关节镜上腔灌洗术治疗中老年颞下颌关节紊乱病的临床研究

目的：评价应用颞下颌关节镜上腔灌洗术治疗临床表现为张口受限合并关节区疼痛的中老年颞颌关节紊乱病患者的临床疗效。方法：对保守治疗无效的16例颞下颌关节紊乱病引起张口受限合并关节疼痛的中老年患者，行颞下颌关节镜上腔灌洗术，分析治疗前后不同时期患者的疼痛值（疼痛直观模拟标尺VAS）、张口度和健侧侧向运动度变化，并通过MRI检测治疗前后关节盘位置的变化。结果：治疗后张口度35mm、健侧侧向运动≥6mm的患者占87．5％（14／16），不同时期的张口度均较治疗前有显著差异（P〈0．001），特别在治疗后1个月内增加明显，疼痛亦有显著缓解（P〈0．001），无并发症的发生。MRI显示，有1例患者的关节盘部分复位。结论：颞下颌关节内窥镜下的上腔灌洗术直视下操作准确，能有效治疗颞下颌关节紊乱病的患者，明显改善张口度和缓解疼痛。颞下颌关节镜治疗技术安全有效，有临床应用价值。     

颞下颌关节上腔封闭-扩张联合灌洗及粘弹补充治疗不可复性关节盘前移位

目的评价颞下颌关节上腔封闭-扩张术联合灌洗及粘弹补充疗法治疗不可复性关节盘前移位的临床效果.方法对29例不可复性关节盘前移位患者行关节上腔封闭-扩张治疗,3～5d后行灌洗术,结束时注入1%透明质酸钠1ml.在治疗的同时配合被动张口训练.以配对t检验对数据进行处理.结果封闭-扩张术后张口度及健侧侧向运动度较治疗前、灌洗及粘弹补充治疗术后张口度及健侧侧向运动度较灌洗术前均有显著增加(P＜0.01),疼痛基本消失.治疗过程中有5例患者出现健侧关节疼痛,经用封闭-扩张治疗后疼痛消失,张口度相应增加3～5mm.结论(1)颞下颌关节上腔封闭-扩张联合灌洗及粘弹补充疗法能有效改善不可复性关节盘前移位患者的张口度及侧向运动度,缓解关节疼痛.(2)封闭-扩张术与灌洗及粘弹补充疗法两者有互补及累加作用.(3)及时发现对侧关节的隐匿病变并进行治疗,能提高整体疗效.     

关节灌洗和透明质酸钠治疗不可复性关节盘前移位的疗效比较

目的探讨关节灌洗和透明质酸钠治疗不同病程的颞下颌关节(TMJ)不可复性关节盘前移位的临床效果。方法选择2006年10月至2009年3月TMJ不可复性关节盘前移位126例(138侧关节)进行关节灌洗和透明质酸腔内注射治疗,按发病病程分为三组:6个月以内组36例;6～12个月组42例;12个月以上组48例。随访12～36个月(平均26个月),并对三种方法的疗效进行比较。结果三组总有效率为88.9%(112/126)。其中6个月以内组术后张口度平均增加(8.2±3.4)mm,健侧侧向运动增加(4.8±1.4)mm,91.7%(33/36)患者疼痛明显缓解,有效率为94.4%(34/36)。6～12个月组张口度平均增加(8.0±3.2)mm,健侧侧向运动增加(4.4±1.5)mm,90.5%(38/42)患者疼痛明显缓解,有效率为92.9%(38/42)。12个月以上组术后张口度平均增加(7.1±4.1)mm,健侧侧向运动增加(3.5±2.4)mm,81.3%(39/48)患者疼痛明显缓解,有效率为83.3%(40/48)。三组比较,张口度、侧向运动改善、疼痛缓解及有效率,6个月以内组和6～12个月组均优于12个月以上组(P<0.05),而6个月以内组和6～12个月组差异无统计学意义(P>0.05)。结论关节灌洗术和透明质酸钠治疗不可复性关节盘前移位是有效的治疗方法,发病在12个月以内治疗效果明显优于12个月以上。因此,早期治疗有助于提高疗效。     

