不同手术方法治疗颞下颌关节强直疗效评价

本文随访了采用不同手术方法治疗的颞下颌关节强直63例,其中采用髁状突切除4例,裂隙式关节成形术38例,嵌入式关节成形术15例,第二趾趾关节带血管移植7例。随访结果,复发15例,复发率为24％;其中髁状突切除1例,裂隙式关节成形术13例,嵌入式关节成形术1例。本文着重对几种手术的优缺点进行了评价。认为单纯的髁状突切除及裂隙式关节成形术可因术后开颌肌群的收缩作用,常导致两切骨断端的重新愈着而复发,且复发率高.采用嵌入式关节成形术,即在切骨后的间隙内折入各种组织或组织代用品,可以起到防止复发和利于咀嚼功能的作用。本文主要采用的是硅橡胶帽的插入,取得了很好的手术效果。采用第二脚趾关节带血管移植重建颞下颌关节,在防止复发和术后咀嚼功能的恢复方面更优于其它手术方法,特别适用于多次手术复发的病人,不足之处是手术复杂,而且要牺牲一个脚趾,部分病人难以接受,这样就在一定程度上限制了它的推广应用。

EVALUATION OF RESULTS USING DIFFERENT SURGICAL TREATMENT IN PATIANTS WITH TEMPEROMANDIBULAP JOINT ANKYLOSIS.

The results of different surgical treatment in 63 patients with temperomandibular joint ankylosis were reported. Several operation methods were used to deal with temperomandibuler joint ankylosis, among them, 4 patients were treated by condylectomy, 38 by gap arthroplasty, 15 by interposition arthroplasty arid 7 by graft of vasetllarizede second metatarsal phalangeal joint. The follow-up results shewed that about one-fourth of them (15/ 63) had postoperative rescurrencs, in cluding 13 patients treated by gap arthroplesty, 1 by condylectomy and another one by interposition arthroplasty. The advantage and disadvantage of above mentioned surgical methods have been discussed here condylectomy and gap arthroplasty could cause healing of bone through contraction of the elevator muscles and furthermore lead to bone reattachment;on the other hand, interposition arthroplasty might prevent it from recurring and rather satisfactory mastication function could be maintained in this study, the siliac cap interposition have received rather good results. Reconstruction of T M J by graft of vascularied second metatarsal phalangeal joint has showed the best results and it indicated especially for the patients of recurrence who had undergone operation many times.