创伤性颞下颌关节强直临床分析

目的 分析引发创伤性颞下颌关节(temporomandibular joint,TMJ)强直的高风险髁突骨折类型,初步探讨TMJ强直发生的可能性机制.方法 对18例创伤性TMJ强直进行临床、影像学检查及评估.取纤维性强直外侧变性的关节囊、关节间的致密纤维组织及骨性强直关节外侧骨块和内侧骨块,HE染色,光镜观察.结果 ...     

Modulation of phosphate/pyrophosphate metabolism to regenerate the periodontium: a novel in vivo approach

Background: The developing periodontium is sensitive to local levels of inorganic phosphate (P_i) and inorganic pyrophosphate (PP_i) as demonstrated by cementum phenotypes resulting from the loss of function of protein regulators of P_i/PP_i homeostasis. The progressive ankylosis protein (ANK) regulates the transport of PP_i, and progressive ankylosis gene (Ank) and knock‐out (KO) mice feature a rapidly forming and thick cementum. We hypothesized that, besides affecting cementum formation, decreased extracellular PP_i levels in Ank KO mice would also impact cementum regeneration. Methods: Periodontal fenestration defects (≈2 mm in length, 1 mm in width, and 0.5 mm in depth) were created on buccal aspects of mandibular molars in Ank KO and wild‐type (WT) mice. Mandibles were harvested at 15 and 30 days post‐surgery for histology, histomorphometry, evaluation of in vivo fluorochrome labeling, and immunohistochemistry (IHC) for proteins including bone sialoprotein (BSP), osteopontin (OPN), dentin matrix protein 1 (DMP1), and ectonucleotide pyrophosphatase/phosphodiesterase 1 (NPP1). Results: A greater amount of new cementum was observed in Ank KO mice at 15 and 30 days post‐surgery (P <0.05), which was confirmed by fluorochrome labeling showing a higher new cementum appositional activity in defect areas in Ank KO mice versus controls. At days 15 and 30 during healing, regenerating cementum and associated cells in Ank KO samples recapitulated expression patterns mapped during development, including limited BSP and positive OPN and DMP1 in the cementum matrix as well as elevated NPP1 in cementoblasts. Conclusions: Within the limits of the study, these findings suggest that reduced local levels of PP_i could promote increased cementum regeneration. Therefore, the local modulation of P_i/PP_i may be a potential therapeutic approach for achieving improved cementum regeneration.     

Computer-assisted condylar reconstruction in bilateral ankylosis of the temporomandibular joint using autogenous coronoid process

During the past 10 years, more than 20 patients a year have been treated at our centre for bilateral ankylosis of the temporomandibular joint (TMJ). Here we describe the use of computer-assisted three-dimensional surgical planning and its clinical effects in condylar reconstruction for such patients using autogenous coronoid process. Sixteen patients with bilateral bony ankylosis of the TMJ from March 2006 to March 2009 were randomly divided into 2 groups and treated by bilateral osteoarthrectomy and condylar reconstruction by free grafting of autogenous coronoid process with and without three-dimensional simulation using Surgicase CMF™ (Materialise, Belgium) software. Clinical examination, radiographs, photographs, and details of the operation and its outcome were used postoperatively to evaluate the clinical effects of the technique. Satisfactory mouth opening was achieved in all cases. There were fewer postoperative malocclusions among patients who had three-dimensional simulation. The combination of computer-assisted three-dimensional surgical planning and simulation and free grafting of autogenous coronoid process is a sound and predictable method for the reconstruction of condyles in patients with bilateral ankylosis of the TMJ as it makes the operation easier and more accurate.     

Tracheostomy-dependent child with temporomandibular ankylosis and severe micrognathia treated by piezosurgery and distraction osteogenesis: case report

Ankylosis of the temporomandibular joint in children is one the most difficult and complex conditions managed by oral and maxillofacial surgeons, and often leads to some facial deformity. Distraction osteogenesis of the mandible provides an excellent treatment for mandibular airway obstruction in children who do not respond to conservative measures, and allows for early removal of the tracheostomy. We report the case of a 1-year-old boy with severe micrognathia and temporomandibular ankylosis who was dependent on a tracheostomy; he was treated with piezosurgery and mandibular advancement by distraction osteogenesis.     

