国产全埋入式颞下颌关节锚固钉的临床应用评价

doi:10.3969/j.issn.1674-8115.2022.06.005

上海交通大学学报（医学版） ›› 2022, Vol. 42 ›› Issue (6): 723-728.doi: 10.3969/j.issn.1674-8115.2022.06.005

• 口腔外科专题 • 上一篇

国产全埋入式颞下颌关节锚固钉的临床应用评价

毛懿¹(), 陈旭卓¹, 王学宏¹, 谢昕儒¹, 徐伟峰¹, 黄慧²(), 张善勇¹()

^1.上海交通大学医学院附属第九人民医院口腔外科，上海交通大学口腔医学院，国家口腔医学中心，国家口腔疾病临床医学研究中心，上海市口腔医学重点实验室，上海 200011
^2.上海交通大学医学院附属第九人民医院口腔影像科，上海 200011

收稿日期:2022-02-18 接受日期:2022-05-08 出版日期:2022-06-28 发布日期:2022-08-19
通讯作者: 黄慧,张善勇 E-mail:maoyi1994@126.com;1974601318@qq.com;zhangshanyong@126.com
作者简介:毛懿（1994—），男，羌族，博士生；电子信箱：maoyi1994@126.com。第一联系人：陈旭卓（1994—），男，博士生；电子信箱：cxzzxcaa@126.com。*为共同第一作者。
基金资助:
上海申康医院发展中心临床三年行动计划(SHDC2020CR3060B);黄浦区产业扶持基金(XK2020013)

Clinical evaluation of Chinese embeded temporomandibular joint anchoring nail

MAO Yi¹(), CHEN Xuzhuo¹, WANG Xuehong¹, XIE Xinru¹, XU Weifeng¹, HUANG Hui²(), ZHANG Shanyong¹()

^1.Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
^2.Department of Oral Imageology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China

Received:2022-02-18 Accepted:2022-05-08 Online:2022-06-28 Published:2022-08-19
Contact: HUANG Hui,ZHANG Shanyong E-mail:maoyi1994@126.com;1974601318@qq.com;zhangshanyong@126.com
Supported by:
Three Years Clinical Research Plan of Shanghai Shenkang Hospital Development Center(SHDC2020CR3060B);Huangpu District Industrial Support Fund(XK2020013)

摘要/Abstract

摘要：

目的·介绍一种采用全埋入式设计的国产新型颞下颌关节锚固钉，并通过临床试验进行效果评价。方法·选取2018年6月—2018年11月于上海交通大学医学院附属第九人民医院口腔外科进行颞下颌关节盘复位固定术的不可复性关节盘前移位患者43例，对于单侧手术患者采用国产全埋入式新型锚固钉复位关节盘，对于双侧手术患者采用右侧新型锚固钉、左侧传统锚固钉复位。分别在术前及术后1个月、术后6个月、术后1年进行临床及磁共振成像（magnetic resonance imaging，MRI）检查评估。临床评估指标包括最大张口度、颞下颌关节疼痛视觉模拟评分；MRI结果评价采用“三圆法”，聚焦于关节盘位置、关节盘长度和髁突高度。采用重复测量方差分析对术前术后患者开口度、疼痛评分、关节盘长度、髁突高度进行统计分析。结果·共31例患者（53侧关节）完成全部随访。国产全埋入式新型锚固钉和传统锚固钉的手术成功率分别为90.3%和90.9%。术后1年，患者下颌运动功能明显改善，张口度由术前的（34.65±8.63）mm提高至（42.84±7.46）mm，差异有统计学意义（P=0.000）；患者疼痛明显缓解，疼痛评分由术前的（2.94±1.13）分降低至（0.39±0.55）分，差异有统计学意义（P=0.000）。术后MRI结果显示关节盘长度增加；术后6个月髁突高度与术后1个月髁突高度比较，差异无统计学意义（P>0.05），术后1年髁突高度较术后1个月髁突高度平均增加1.54 mm（P=0.002）。应用新型锚固钉的患者31侧关节均无异物感，而应用传统锚固钉的22侧关节中，7例患者表示在该侧耳屏前能触摸到突起，其中2例患者出现明显异物感。结论·国产全埋入式新型锚固钉与传统锚固钉的手术成功率相近，且能显著减少术后异物感。颞下颌关节盘复位固定术有助于改善关节功能、缓解疼痛，新骨形成可在术后1年通过MRI检出。

关键词: 颞下颌关节, 关节盘前移位, 关节盘复位固定术, 锚固钉

Abstract:

Objective·To introduce and evaluate a Chinese embedded temporomandibular joint (TMJ) anchoring nail in a clinical trial.