颞下颌关节紊乱病磁共振诊断的研究

目的:研究MRI对颞下颌紊乱病诊断的准确性和可信性.方法:利用MRI对19例单侧关节疼痛颞下颌关节紊乱病(TMD)患者38侧关节完成开闭口斜矢状位T1和T2加权成像,观察盘突关系、盘形态改变及关节腔内积液情况.利用关节镜诊断为金标准判定MRI诊断的准确率.同期行灌洗术治疗,分析治疗前后不同时期患者的疼痛值(疼痛直观模拟标尺VAS)变化.结果:MRI检查结果显示在患侧89.47%(17/19)显示不可复性关节盘移位,10.53%(2/19)显示可复性关节盘移位,47.37%(9/19)关节上腔前隐窝出现积液.在健侧15.79%(3/19)显示可复性关节盘移位,无不可复性关节盘移位和腔内积液出现.通过关节镜手术对患侧进行检查,关节盘移位在MRI片上均得到证实,MRI检查的准确率为100%,灌洗术后疼痛100%有显著缓解(P<0.001).结论:颞下颌关节紊乱病与关节盘移位和腔内积液密切相关,通过MRI检查可以准确有效的对颞下颌紊乱病进行诊断,灌洗术对关节疼痛治疗效果显著.     

应用颞颌关节镜治疗颞颌关节盘前移位的临床研究

目的：探讨颞颌关节镜治疗颞颌关节不可复性盘前移位的临床应用效果。方法：对98例颞颌关节不可复性盘前移位患者分别采用颞颌关节镜进行关节盘前松解复位灌洗、关节上腔粘连松解灌洗、单纯关节上腔灌洗等治疗方法,通过观察疼痛程度、张口度及侧向运动度的改变,评价其临床疗效。结果：灌洗治疗后患者张口度、侧向运动度和疼痛程度较治疗前均明显改善。关节盘前松解复位灌洗组和粘连松解灌洗组治疗后疼痛减少值、张口度及侧向运动度增加值明显高于单纯灌洗组。关节盘前松解复位灌洗组在张口度增加值及疼痛减少值的改变优于粘连松解灌洗组。结论：关节上腔灌洗可以作为颞颌关节内紊乱疾病的有效治疗方法,而针对不可复性盘前移位的患者,颞颌关节镜下关节盘前松解复位灌洗治疗则具有更好的疗效。     

颞下颌关节灌洗术与扩张术治疗不可复性关节盘前移位的对比研究

目的采用颞下颌关节上腔灌洗术与扩张术治疗不可复性关节盘前移位,通过对比评价两种方法的临床疗效。方法收集62例不可复性关节盘前移位引起张口受限的患者,分成两组,其中一组31例行关节上腔灌洗治疗;另一组31例行关节上腔扩张术,分析两组治疗前与治疗后1月患者张口度与疼痛值的变化情况并对其结果进行处理。结果两组患者治疗后的张口度与疼痛均较治疗前有显著改善,治疗后1个月,灌洗组患者的平均张口度增加11～34mm,达正常水平;扩张组的平均张口度增加6～29mm,仍处在张口受限的水平。两组患者张口度的改善有显著差异(P<0.01)。疼痛的改善在两组患者之间无显著差异。结论颞下颌关节灌洗术与扩张术均能改善不可复关节盘前移位患者的张口度,缓解疼痛。灌洗术的疗效较扩张术的疗效显著,不可复性关节盘前移位患者的治疗可遵循由简单到复杂,由创伤小到创伤大的顺序治疗方法。     

颞下颌关节紊乱病关节上腔灌洗术的压力研究

目的:观察关节灌洗术对不可复性盘前移位颞下颌关节内压力的影响,从生物力学角度初步探讨关节灌洗术的作用机理及不同操作手法对关节的影响。方法:颞下颌关节紊乱病患者8例10侧,在关节灌洗术时将8号针头插入关节上腔,进行颞下颌关节内压的测定。操作手法分两种:操作一、进水口进行间歇性加压的重复动作。操作二、封闭出水口,进水口加压达到患者所能忍受最大值并保持5秒钟后松开出水通道,使关节内液体间歇喷出。重复3次并记录关节内压变化曲线,计算平均值。结果:关节灌洗术手术操作一,平均加压27.575±5.657kPa,停止操作时为15.555±8.158kPa,灌洗压力落差平均12.020±4.342kPa;手术操作二,平均加压可达42.903±5.508kPa,停止时22.512±3.929kPa,压力落差为20.391±3.310kPa。结论:关节灌洗术可以通过不同操作手法,在颞下颌关节中形成不同的压力落差,从而达到治疗颞下颌关节紊乱病的目的。     