截瘫后异位骨化致髋关节僵直1例

截瘫后异位骨化是少见的病例,而伴有髋关节僵直则更为少见,现报告1例截瘫后异位骨化致髋关节僵直。     

外伤性颞下颌关节强直的病因学研究

目的：探讨外伤性颞下颌关节强直与髁突骨折的关系。方法：92例外伤性颞下颌关节强直和342例髁突骨折病例。分析颞下颌关节强直患者临床及影像学资料并与髁突骨折患者进行对比研究。结果：颞下颌关节强直患者26例伤后明确诊断为髁突骨折,根据强直就诊时X线,还有43例存在髁突骨折痕迹,髁突骨折共计69例（69/92,75.0%）。颞下颌关节强直大多是0-10岁（56例,占60.9%）时的外伤所致,就诊大多在11-20岁（51例,占55.4%）,而髁突骨折的病例以成年人（≥21岁）多见（230例,占67.3%）,差异有统计学意义（X^2=113.79,X^2=45.25,P〈0.01）。髁突骨折以男性多见（232/342,67.8%）,而颞下颌关节强直患者中女性多见（48/92,52.2%）,差异有统计学意义（X^2=12.54,P〈0.01）。髁突骨折病人受伤时伴有身体其他部位外伤的有103例（103/342,30.1%）,与颞下颌关节强直（35/92,38.0%）相比差异有统计学意义（X^2=4.14,P〈0.05）。结论：虽然髁突骨折是导致外伤性颞下颌关节强直最主要原因,但髁突骨折早期不及时、不正确的诊疗对颞下颌关节强直的发生有着很大的影响。是否处在生长发育期、创伤严重程度与颞下颌关节强直发生密切相关。     

动态关节松动术治疗桡骨远端骨折后关节僵硬的初步研究

目的初步研究动态关节松动术对桡骨远端骨折后关节僵硬的疗效及应用价值。方法将18例桡骨远端骨折后关节僵硬的患者分为动态关节松动术组10例和对照组8例。动态关节松动术组采用动态关节松动术治疗,对照组采用Kaltenborn关节松动术治疗,3周后对两组治疗前后的腕部关节活动度和关节功能进行比较。结果动态关节松动术组与对照组治疗后的腕关节活动度及关节功能均优于康复治疗前(P<0.05)。治疗后两组患者之间的关节活动度和功能无明显差异(P>0.05)。结论动态关节松动术是一种治疗桡骨远端骨折后关节僵硬的有效手段,可作为该类患者的康复方法之一。     

关节镜辅助小切口治疗膝关节僵硬48例

膝关节僵硬多为膝部骨折、韧带损伤手术及长期制动等各种原因造成，是一种严重的并发症，也是一个治疗上的难题。自2003年至2006年采用关节镜辅助小切口治疗膝关节僵硬48例，取得了良好的效果，现报告如下。     

膝关节伸膝装置粘连性僵硬的手术疗效观察

膝关节的伸膝装置粘连性僵硬是临床上常见的骨科并发症之一，自2001年2月-2005年10月，对34例此类患者采用关节镜下关节内松解加手术锐性松解、生物膜铺垫术治疗，获得较满意的疗效，报告如下。     

Silicone CAP arthroplasty in temporomandibular joint ankylosis

Four patients with temporomandibular joint ankylosis, three bilateral, one unilateral, were treated successfully by using the technique of silicone cap arthroplasty. Among these patients two were recurrent cases. Mean maximum incisal opening distance was 6.0 mm preoperatively and 24.7 mm postoperatively. In the follow-up period ranging between 19 months and 5 years, all of the patients had satisfactory mouth opening for chewing and speaking without any reankylosis. We believe that the silicone cap provides a satisfactory range of motion and prevents cortical callus formation across the cap by wrapping around the mandibular stump, this reduces the risk of reankylosis. The simplicity and the short duration of the operation as well as the nonexistence of an additional scar are other reasons for preferring this method. Furthermore, the silicone cap arthroplasty technique has the advantage of controlling the amount of bone removal thus decreasing the risk of the development of a short ramus. Received: 1 December 1997 / Accepted: 21 August 1998