] 江苏省自然科学基金面上项目(BK20201350),江苏省高校优势学科建设工程资助项目(项目编号: 2018-87)
目的：评价小切口入路颞下颌关节盘复位缝合术治疗不可复性关节盘前移位的临床疗效。方法：选取2020年4月至2020年—12月于南京医科大学附属口腔医院我院口腔颌面外科就诊的48例（54侧）颞下颌关节盘不可复性前移位患者, 采用耳屏内小切口入路，行颞下颌关节盘复位及缝合固定术进行治疗，分析术前、术后3个月患者开口度、疼痛值、关节功能评价以及磁共振成像（magnetic resonance imaging，MRI）影像学表现，并进行统计学分析。结果：术前平均开口度为(19.46±3.91)mm(12~26 mm)，术后开口度为(32.57±5.21)mm(27~40 mm)；疼痛视觉模拟评分直观模拟标尺(visual analogue scale, VAS)术前大张口疼痛平均为[25(25,75)]，术后为[25(0,50)]；术前进食疼痛平均为[25(0,100)]，术后为[0(0,25)]；术前关节功能自我评价为56.86±22.56(20~85)，术后自我评价为81.50±11.71(60~100)，术后3个月的开口度、疼痛VAS值及关节功能自我评价均比术前有显著改善，差异具有统计学意义(p0.05)。MRI影像学显示关节盘复位有效率达90.74%(49/54侧)。结论：颞下颌关节盘复位缝合术可以有效复位前移的关节盘，显著改善开口度、缓解疼痛并改善关节功能。
PURPOSE: To estimate the clinical outcome of small incision temporomandibular joint disc repositioning and suturing for patients with anterior disc displacement of the temporomandibular joint without reduction. METHODS: 48 patients(54 joints) were included. All the patients who suffered from anterior disc displacement of the temporomandibular joint without reduction, underwent temporomandibular joint disc repositioning and suturing in the Department of Oral and Maxillofacial, Stomatological College of Nanjing Medical University between April 2020 and December 2020. The values of maximal interincisal opening(MIO), visual analogue scale(VAS), and self-evaluation of joint function as well as magnetic resonance imaging(MRI) between preoperative and postoperative 3 months were compared. RESULTS: MIO improved from a mean of 19.46±3.91mm(12~26mm) preoperatively to 32.57±5.21mm(27~40mm) postoperatively; VAS of maximal opening decreased from a mean of [25(25,75)] preoperatively to [25(0,50)] postoperatively; VAS of chewing decreased from a mean of [25(0,100)] preoperatively to [0(0,25)] postoperatively; self-evaluation of joint function improved from a mean of 56.86±22.56(20~85) preoperatively to 81.50±11.71(60~100) postoperatively. There were significant differences in all results(p0.05). MRI scans showed that of all 49 joints, 43 cases were judged as excellent and good on disc-condyle position(90.74%). CONCLUSIONS: Temporomandibular joint disc repositioning suturing proves reliable and effective for patients with anterior disc displacement of the temporomandibular joint without reduction, significantly improves patients with limited mouth opening and pain symptoms.