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颞下颌关节外科 总被引:3,自引:0,他引:3
杨驰 《口腔颌面外科杂志》2006,16(3):193-198
1颞下颌关节外科颞下颌关节(temporomandibular joint,TMJ)是一个器官,所罹患的疾病种类几乎包含了其他器官(其他关节)的所有病变。虽说颞下颌关节有其特殊性,但总体上应遵循其他关节外科的术语、分类、诊治原则和方法、疗效评价方法和成功标准。1.1颞下颌关节外科的内容按美国 相似文献
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化脓性颞下颌关节炎的治疗 总被引:1,自引:0,他引:1
目的 探讨化脓性颞下颌关节炎的治疗方法及其疗效。方法 对我科近5年就诊的30例化脓性颞下颌关节炎患者,关节局部进行单针低压灌洗、双针低压灌洗、关节腔灌洗结合颞下间隙切排及关节内镜手术等4种方式治疗;治疗效果通过关节腔穿刺、张口度、颌疼痛和颌功能等方面的检查来评判;随访观察后遗症的发生情况。结果 治疗的总有效率为100%(30/30);单针低压灌洗、双针低压灌洗、关节腔灌洗结合颞下间隙切排和关节内镜手术的有效率分别为14/20、9/13、1/1和4/4;后遗症主要为骨关节病。结论 化脓性颞下颌关节炎急性期的治疗要素是适当的关节腔低压灌洗、减轻关节负荷及全身配合应用抗生素;对伴有颞下间隙脓肿的患者,在进行关节腔灌洗的同时,还可行下颌下切口的颞下间隙引流;对一些灌洗治疗无效或有后遗症的患者,关节内镜手术有优异的疗效。 相似文献
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Constantinus Politis Paul J. W. Stoelinga Gerard W. Gerritsen Abraham Heyboer 《Cranio : the journal of craniomandibular practice》2013,31(4):319-330
Between 1973–1987, 40 patients (51 joints) underwent 71 surgical procedures on the temporomandibular joint (TMJ). Indications for surgery included painful TM dysfunction, not alleviated by conservative treatment of at least 12 months' duration, or complete anterior disk dislocation not responding to conservative treatment for three to six months. The incidence of surgical treatment in the period 1983–1987 was 4.1% in a group of 679 patients. The mean follow-up is 5.8 years (range 1–15 years).At the follow-up examination (37/51) 72.5% of the treated joints appeared to have an excellent or good result; however, 14/51 joints had one or more reoperations (= 14/40 patients: 35%).The first surgical procedure on the TMJ resulted in an excellent or good result in 29/51 (57%) joints: 6/14 (= 42.9%) high condylectomies; 5/8 (= 62.5%) high condylectomies with a plication procedure; 15/24 (= 62.5%) plication procedure only; 2/2 silastic implants. After one or more reoperations, these figures improved to 10/14 (71%) high condylectomies, 7/8 (87.5%) high condylectomies with a plication procedure, 17/24 (70.8%) plication procedures.Radiographic changes, including flattening of the condyle, lack of condylar contour, erosion, sclerosis, subcondral cysts, and osteophytes were seen in all (16/16) patients in which a high condylectomy was performed. Out of 22 joints in which only a disk repositioning and plication procedure was performed, only 4/22 showed radiographic changes. The radiographic status was not correlated to the clinical picture at the time of the follow-up examination. 相似文献
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化脓性颞下颌关节炎的特征与诊断 总被引:2,自引:0,他引:2
目的探讨化脓性颞下颌关节炎的临床特征及其早期诊断方法。方法收集我科近5年的30例化脓性颞下颌关节炎患者,对其临床症状,关节液的性质和量,关节液的组织学和细菌学表现,影像学检查,其它实验室检查及后遗症进行分析。结果患者主要为成年人(>18岁占29/30);血源性感染多见;多数(25/30)局部症状轻,全身反应不明显;关节液组织学检查见大量粒细胞,可伴纤维蛋白或纤维软骨碎片;15/30患者关节液细菌学检查见到细菌,培养出的病原菌主要为金黄色葡萄球菌和腐生葡萄球菌;后遗症轻,主要为继发性骨关节病。结论当今化脓性颞下颌关节炎表现出感染源隐匿性、症状不典型性、后遗症轻等特点;关节腔穿刺和关节液分析是其必要的诊断手段。 相似文献
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口腔种植修复临床效果五年回顾研究 总被引:3,自引:0,他引:3
目的:评估柱状种植体应用5年的临床效果。方法:2001年2月至2005年12月植入柱状种植体共931枚,其中Pitt-easy种植体174枚,Frialit-2种植体148枚,Camlog种植体350枚,XiVE种植体176枚,Ankylos种植体45枚,I.M.Z种植体38枚。全部种植体均在2005年12月前完成上部结构修复,其中固定修复456例,活动修复8例,共计464例患者。平均追踪30个月(4-59月)。观察方法为X线检查和临床检查,采用Wheeler存留标准评估,纳入Kaplan-Meier存留曲线统计。结果:种植修复体完成时451例患者对修复效果满意,13例患者对修复体不满意,重做后10例表示满意,3例表示可以接受。随访中有34例患者共46枚种植体确诊为种植体周围炎。有明确记录的共24枚种植体脱落。5年随访累计修复体松动14件,修复体折断8件。据Wheeler存留标准统计5年存留率为95.2%。结论:种植修复患者的满意度高,本组种植体的5年存留率达到95.2%。 相似文献
