三维可调式髁突假体置换的实验研究

目的 探讨新型三维可调式人工髁突进行关节置换的可行性。方法用新设计的三维可调式髁突假体在３只成年恒河猴升支及髁突切除后作即刻关节置换，术后３，６，１４个月各处死１只。通过手术前后Ｘ线对比观察，咀嚼功能测定，解剖和组织学检查进行评价。结果 假体各部件间紧固性可靠，接骨螺钉固定基本稳定，髁突假体无组织不良反应，不会引起非手术侧关节结构的病理性改变。     

生物活性玻璃陶瓷人工髁突置换对颞下颌关节盘及 …

目的：考察生物陶瓷人工髁突用于ＴＭＪ置换的可行性。方法；在杂种狗上建立髁突置换模型，采用Ｘ线、组织学方法观察术后１、３、５、１０个月关节腔、关节盘及关节突的改变。结果：虽然人工髁突具有良好的生物相容性及力学强度，但却可在植入早期引起滑膜充血、增生、５月以后关节盘增厚，关节内纤维组织增生及软骨岛形成，１０月关节腔完全被软组织充填，粘连，结论：这是生物陶瓷人工髁突表面的硬度及陶瓷微粒弥散入周围的组织。     

正常颞下颌关节与人工关节假体髁突的运动比较

颞下颌关节髁突的运动对于关节疾病的诊断和治疗有重要意义,髁突运动的测量方法众多,可分为有创性和无创性两大类。文章对有关正常颞下颌关节和人工关节假体髁突运动测量方面的文献进行综述,旨在为自主人工关节假体的设计提供参考。     

生物活性玻璃陶瓷人工髁突置换对颞下颌关节盘及关节结节影响的实验研究

目的 :考察生物陶瓷人工髁突用于TMJ置换的可行性。方法 :在杂种狗上建立髁突置换模型 ,采用X线 ,组织学方法观察术后1,3,5,10个月关节腔、关节盘及关节突的改变。结果 :虽然人工髁突具有良好的生物相容性及力学强度 ,但却可在植入早期引起滑膜充血、增生 ,5月以后关节盘增厚 ,关节内纤维组织增生及软骨岛形成 ,10月关节腔完全被软组织充填 ,粘连。结论 :这是生物陶瓷人工髁突表面的硬度及陶瓷微粒弥散入周围的组织。在未解决上述问题之前 ,临床上应用此方法应十分慎重     

颞下颌关节骨性结构观测及临床意义

本文报告了20例剥制颅骨40侧颞下颌关节骨性结构的观测结果,颞下颌关节窝的横径、前后径和髁状突内外径、前后径、前斜面距和后斜面距等与文献报道结果相似,但下颌结节后斜面斜度则有所不同;报告了髁状突角的变化及髁状突与关节窝的不协调结果.观测结果为X线摄片、颞下颌关节骨性结构病症诊治及颞下颌人工关节设计提供有意义参数.     

髁突置换治疗创伤性颞下颌关节强直五例

目的 总结用人工髁突置换治疗创伤性颞下颌关节强直(temporomandibular joint ankylosis,TMJA)的临床效果.方法 2006年8月至2008年4月北京大学口腔医学院·口腔医院口腔颌面外科共5例创伤性TMJA患者接受人工髁突置换手术,患者均为男性.术前行CT检查后,用快速成形技术制作三维头模,在头模上模拟切除关节骨球、关节成形、选择适宜的人工髁突,术中依术前设计安放并固定人工髁突.术后1周和复查时评价手术效果.结果 5例共植入6侧人工髁突(1例为双侧).3例复查时间为术后8～30个月,另外2例失访.复查时张口度平均为30 mm,2例咬合关系良好,1例前牙区有约1 mm的开骀.结论 人工髁突置换可以作为创伤性TMJA手术治疗的方法之一,其临床效果还需进一步验证.     

中国人颞下颌关节骨性结构的三维测量和聚类分析

目的    通过对中国人颞下颌关节骨性结构进行三维测量和聚类分析,为人工关节假体的设计和选型提供依据。方法    选取2011年1月至2015年12月在上海交通大学医学院附属第九人民医院因非颞下颌关节疾病就诊,进行颌面部CT扫描的中国人患者448例（797侧正常颞下颌关节）进行研究。采用Proplan CMF 1.4软件对其颌面部CT扫描数据进行三维重建,选择13项特征性指标对关节窝及髁突进行三维测量,并对数据进行统计分析和聚类分析,以确定人工关节假体的设计类型。结果    初步建立了中国人颞下颌关节骨性结构的解剖数据库,13项测量指标性别差异均有统计学意义。聚类结果显示中国人的颞下颌关节窝分为3种类型,髁突分为4种类型（判别分析：关节窝数据准确率97.24%、髁突-下颌支数据准确率94.98%）。结论    中国人颞下颌关节骨性结构的三维测量和聚类分析为人工关节假体的设计选型提供了依据。     

