2例个体化人工关节用于颞下颌关节置换的初步效果评价

目的：采用CAD／CAM技术设计个体化人工全颞下颌关节，通过全关节置换，治疗严重颞下颌关节病，对其疗效进行初步评价。方法：2例女性颞下颌关节疾病患者，年龄分刖为53岁和60岁。术前经MRI等检查发现严重的关节盘及髁突病变，开口度分别为2．0cm和1．8cm，均表现有明显的关节疼痛。2例患者均采用TMJ Concepts公司的个体化人工颞下颌关节全关节置换术。结果：成功完成了2例3侧颞下颌关节的置换手术。未出现术后并发症。关节疼痛在术后2周后逐渐缓解。6个月后开口度分别为2．7cm和2．9cm。术后口颌功能改善良好。结论：人工全颞下颌关节置换治疗严重颞下颌关节骨关节病具有良好的效果，个体化设计可为人工关节发挥良好功能提供有效的保证．

A primary application and evaluation of temporomandibular joint replacement with custom-made prosthesis

PURPOSE: To evaluate the effects of total temporomandibular joint replacement in treatment of severe temporomandibular joint(TMJ) osteoarthropathy with custom-made prosthesis. METHODS: 2 female patients involving 3 joints (1 unilateral, 1 bilateral), with an average age of 56.5 years, were diagnosed as internal derangement(ID) in V stage(Walkes's Staging) depending on MRI, 3D-CT scanning and clinical characteristics. The maximal mouth opening was 2.0cm,1.8cm respectively. 3 joints were designed and manufactured according to their anatomic characters. Condylectomy, insertion and fixation of the artificial TMJ components were performed via a modified endaural incision. RESULTS: Total TMJ joint replacement surgery was successfully performed in both patients. No significant complications occurred postoperatively. Pain relieved 2 weeks after the operation. The maximal mouth opening(MMO) were improved to 2.5cm,2.8cm respectively in 3 months. CONCLUSIONS: Total TMJ replacement with custom-made prosthesis demonstrated a good result for severe osteoarthropathy of TMJ in this research. Long-term effects will be appraised relied on a long-term follow-up. Supported by Shanghai Leading Academic Discipline Project (Grant No.Y0203).