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颞下颌关节自身的生物力学特性与颞下颌关节紊乱的发病有着不可分割的关系。本文从颞下颌关节组织的粘弹性,弹性模量和关节盘的摩擦特性等几个方面综述近年来的研究进展。 相似文献
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颞下颌关节骨关节病的临床诊断 总被引:5,自引:4,他引:1
目的:探讨颞下颌关节骨关节病的临床症状、体征、影像学特点与临床诊断的相关关系。方法:选取40例OA患者,其中男性6例,女性34例,平均年龄34.8岁。纳入标准为患者有明显的临床症状,进行过临床检查、X线检查及关节造影检查,并排除有全身系统性疾病的患者。由专业医生进行Fricton颞下颌关节功能紊乱指数评分;X线检查由放射科专业医生阅片,再对其进行影像学分期,所有40例OA被分为4期。结果:经过综合评定,40例OA中,Ⅰ期9例;Ⅱ期9例;Ⅲ期11例;Ⅳ期11例。Fricton功能障碍指数评分,Ⅰ期0.38;Ⅱ期0.35;Ⅲ期0.28;Ⅳ期0.26,经统计学处理,其中第Ⅳ期与第Ⅰ期之间有有统计学意义(P(0.05);疼痛指数评分,Ⅰ期6.23;Ⅱ期5.93;Ⅲ期4.73;Ⅳ期3.05,经统计学处理,其中第Ⅳ期与第Ⅰ期之间有有统计学意义(P(0.05)。结论:骨关节病患者的临床症状、体征与其影像学分期有一定的相关性。 相似文献
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目的:探讨采用木瓜蛋白酶在兔颞颌关节上腔注射,建立兔颞颌关节骨关节炎动物模型的可行性。方法:对 6只日本大耳白兔行颞颌关节上腔注射,实验侧注射013 ml 116%木瓜蛋白酶溶液,对照侧注射013 ml生理盐水,1 周后重复1次,首次注射后第2、4、6周分批处死实验动物,切取颞颌关节做大体及组织病理学观察。结果:实验侧关节注射木瓜蛋白酶后出现关节软骨变薄、基质分解破坏、滑膜增生等炎症及退行性改变,并随观察时间的延长而进一步发展,但在首次注射后第6周时出现不同程度的修复性改变。结论:兔颞颌关节注射木瓜蛋白酶后的改变与人颞颌关节骨关节炎病理改变具有相似性,可重复,可作为研究颞颌关节骨关节炎病理、发病机理及治疗方法的实验工具。 相似文献
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颞颌关节紊乱病患者心理学相关因素分析 总被引:10,自引:1,他引:9
目的对40例非咬合因素引起的颞颌关节紊乱病(TMD)患者进行心理学研究,了解TMD与心理障碍的关系。方法对40例TMD患者进行心理学病因、心因性躯体化症状观察,并对与TMD患者相配对的正常组进行自评焦虑量表(SAS)、自评抑郁量表(SDS)、症状自评量表(SCL90)量表分析。结果40例TMD患者主要的心理学病因有恐癌症、疑病症,工作紧张,生活事件,家庭矛盾。所有患者均存在心因性躯体化症状,最常见为睡眠障碍;存在中、重度的焦虑(75%)和抑郁(90%);SCL90量表主要是焦虑、抑郁、敌对和躯体化(P<0.01)。结论 非咬合因素引起的TMD患者存在着不同程度的心理障碍,心理学病史、躯体化症状具有临床参考价值;心理量表分析可进一步明确心理障碍的类型和程度,心理行为治疗对这类TMD有一定的帮助。 相似文献
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Natalia Lucia Gomez Luis Alejandro Boccalatte gueda Lopez Ruiz María Gabriela Nassif Marcelo Fernando Figari Lucas Ritacco 《Journal of maxillofacial and oral surgery》2021,20(3):394
BackgroundDisorders of the temporomandibular joint (TMJ) are frequent and are usually associated with other disorders of the facial skeleton. Surgery might be needed to correct TMJ anatomy and function and, in cases where pathologies coexist, a two-stage corrective surgery might be needed. However, the current fashion of single-stage procedures is feasible with the aid of new technologies such as computer-assisted surgery (CAS). This is a step forward toward performing complex procedures such as a TMJ replacement with simultaneous orthognathic surgery. CAS allows designing patient-fitted prosthesis and more predictable and accurate surgeries. Moreover, intraoperative development can be controlled in real time with intraoperative navigation, and postoperative results can be measured and compared afterwards.AimsThe primary purpose of this article is to present the protocol used in our institution for orthognathic surgery associated with unilateral and bilateral TMJ replacement with patient-fitted prostheses guided with CAS.Materials and methodsWe present two cases to illustrate our protocol and its results.ResultsIn the first case, the difference in millimeters between planning and surgical outcomes was 1.72 mm for the glenoid component and 2.16 mm for the condylar prosthesis; for the second case, differences in the right side were 2.59 mm for the glenoid component and 2.06 mm for the ramus, and in the left side, due to the anatomy the difference was a little greater, without clinical significanceConclusionCombined surgery of the midface and mandible with total TMJ replacement is feasible and beneficial for the patient. CAS facilitates the planning and design of custom-fit prosthesis and execution of these procedures. 相似文献