垫治疗青少年颞下颌关节紊乱病的临床疗效分析

目的:考察垫对青少年颞下颌关节紊乱病患者临床症状的改善情况。方法:采用稳定性垫或再定位垫治疗71例颞下颌关节紊乱忠者,比较治疗前后张口度、颌面部疼痛和关节弹响的变化情况。结果:治疗组51例患者中疼痛34例,张口受限15例,疼痛伴张口受限14例,单纯性疼痛20例,治疗后疼痛及张口受限均得到缓解,缓解率为100%。治疗前疼痛指数和张口度分别为7.5±2.09和26.5±5.12mm,治疗后分别为2.4±1.58和40.1±5.03mm,差异均有显著性(P<0.05);关节弹响41例,治疗后18例弹响消失,16例弹响减轻。对照组中有2例弹响自行消失,3例疼痛自行缓解,其余无变化,差异有统计学意义(P<0.05)。结论:垫对颞下颌关节紊乱病患者的临床症状有显著缓解作用。     

关节上腔冲洗加封闭治疗颞下颌关节紊乱病的疗效观察

目的　评价关节上腔冲洗加封闭治疗颞下颌关节紊乱病的临床疗效。方法　用生理盐水反复冲洗关节上腔 ,然后注射糖皮质激素。共治疗 35例 TMD患者。结果　随访 6— 40个月 ,张口度平均增加 7.5 mm(P<0 .0 1) ,88.2 % (30 / 34)的病人疼痛缓解 ,72 .2 % (13/ 18)的病人弹响消失 (或好转 )。总有效率为 82 .9% (2 9/ 35 )。结论　关节上腔冲洗加封闭治疗颞下颌关节紊乱病是种有效的治疗方法。     

垫治疗青少年颞下颌关节紊乱病的临床疗效分析

目的：考察[牙合]垫对青少年颞下颌关节紊乱病患者临床症状的改善情况。方法：采用稳定性[牙合]垫或再定位[牙合]垫治疗71例颞下颌关节紊乱患者，比较治疗前后张口度、颌面部疼痛和关节弹响的变化情况。结果：治疗组51例患者中疼痛34例，张口受限15例，疼痛伴张口受限14例，单纯性疼痛20例，治疗后疼痛及张口受限均得到缓解，缓解率为100％。治疗前疼痛指数和张口度分别为7．5±2．09和26．5±5．12mm，治疗后分别为2．4±1．58和40．1±5．03mm，差异均有显著性（P〈0．05）；关节弹响41例，治疗后18例弹响消失，16例弹响减轻。对照组中有2例弹响自行消失，3例疼痛自行缓解，其余无变化，差异有统计学意义（P〈0．05）。结论：[牙合]垫对颞下颌关节紊乱病患者的临床症状有显著缓解作用。     

Operative versus simple arthroscopic surgery for chronic closed lock of the temporomandibular joint: a clinical study of 344 arthroscopic procedures

Arthroscopic surgery has been reported to decrease pain in relation to the TMJ, improving maximal interincisal opening (MIO). The aim of the present study was to report the clinical outcome of arthroscopic surgery for the treatment of chronic closed lock (CCL) of the TMJ. Five hundred consecutive patients (670 joints) with TMJ derangement who underwent arthroscopy between 1995 and 2004 were retrospectively analysed. All were classified as II-V according to Wilkes. Within the series, various arthroscopic procedures were performed. The inclusion criteria for CCL of the TMJ were met by 257 patients (344 joints). The mean age was 30.24 years; 237 (92%) were female and 20 (8%) male. Mean preoperative visual analogue scale score for evaluation of TMJ pain was 53.21+/-23.02. Mean MIO was 24.75+/-4.89 mm. Following arthroscopy, a significant decrease in TMJ pain was achieved (p<0.0001). For MIO, mandibular protrusion and lateral excursion movements, a significant increase in mean values was observed following surgery (p<0.0001). No statistical differences were observed between arthroscopic lysis and lavage and operative arthroscopy in relation to postoperative pain or MIO at any stage of the follow-up period. Arthroscopy should be considered as a first-line treatment for CCL of the TMJ.     