2例个体化人工关节用于颞下颌关节置换的初步效果评价

目的：采用CAD／CAM技术设计个体化人工全颞下颌关节，通过全关节置换，治疗严重颞下颌关节病，对其疗效进行初步评价。方法：2例女性颞下颌关节疾病患者，年龄分刖为53岁和60岁。术前经MRI等检查发现严重的关节盘及髁突病变，开口度分别为2．0cm和1．8cm，均表现有明显的关节疼痛。2例患者均采用TMJ Concepts公司的个体化人工颞下颌关节全关节置换术。结果：成功完成了2例3侧颞下颌关节的置换手术。未出现术后并发症。关节疼痛在术后2周后逐渐缓解。6个月后开口度分别为2．7cm和2．9cm。术后口颌功能改善良好。结论：人工全颞下颌关节置换治疗严重颞下颌关节骨关节病具有良好的效果，个体化设计可为人工关节发挥良好功能提供有效的保证．     

成人下颌偏斜患者颞下颌关节形态及位置的变化

目的：研究下颌偏斜患者颞下颌关节形态及其位置的变化.方法：对21例下颌偏斜患者和20例个别理想[牙合]志愿者拍摄颞下颌关节中位断层片,选择描述髁突位置及髁突和关节窝形态的15个指标进行测量及统计分析.结果：下颌偏斜患者双侧关节结节高度、关节窝指数增大,髁突后斜面与水平基准线的夹角减小;偏斜侧的关节前间隙、关节前后间隙面积比,髁突高度、髁突上部高度减小;对侧的关节上间隙、髁突高度、髁突上部高度、髁突前斜面与水平基准线的夹角、关节窝后斜面与水平基准线的夹角增大.结论：下颌偏斜患者的双侧髁突和关节窝形态及髁突在关节窝中的位置都发生了改变,尤其以非偏斜侧髁突变化较为明显.     

下颌髁突重建的研究进展

颞下颌关节(TMJ)是颌面部唯一的活动关节,手术重建下颌髁突,是恢复TMJ功能的基本要求。 一、髁突重建的适应症 任何原因造成髁突骨性部分或完全丧失、髁突与关节凹、关节结节之间骨性粘着并有临床症状,如关节疼痛、杂音和功能丧失以及颌面部和牙颌畸形等,均需行髁突重建。髁突重建主要见于以下几种情况:     

髁状突骨折与颞颌关节骨性强直关系的初步探讨

目的　探讨髁状突骨折与发生颞颌关节骨性强直的关系。方法　对 2 8例有髁状突骨折病史的颞颌关节骨性强直患者 ,术前拍颞下颌骨全景X线片 ,CT横断或冠状扫描 ,部分病侧同时行二维和三维重建 ,并与外伤后X线片对照。在施行颞颌关节成形关节重建术中 ,采用颧弓根水平高位截骨 ,探查髁状突和关节盘的存在。结果　 2 8例伤后的X线片均提示 :发生颞颌关节强直的病例为髁状突高位 (囊内 )横断骨折。而且 ,髁状突骨折块移位大 ,下颌升支明显上移。术前冠状CT显示髁状突移位于关节骨性强直区的内侧 ,上移的下颌升支与关节窝骨性融合。术中探查发现 2 0例 2 2侧有明显移位的完整的髁状突和关节盘。结论　在髁状突颈部高位 (囊内 )横断骨折病例 ,若髁状突骨折块发生严重移位、脱出关节窝外 ,可同时伴发关节盘移位。而下颌升支则在升颌肌群牵引下明显上移 ,形成对关节窝的继发损伤 ,最终导致颞颌关节骨性强直。对该类髁状突骨折应积极开放复位固定     

Historical development of alloplastic temporomandibular joint replacement after 1945 and state of the art

The variety of temporomandibular joint (TMJ) prostheses and condylar reconstruction plates available is in contradiction to their rare application. This emphasizes that alloplastic TMJ reconstruction is still evolving. This article reviews the history of TMJ reconstruction. Medline as well as public and private libraries have been searched. Current systems are reviewed. Prosthetic devices can be differentiated into fossa-eminence prostheses, ramus prostheses and condylar reconstruction plates, and total joint prostheses. Fossa and total joint prostheses are recommended when the glenoid fossa is exposed due to excessive stress (degenerative disorders, arthritis, ankylosis, multiply operated pain patients). Singular replacement of the condyle is preferred as a temporary solution in ablative surgery. The use of prosthetic devices for long-term replacement should be restricted to selected cases, taking care to retain the disk, in order to prevent penetration into the middle cranial fossa. The term ‘condylar reconstruction plate’ reflects this more clearly than ‘ramus prosthesis’ which suggests permanent reconstruction. Long-term studies comparing the functional and aesthetic results of the various prostheses and condylar reconstruction plates are not available, which leaves the choice to personal experience.     

