况[（ ± s）mm]

组别	例数	术前	术后1个月	术后6个月	术后12个月
6个月以内组	15	28.27 ± 3.85	38.07 ± 2.58^a	38.73 ± 2.63^a	39.53 ± 3.46^a
6 ~ 12个月组	22	26.86 ± 2.79	37.32 ± 4.72^a	37.55 ± 4.01^a	38.23 ± 5.66^a
12个月以上组	17	27.71 ± 3.12	35.94 ± 3.38^a	34.94 ± 3.19^a	34.76 ± 3.17^a

表1 三个治疗组手术前后最大张口度改善情况[（ ± s）mm]

组别	例数	术前	术后1个月	术后6个月	术后12个月
6个月以内组	15	28.27 ± 3.85	38.07 ± 2.58^a	38.73 ± 2.63^a	39.53 ± 3.46^a
6 ~ 12个月组	22	26.86 ± 2.79	37.32 ± 4.72^a	37.55 ± 4.01^a	38.23 ± 5.66^a
12个月以上组	17	27.71 ± 3.12	35.94 ± 3.38^a	34.94 ± 3.19^a	34.76 ± 3.17^a

表2 三个治疗组手术前后颞下颌关节疼痛VAS值情况（ ± s）

组别	例数	术前	术后1个月	术后6个月	术后12个月
6个月以内组	15	54.79 ± 8.29	19.94 ± 10.22^a	20.21 ± 9.29^a	18.69 ± 9.41^a
6 ~ 12个月组	22	50.97 ± 10.52	20.35 ± 9.86^a	19.86 ± 10.65^a	19.48 ± 10.71^a
12个月以上组	17	44.90 ± 12.58	21.38 ± 10.30^a	23.25 ± 9.58^a	22.53 ± 10.19^a

表2 三个治疗组手术前后颞下颌关节疼痛VAS值情况（ ± s）

组别	例数	术前	术后1个月	术后6个月	术后12个月
6个月以内组	15	54.79 ± 8.29	19.94 ± 10.22^a	20.21 ± 9.29^a	18.69 ± 9.41^a
6 ~ 12个月组	22	50.97 ± 10.52	20.35 ± 9.86^a	19.86 ± 10.65^a	19.48 ± 10.71^a
12个月以上组	17	44.90 ± 12.58	21.38 ± 10.30^a	23.25 ± 9.58^a	22.53 ± 10.19^a

图1 三个治疗组术后张口度改善情况

图2 三个治疗组术后VAS值改善情况

图3 典型病例患者术前、术后MRI检查结果

图4 典型病例患者术前、术后张口度改善情况

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