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

INITIAL STUDY FOR CORRELATION BETWEEN CONDYLAR FRACTURES AND TEMPOROMANDIBULAR JOINT ANKYLOSIS

Objective To explore the correlation between condylar fractures and temporomandibular joint (TMJ) ankylosis. Methods 28 patients with TMJ ankylosis in this groups, 16 males, 12 females, age 5 to 34 years, 26 patients<10 years, 26 unilateral and 2 bilateral, Histomy of trauma was documented in all cases. All patients were took the orthopanotomograms, cross sectional or coronal sectional CT (two dimensional and three dimensional reconstruction were performed in some patients). But these X ray were compared with past trauma. The high osteotomy of base of zygomatic and the exploration for condylar process and meniscus were performed in the reconstruction operation of the TMJ. Results The high position condylar intracapsular fractures, serious dislocation of condylar segment, and obvious ascending of mandibular ramus were observed in CT imaging of these patients with TMJ ankylosis. The condyle of replacement was found inside the masses of bony overgrowth. The bony overgrowth was developed from the ascending ramus and the zygomatic processes. At surgery, the condyle and the meniscus of the serious replacement was found in the 20 patients (22 joints), unilateral ankylosis was only observed in 8 bilateral condylar fractures. In non affected side, 2 patients were middle or low position fracture, 4 patients were high fracture, but the condylar segment dislocation was light. Conclusion The TMJ ankylosis can be caused if the serious dislocation of the condylar segment with meniscus and ascending of the ramus occurred. For this case, the operation of open reduction and fixation should be taken.