Methods·From June 2018 to November 2018, 43 patients with anterior disc displacement without reduction were selected from the Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. TMJ disc reposition and fixation was performed to them all. For unilateral patients, a Chinese embedded nail was used to reduce the articular disc. For bilateral patients, a Chinese embedded anchoring nail was used on the right side and a traditional anchoring nail was used on the left side. Clinical and magnetic resonance imaging (MRI) examination were performed before surgery, 1 month after surgery, 6 months after surgery and 1 year after surgery. Clinical evaluation indexes included maximum interincisal opening (MIO) and TMJ pain score. The disc position, disc length and condylar height were measured by MRI, by using three-circle method. Repetitive measnre analysis of variance was used for statistical analysis of preoperative and postoperative MIO, visual analog scale (VAS) score for TMJ pain, disc length and condyle height.

Results·Thirty-one patients with fifty-three joints finished all follow-up periods. The success rates of Chinese embedded anchoring nail and traditional anchoring nail were 90.3% and 90.9%, respectively. One year after surgery, the patients' jaw motion improved significantly. The MIO increased from (34.65±8.63) mm before surgery to (42.84±7.46) mm 1 year after surgery (P=0.000). The pain was significantly alleviated, and the VAS score for TMJ pain decreased from (2.94±1.13) before surgery to (0.39±0.55) 1 year after surgery (P=0.000). Postoperative MRI examination result showed increased disc length. The condyle height did not change significantly 6 months after surgery (P>0.05), but it increased by an average of 1.54 mm 1 year after surgery (P=0.002). None of the 31 joints with the Chinese embeded anchorage nail had foreign body sensation, while of the 22 joints with the traditional anchorage nail, 7 patients could feel the protrusion in front of the tragus, and 2 of them had obvious foreign body sensation.

Conclusions·Improved Chinese embedded TMJ anchoring nail has similar success rate and less foreign body sensation than traditional anchoring nail. TMJ disc repositioning and fixation is beneficial to improve joint function and relieve pain. New bone can be detected 1 year after surgery.

Key words: temporomandibular joint (TMJ), anterior disc displacement (ADD), disc repositioning and fixation, anchoring nail

中图分类号:

R782.6

毛懿, 陈旭卓, 王学宏, 谢昕儒, 徐伟峰, 黄慧, 张善勇. 国产全埋入式颞下颌关节锚固钉的临床应用评价[J]. 上海交通大学学报（医学版）, 2022, 42(6): 723-728.

MAO Yi, CHEN Xuzhuo, WANG Xuehong, XIE Xinru, XU Weifeng, HUANG Hui, ZHANG Shanyong. Clinical evaluation of Chinese embeded temporomandibular joint anchoring nail[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(6): 723-728.

图/表 3

图1 国产全埋入式新型锚固钉示意图Note：A. Schematic diagram of Chinese embeded anchoring nail. B. Schematic diagram of Chinese embeded anchoring nail after assembly.

Fig 1 Schematic diagram of Chinese embeded anchoring nail

图2 三圆法MRI测量示意图

Fig 2 Schematic diagram of MRI measurement

图3 术前和术后不同阶段临床及MRI检查结果Note：A.MIO at each stage. B. VAS of pain at each stage. C. Disc length at each stage. D. Condylar height at each stage. ①P=0.000, compared with the T0 group;②P=0.002, compared with the T1 group.

Fig 3 Clinical and MRI examination results at each stage before and after surgery

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国产全埋入式颞下颌关节锚固钉的临床应用评价

Clinical evaluation of Chinese embeded temporomandibular joint anchoring nail

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