Novel approach to the study of jaw kinematics in an alloplastic TMJ reconstruction

Total alloplastic temporomandibular joint (TMJ) reconstruction is a reliable treatment modality in patients with severely diseased TMJ with good clinical behaviour. TMJ mandibular function after alloplastic reconstruction has scarcely been analysed as a biomechanical parameter and investigation has generally been limited to interincisal measurements without deeper insight into joint kinematics. Dynamic stereometry to assess condylar movements relative to the fossa was performed at the 5 year follow-up of a patient who underwent condylar resection of the right TMJ followed by total alloplastic joint reconstruction to treat pigmented villonodular synovitis. The patient could achieve wide mouth opening, but overall mandibular kinematics showed a strong deviation towards the prosthetic side due to the lack of mandibular translation caused by the absence of the lateral pterygoid attachment. Possible overloading of the joint contralateral to the TMJ prosthesis might be prevented by optimizing replacement joint design.     

全身(远处)感染致颞下颌关节强直:1例报告及文献复习

颞下颌关节强直可由创伤、感染、退行性变及间隙缺损导致。其中以局部感染多见,而全身感染则罕见。本文报道1例因全身远处感染导致双侧颞下颌关节强直的患者,该35岁女性患者因开口困难近20年就诊,并于20年前出现包括颞下颌关节区的全身多处脓肿,CT显示髁突与颞骨融合。采用双侧颞下颌关节截除术及人工关节置换术治疗,术后3个月开口度达2.5 cm,患者获得了满意的进食及语言功能。     

Histologic analysis of costochondral and sternoclavicular grafts in the TMJ of the juvenile monkey

Variability in growth response of the mandible after replacement of the mandibular condyle with the costochondral junction of a rib (CCJ) is common. Other donor graft sites that are more similar to the mandibular condyle might be more suitable for mandibular condylar replacement. Previous studies have shown the histomorphologic and developmental similarities between the sternoclavicular joint (SCJ) and temporomandibular joint (TMJ). The purpose of this study was to evaluate histologically short-term adaptations within the TMJ after replacement of the mandibular condyle with the autogenous sternal head of the clavicle, and to compare these adaptations with autogenous CCJ and mandibular condyle (surgical control) transplants. Bilateral vertical ramus osteotomies were performed in 12 juvenile Macaca mulatta with the left condyle being immediately replaced and the right condyle removed and replaced with either the sternal head of the clavicle or costochondral junction of a rib. All grafts were stabilized with maxillomandibular fixation for five weeks. Two animals in each group were killed at five, 11, and 17 weeks postsurgery and prepared for histologic analysis. The results indicate that: 1) incorporation of all grafts into the recipient site occurred and all animals had good mandibular function and occlusion throughout the follow-up period; 2) the clavicular and mandibular condylar grafts were incorporated sooner than the CCJ grafts; 3) clavicular graft changes resembled those of the condylar grafts histologically while the costal grafts remained inert and unchanged; and 4) a new condylar process with cartilage similar to that of a normal mandibular condyle regenerated in the costal graft animals from cells presumably contributed by the periosteum of the mandibular ramus and TMJ capsule.(ABSTRACT TRUNCATED AT 250 WORDS)     

Practical evaluation of the lateral temporomandibular joint radiograph

The reevaluation of the lateral transcranial radiograph is needed because of the confusion that surrounds the diagnosis and treatment of TMJ dysfunction-pain. The lack of universal acceptance of the validity of the lateral TMJ radiograph contributes to the lack of progress of TMJ dysfunction-pain treatment and improved methods for the treatment of prosthodontic patients. The lateral transcranial TMJ radiograph was reevaluated for its duplicability (+/- 0.2 mm). The image was found to be a cross section of the lateral third of the condyle rather than a composite view of the condyle made at an angle. The condylar position in the fossa can be correctly evaluated in transcranial radiographs, because the relative condylar position in the fossa is similar in all sagittal views and the image is always of the same sagittal plane (lateral third). Soft tissue within or lining the fossa does not affect the evaluation of condylar position. Chronic osteoarthritic TMJ pathology can exist without subjective pain; therefore, routine use of initial TMJ radiographs with subsequent radiographs at 5-year intervals is suggested for all patients. Because condylar repositioning may be indicated before subjective pain symptoms appear, condylar repositioning should be contemplated whenever extensive prosthodontic treatment is needed. In addition, if chronic osteoarthritic lesions are observed initially, radiographs are indicated at more frequent intervals and anti-inflammatory agents should be considered for routine use depending on the rate and extent of the pathologic development. The existence of osteoarthritic lesions was confirmed by serial radiographs over 5 to 10 years. If an osteoarthritis is present, condylar repositioning (when condylar displacement is present) or changes in occlusion should be considered. There is some clinical evidence that condylar displacement is associated with pathologic remodeling and/or osteoarthritic lesions of the condyle and that condyle repositioning arrests the pathologic process. The principle of condylar concentricity , previously established for the treatment of TMJ dysfunction-pain syndrome and for functional centric relation in prosthodontics, was formulated by associating condylar position in the fossa with TMJ dysfunction-pain in many patients. This article suggests the value of the lateral TMJ radiograph as an important practical aid in the diagnosis and treatment of TMJ dysfunction pain and in the establishment of functional centric relation in prosthodontics.     