An arthroscopic technique for closure of perforations in temporomandibular joint retrodiscal tissues

The objective of this retrospective study was to introduce and evaluate an arthroscopic discopexy for closure of retrodiscal tissue perforations. A total of 112 patients (135 joints) receiving an arthroscopic discopexy for management of retrodiscal tissue perforations between January 2016 and September 2019 were included. Pre- and postoperative visual analogue scale (VAS) pain scores and maximum inter-incisal opening (MIO), as well as magnetic resonance imaging (MRI) data, were collected and analysed. Success was recorded when the disc position was >11 o’clock, VAS pain score <3, and MIO>25 mm. For patients with a condyle deformity, postoperative bone remodelling was also recorded. The VAS pain score decreased from 3.04 ± 2.66 preoperatively to 0.88 ± 1.13 at 12 months postoperatively (P < 0.001) and MIO increased from 33.90 ± 7.39 mm to 35.19 ± 6.14 mm (P = 0.029). MRI evaluation revealed that 133 discs were successfully repositioned back on top of the condyle. Among these, 11 joints were associated with either VAS pain score ≥3 or MIO ≤25 mm. Therefore, a success rate of 90.4% (122/135) was achieved at 12 months postoperative. Bone remodelling was detected in 72 joints. Arthroscopic discopexy is a minimally invasive and effective treatment for retrodiscal tissue perforations that achieves the purpose of simultaneously restoring the intra-articular structures and relieving clinical symptoms.     

Techniques of Yang’s arthroscopic discopexy for temporomandibular joint rotational anterior disc displacement

Disc displacement is a common disorder affecting the temporomandibular joint. According to previous publications, the displaced disc can be categorized into pure anterior displacement and rotational displacement (anteromedial and anterolateral). However, the technique of arthroscopy treatment has only been reported for patients with pure anterior disc displacement. In this study, an arthroscopic discopexy for rotational anterior disc displacement was developed and its effectiveness evaluated over 24 months of follow-up. A total of 532 patients (749 joints) with rotational anterior disc displacement, admitted to Shanghai Ninth People’s Hospital between January 2011 and December 2015, were included. The success rate was based on clinical parameters (visual analogue scale (VAS) for pain, maximum inter-incisal opening (MIO), and complications) and radiographic data. The clinical and radiographic data were collected preoperatively and at 1, 6, 12, and 24 months postoperative. The VAS score decreased to 0.73 ± 1.43 following surgery (P < 0.001). A significant improvement in MIO (34.73 ± 6.28 mm) was also detected (P < 0.001). Magnetic resonance imaging showed discs repositioned in both sagittal and coronal images for 714 of the 749 joints, giving a success rate of 95.3%. This study reports an effective and predictable technique of arthroscopic discopexy for rotational anterior disc displacement.     

颞颌关节紊乱综合征的新疗法——关节内窥镜手术探讨

采用Stryker颞颌关节内窥镜对58例颞颌关节紊乱综合征患者进行关节内手术。随访6—40个月。根据手术前后患者颞颌关节区疼痛,杂音和下颌运动的变化情况评定疗效,分三级:优良、改善和无效。结果为优良者占27.6％,改善者占50.0％,无效者占22.4％,有效率(优良+改善)77.6％。术后患者张口度平均增加6.6mm(P<0.001)。作者认为颞颌关节内窥镜手术创伤小,对一些关节内病变,特别是关节内结构性紊乱,疗效良好,是一种很有价值的治疗手段。本文对内窥镜手术的机理,适应症,疗效及稳定性,并发症和手术操作等进行了讨论。     

Prospective outcome assessment of the therapeutic benefits of arthroscopy and arthrocentesis of the temporomandibular joint

