改良切口关节盘锚固术治疗颞下颌关节盘不可复性前移位的临床评价

目的: 评价应用改良切口关节盘锚固术治疗颞下颌关节盘不可复性前移位的临床疗效。方法: 选取2014年9月—2016年9月我院颞下颌关节专科就诊的24例（30侧）颞下颌关节紊乱病患者,采用改良切口颞下颌关节盘锚固术进行治疗, 分析术前、术后6个月不同时期患者的疼痛值、开口度的变化及MRI影像学表现,采用SPSS17.0软件包中的t检验评价手术效果。结果: 治疗前平均开口度为（23.63±3.31）mm(17~29 mm),治疗后平均开口度为（38.00±2.30）mm(32~42 mm),治疗后开口度≥35 mm 的患者占 87.5%（21/24）;疼痛直观模拟标尺（visual analogue scale,VAS）值术前为29.76±23.35（0~80）,术后6个月为3.71±7.91（0~50）,术后6个月的开口度及VAS值均与治疗前有显著差异（P<0.05）。MRI影像学评价有效率达96.67%（29/30侧）,所有病例均无并发症发生。结论: 颞下颌关节盘锚固术能有效治疗颞下颌关节盘不可复性前移位,在复位关节盘的前提下,显著改善开口度和缓解疼痛。

Clinical evaluation of modified temporomandibular joint disc anchor for disc displacement of temporomandibular joint

PURPOSE: To estimate and analyze the outcome of modified temporomandibular joint disc anchor for disc displacement of temporomandibular joint (TMJ). METHODS: Twenty-four patients (30 joints) who underwent modified temporomandibular joint disc anchor surgery based on Professor Yangchi's criteria between September 2014 and September 2016 were included in this study. The scores for preoperative maximal interincisal opening (MIO), visual analogue scale (VAS) score for pain and magnetic resonance imaging (MRI) before surgery, 6 months after surgery were compared using SPSS17.0 software package. RESULTS: MIO improved from a mean of 23.63±3.31 mm (range: 17-29 mm) preoperatively to 38.00±2.30 mm (range: 32-42 mm) 6 months postoperatively. Twenty-one of 24 patients (87.50%) had MIO≥35 mm after operation, which showed a significant improvement (P <0.05) at 6-month follow-up. VAS improved from a mean of 29.76±23.25(0-80) preoperatively to 3.71±7.91(0-50) 6 months postoperatively (P <0.05).The position of the discs in 29 of 30 (96.67%) TMJs had kept stable on MRI. There was no complication in any case. CONCLUSIONS: Modified temporomandibular joint disc anchor surgery is a reliable and effective procedure for temporomandibular joint dysfunction that improves pain and mouth opening. The position of TMJ discs postoperatively is stable on MRI.