Two-stage reconstruction of the temporomandibular joint following treatment of synovial chondromatosis

Two stage reconstruction of a TMJ following excision of synovial chondromatosis is described. The condylar stump was used in combination with a glenoid fossa implant by performing a unilateral osteotomy 6 months after the tumor was excised. This technique might be considered in other situations that require a total joint replacement.     

Longitudinal study of patients with TMJ dysfunction by tomographic examination: Condylar position and clinical sign

For patients with TMJ dysfunction, operators often change the condylar position by various methods. The aim of this study is to investigate how much the changes with time of condylar positions are related to the changes of clinical signs. The subjects were 584 joints of 127 patients with TMJ dysfunction to whom the serial lateral TMJ tomography was performed more than twice. In the most of cases where the condylar position had moved downward, inter-incisal distance had increased and TMJ noise had ameliorated. Furthermore, in many cases where the condylar position had moved forward, the amelioration of the TMJ pain was observed. It was considered that those ameliorations occurred because the positional relationship between the condylar head and the articular disk or posterior attachment had been improved.     

Temporomandibular joint reconstruction with total alloplastic joint replacement

This paper is a preliminary paper which presents the early findings of an ongoing prospective trial on the use of the TMJ Concepts and Biomet Lorenz total joint replacement systems for the reconstruction of the temporomandibular joint (TMJ). Total alloplastic replacement of the TMJ has become a viable option for many people who suffer from TMJ disease where surgical reconstruction is indicated. Degenerative joint diseases such as osteoarthritis, rheumatoid arthritis, psoriatic arthritis, TMJ ankylosis, malunited condylar fractures and tumours can be successfully treated using this technique. There are a number of TMJ prostheses available. Two of the joint replacement products, which have been found to be most reliable and have FDA approval in the United States, are the TMJ Concepts system and the Biomet Lorenz system, and for this reason they are being investigated in this study. This study presents the findings of seven patients with a total of 12 joint replacements using either the TMJ Concepts system or the Biomet Lorenz joint system. Two patients (3 joints) had the TMJ Concepts system and five patients (9 joints) had the Biomet Lorenz system. Although still early, the results were generally pleasing, with the longest replacement having been in position for three years and the most recent six months. The average postoperative mouth opening was 29.7 mm (range 25-35 mm) with an average pain score of 1.7 (range 0-3, minimum score of 0 and maximum 10). Complications were minimal and related to sensory disturbance to the lip in one patient and joint dislocation in two patients.     

Maximum voluntary bite force in patients with alloplastic total TMJ replacement – A prospective study

Alloplastic temporomandibular total joint replacement (TJR) for end-stage disease, congenital disorders and following ablative oncological surgery has been shown to reduce pain and improve function. The purpose was to assess the maximum voluntary bite force and maximum interincisal opening (MIO) in patients undergoing alloplastic total temporomandibular joint replacement (TJR).Seventeen patients with different diagnoses resulting in condylar hypomobility (8 patients; 15 joints) and condylar instability (9 patients; 12 joints) had undergone alloplastic TMJ reconstruction. Maximum voluntary bite force and MIO were measured at pre-operatively (T0), 2 (T1), 6 (T2) and 12 (T3) months. For ordinal data comparison at different time-points, the Wilcoxon signed-ranks test was used.There was a significant improvement in maximum voluntary bite force for both, patients with condylar hypomobility (P = 0.003) and condylar instability (P = 0.007). Analysis of MIO revealed a significant improvement at T3 (P = 0.002).Alloplastic TJR would appear to increase maximum voluntary bite force and MIO. Biomechanical integrity of the stomatognathic system and the ability of the patient to triturate food could be improved by alloplastic temporomandibular joint (TMJ) replacement.