Patients who fail to respond to routine conservative measures to treat pain, restriction, and locking in the temporomandibular joint (TMJ) may have therapeutic arthroscopy or arthrocentesis, both of which are associated with symptomatic improvement in 86% of patients. To our knowledge there are no current data on improvements in mouth opening and lateral deviations after these procedures. This prospective audit includes 244 patients treated between 2005 and 2010 from one surgeon's practice, who were followed up at least once at 6 weeks after arthroscopy or arthrocentesis. They had various conditions but all had tender joints. Measurements of interincisal opening, left and right lateral excursions, and protrusion were taken before and during operation with callipers (mm). Opening and pain scores were also recorded on 10 cm analogue scales before operation and at 6 weeks. Pain scores improved with intervention from a mean score of 37.1–16.1 (range 0–100). The improvement in mouth opening ranged from 0 to 78% (as some patients had locking or pain with normal opening before operation), and 86% had improved enough to be discharged at 6 weeks. Temporary forehead weakness in two patients resolved within the timescale of the study. The study shows improvements in mouth opening, and confirms that pain scores can be improved after arthroscopy or arthrocentesis when conservative approaches have failed. In the hands of a skilled practitioner, arthroscopy can be a useful diagnostic and therapeutic adjunct, which can be used repeatedly with low morbidity.     

Closed lock (MRI fixed disc): a comparison of arthrocentesis and arthroscopy

Twenty-six patients with a sudden-onset of persistent limited mouth opening and with MRI signs of articular discs fixed to the glenoid fossa were studied. After unsuccessful non-surgical treatment, arthroscopy with sodium hyaluronate infusion was performed in 16 joints. Follow-up ranged from 24 to 60 months (mean: 30.3 months). All patients were clinically assessed preoperatively, and at 1, 3, 6, 9, 12, 18 and 24 months postoperatively. The clinical variables analysed were: joint pain using a visual analogue scale (VAS) (1-15), joint noises (clicking, crepitus or none), history of locking, duration of the symptoms, maximal interincisal opening (MIO), maximal protrusive movement (MP) and maximal contra-lateral movement (ML). MRI images were obtained preoperatively to analyse the morphological and dynamic characteristics of the temporomandibular joint. Eight of the patients who refused to undergo arthroscopy were treated with arthrocentesis. These patients were studied following the same criteria as stated above. Mean age of the group was 24.3 years (16-35 years). 20 patients were female and 6 male. The preop-MRI examination revealed a normal disc position in 16 joints and an anteriorly displaced disc in 10 cases. All of the discs were fixed to the glenoid fossa preventing an anterior translation of the condylar head. After non-surgical treatment only two patients improved while all the other patients showed a severe decrease in the MIO (mean 23.3 +/- 2.2 mm), LM (3.8 +/- 1.4) and a high pain level (9.7 scale). Sixteen patients underwent arthroscopy. A significant reduction in pain was noted after arthroscopy. Furthermore, a significant increase in MMO and LM was demonstrated postoperatively. Arthroscopic findings included the presence of adherences and synovitis. Eight patients who refused arthroscopy were treated with TMJ arthrocentesis. All such patients improved their symptoms postoperatively. In conclusion both TMJ arthroscopy and arthrocentesis give good results upon treating patients with anchored disc phenomenon (ADP).     

Prospective assessment of outcomes following disposable arthroscopy of the temporomandibular joint

Temporomandibular disorder (TMD) is a common cause of chronic facial pain that is often treated successfully without operation, but when no improvement is seen arthroscopy may be considered as a therapeutic and diagnostic tool. We prospectively assessed the outcome of 115 arthroscopic procedures to assess the effectiveness and reliability of a 1.2 mm disposable arthroscope (OnPoint™, Biomet Microfixation, Jacksonville, USA). All patients included had not improved after standard conservative management. Discharge from clinic was classed as a successful outcome. Measurements taken before, during, and after operation included mouth opening and lateral deviations (mm). Pain was assessed before and after operation using a 10 cm visual analogue scale. Mean improvement in pain scores was 69% and in mouth opening was 19%, and overall success was 76%. Compared with a previous study using a 1.9 mm scope there were fewer complications after arthroscopy with the small diameter scope.     

