骨性颞下颌关节强直伴小颌畸形及阻塞性睡眠呼吸暂停综合征的牵引成骨治疗

目的:探讨内置式颌骨牵引成骨在治疗骨性颞下颌关节(temporomandibular joint, TMJ)强直伴小颌畸形并发阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)中的应用.方法:应用内置式颌骨牵引成骨,治疗11例(15侧)TMJ强直伴小颌畸形及OSAS患者.患者年龄9～42 岁.4例为双侧颞下颌关节强直伴重度小颌畸形,7例为单侧TMJ强直伴小颌畸形.9例合并重度OSAS,2例伴有轻、中度OSAS.8例患者行双侧下颌骨体延长,3例患者行单侧下颌骨体延长.11例患者15侧TMJ强直均行牵引成骨关节成形术.术后复查10～22 个月,平均复查时间15.3 个月.手术包括两个阶段:第一阶段,小颌畸形的牵引成骨治疗;第二阶段,TMJ强直的牵引成骨关节成形术.术后间歇期4～7 d,牵引速度1 mm*d-1,分4次进行.稳定期为3～4个月.术后即行开口训练.每一患者术前、术后均行X线头影测量及睡眠多导图仪(polysomnography, PSG)检查.结果:11例患者19侧下颌骨经牵引延长后,小颌畸形及OSAS得到有效治疗.15侧关节强直经牵引成骨关节成形术矫治后,开口度均恢复正常.牵引间隙内成骨良好,未见感染及成骨不良等并发症发生,无关节强直复发.结论:牵引成骨技术可有效矫治TMJ强直导致的小颌畸形伴OSAS,并为关节成形提供了新的治疗手段.手术方法简便,风险小,治愈率高,近期效果稳定.远期疗效有待进一步观察.

Distraction osteogenesis for treatment of temporomandibular joint ankylosis accompanying with mandibular micrognathia and obstructive sleep apnea syndrome

Objective:To study the application of distraction osteogenesis in correction of temporomandibular joint (TMJ) ankylosis accompanying with micrognathia and obstructive sleep apnea syndrome(OSAS). Methods:Eleven patients (15 sides of TMJ ) of TMJ ankylosis accompanying with mandibular micrognathia and OSAS were treated with distraction osteogenesis. Four patients were bilateral TMJ ankylosis and 7 patients were unilateral TMJ ankylosis. OSAS was diagnosed in all patient preoperatively. The treatment included distraction osteogenesis of mandible and TMJ arthroplasty. Distractions were started on the 5th to 8th day postoperatively. The distraction rhythm and rate was 0.25 mm four times a day. The patients underwent active mouth opening postoperatively. Distractor was kept in place for 3-4 months after completion of distraction and then removed. Results:After operation, micrognathia and OSAS of 11 patients were corrected effectively and the range of mouth opening was increased to normal, bone formation in the gaps were perfect and no complications were found. Conclusion:TMJ ankylosis accompanying with micrognathia and OSAS can be treated effectively bydistraction osteogenesis . Distraction osteogenesis of arthroplasty is a new method for treatment of TMJ ankylosis. The procedure is simple with low risk, high curative rate, and stable result. However long term result needs further evaluation.