【摘要】 目的探讨创伤性颞下颌关节强直伴内侧髁突残存的不同手术方法及疗效。方法遵义医学院附属口腔医院2008年~2013年收治的创伤性颞下颌关节强直伴内侧髁突残存的患者18例,其中10例行关节间隙成形+喙突游离移植+颞肌筋膜瓣治疗,8例行外侧成形+颞肌筋膜瓣治疗。通过临床及CBCT随访比较两种方法的临床治疗效果,对术后复发率、咬合、面型的影响以及最大开口度变化进行统计学分析。结果术后随访12~24月,关节间隙成形+喙突游离移植+颞肌筋膜瓣组术后复发患者2例(2/10),外侧成形术+颞肌筋膜瓣组术后无复发病例。外侧成形术+颞肌筋膜瓣组术后患者咬合、面型及最大开口度与关节间隙成形+喙突游离移植+颞肌筋膜瓣组比较有显著性差异(P<0.05)。结论在内侧残存的髁突及关节盘可保留的情况下,采用外侧成形术+颞肌筋膜瓣是治疗创伤性颞下颌关节强直的理想术式。更多还原

【Abstract】 Objective To compare the outcome of two different surgical methods for the treatment of traumatic temporomandibular joint( TMJ) ankylosis with medially displaced residual condyle. Methods From 2008 to 2013,18 patients diagnosed with traumatic TMJ ankylosis with medially displaced residual condyle were included in the present study. Ten patients were treated with gap arthroplasty( GA) and joint reconstruction with autogenous coronoid process graft and temporalis myofascial flap( TMF),8 patients were treated with lateral arthroplasty( LAP) and TMF. The long-term results of these treatments were compared by postoperative CT and clinical follow up. The recurrence rate,occlusion,facial pattern and maximal incisal opening( MIO) before and after operation were evaluated. Results All patients were followed up for 12 to 24 months. Two of the 10 patients treated with GA and joint reconstruction with autogenous coronoid process graft and TMF had ankylosis after operation,and none joints treated with LAP and TMF had ankylosis after operation.Compared with GA and joint reconstruction with autogenous coronoid process graft and TMF,LAP and TMF significantly improved occlusion,facial pattern and MIO( P < 0. 05). Conclusion When the medially displaced residual condyle and articular disc could be retained,LAP and TMF is a feasible and effective surgical method for the treatment of traumatic TMJ ankylosis.更多还原