Rearthroscopy of the temporomandibular joint: A retrospective study of 600 arthroscopies

Purpose

Arthroscopic surgery is an effective treatment for patients with temporomandibular disorders, releasing symptoms and restoring the mandibular function. In patients with poor arthroscopic outcomes, several options of treatment can be considered such as conservative nonsurgical therapy, open surgery, or a second arthroscopy. The purpose of this study was to evaluate our results after 619 arthroscopies.

The incidence of reoperation after temporomandibular joint arthroscopic surgery: a retrospective study of 450 consecutive joints

PURPOSE: The purpose of this study was to investigate the incidence of reoperation after temporomandibular joint arthroscopic surgery in 315 consecutive patients (488 joints). STUDY DESIGN: The clinical data and operative reports of all patients who underwent arthroscopic procedures from 1995 to 2000 were reviewed retrospectively. Patients had a preoperative clinical and panoramic radiographic evaluation. Most of the patients had disk displacement without reduction. In the remaining patients, the intra-articular pathologic conditions ranged from disk displacement with reduction to degenerative joint disease. The outcome assessment was based on reduction in pain, improvement in vertical dimension of mouth opening, and mandibular excursions. The same surgical team performed all arthroscopic procedures. Before surgery, all patients received at least 3 to 6 months of nonsurgical therapy consisting of anti-inflammatory medications, muscle relaxants, splint therapy, physiotherapy, exercise, moist heat, cold laser, ultrasound, and soft diet or a combination thereof. Patients were monitored postoperatively for as long as 5 years. RESULTS: Results showed that approximately 20% of those patients who had temporomandibular joint arthroscopic surgery underwent further temporomandibular joint procedures ranging from repeat arthroscopic surgery to open-joint arthrotomy. CONCLUSION: Temporomandibular joint surgical arthroscopy is an appropriate therapeutic modality for patients with temporomandibular joint internal derangements, with reoperation required for only 20% of patients.     

Magnetic resonance evaluation of the disk before and after arthroscopic surgery for temporomandibular joint disorders

OBJECTIVE: The purposes of this study were (1) to assess functional and pain outcomes after arthroscopic surgery on patients with temporomandibular joint disorders (TMD); (2) to evaluate postsurgical changes in disk position, mobility, and morphology on magnetic resonance imaging (MRI); and (3) to measure the association between changes in disk position, mobility, and morphology on MRI and clinical outcomes. STUDY DESIGN: A retrospective analysis was conducted of temporomandibular joints with internal derangement and osteoarthritis that were refractory to nonsurgical treatments and underwent arthroscopic surgery and on which MRI was performed within 1 month after the initial visit and 1 year after arthroscopic surgery. Clinical findings were assessed on the basis of mandibular range of motion and joint pain level on a visual analog scale at the initial visit and 1 year after arthroscopic surgery. The disk position, mobility, and morphology on MRI were compared with clinical findings and were statistically analyzed before and after arthroscopic surgery. The treatment outcome was judged according to our success criteria. The associations between changes in disk position, mobility, and morphology and clinical outcomes after arthroscopic surgery were statistically analyzed. RESULTS: Forty-three joints of 43 patients who underwent arthroscopic surgery were assessed in this study. After arthroscopic surgery, mandibular range of motion and visual analog scale results improved statistically. According to the criteria for clinical resolution, 32 surgeries were successful and 11 were unsuccessful. Preoperative and postoperative MRI showed that most joints had anterior disk displacement (ADD) without reduction. Postoperative MRI revealed that, statistically, the number of mobile disks had increased and deformity of the disks had progressed. In the successful group, postoperative MRI revealed that all joints had mobile disks. In both groups, most joints had ADD without reduction before and after arthroscopic surgery, and, statistically, deformity of the disks progressed after arthroscopic surgery. CONCLUSIONS: Arthroscopic surgery was an effective treatment for TMD refractory to nonsurgical treatments. This study provides important information of clinical significance. Disk position remained ADD without reduction, disk mobility increased, and deformity of the disks progressed after arthroscopic surgery.