青少年不同发育阶段颞下颌关节盘锚固术后复发率的差异

doi:10.3969/j.issn.1674-8115.2022.02.006

上海交通大学学报(医学版) ›› 2022, Vol. 42 ›› Issue (2): 173-177.doi: 10.3969/j.issn.1674-8115.2022.02.006

• 论著 · 临床研究 • 上一篇

青少年不同发育阶段颞下颌关节盘锚固术后复发率的差异

王学宏¹(), 陈旭卓¹, 毛懿¹, 沈达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，国际口腔医学中心，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.南京医科大学附属苏州医院口腔科，苏州 215000

收稿日期:2021-08-31 出版日期:2022-02-28 发布日期:2022-03-17
通讯作者: 沈达,张善勇 E-mail:carl1018@163.com;37735375@qq.com;zhangshanyong@126.com
作者简介:王学宏（1997—），男，硕士生；电子信箱：carl1018@163.com。
基金资助:
2020年度苏州市临床重点病种诊疗技术项目(LCZX202011);上海交通大学医学院附属第九人民医院临床研究助推计划(JYLJ202105)

Difference in recurrence rates after temporomandibular joint disc repositioning surgery with miniscrew anchor at different developmental stages in adolescents

Xuehong WANG¹(), Xuzhuo CHEN¹, Yi MAO¹, Da SHEN²(), Shanyong ZHANG¹()

^1.Department of Oral and Maxillofacial 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 Disease; Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
^2.Department of Stomatology, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou 215000, China

Received:2021-08-31 Online:2022-02-28 Published:2022-03-17
Contact: Da SHEN,Shanyong ZHANG E-mail:carl1018@163.com;37735375@qq.com;zhangshanyong@126.com
Supported by:
Clinical Diagnosis and Treatment Research Project of Key Diseases, Suzhou, 2020(LCZX202011);Clinical Research Program of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine(JYLJ202105)

摘要/Abstract

摘要：

目的·基于磁共振，对经开放性颞下颌关节盘锚固术治疗的颞下颌关节盘前移位（anterior disc displacement，ADD）青少年患者进行回顾性研究，评价青少年不同发育阶段术后复发率的差异。方法·纳入2015年1月—2020年1月在上海交通大学医学院附属第九人民医院口腔外科行颞下颌关节盘锚固术的青少年患者（12岁≤年龄≤18岁），以快速生长发育期15岁年龄为界分为A（>15岁）、B（≤15岁）2组，经术后至少半年磁共振随访，评估手术前后关节盘位置和髁突高度的变化。随访期间若再次出现ADD，则认为术后复发。在导出的磁共振图像上，采用三圆中心法进行关节盘位置、长度和髁突高度的定量分析，比较手术前后2组间的差异，使用SPSS 25.0软件包进行统计学分析。2组手术复发率差异采用χ²检验，2组关节盘长度、移位程度及髁突生长高度差异采用独立样本t检验。结果·符合纳入条件的患者共90例（144侧关节），其中男性26例，女性64例，平均年龄（14.2±1.2）岁，平均随访时间（16.0±12.0）个月，术后1周显示所有移位关节盘均复位。磁共振显示：术后随访阶段，A组96.4%（54/56）的关节盘位置良好，而3.6%（2/56）的关节盘前移复发；B组85.2%（75/88）的关节盘位置良好，14.8%（13/88）的关节盘前移复发；B组患者复发率大于A组，差异具有统计学意义（P=0.032）。分析可能的影响因素，发现A组患者术后随访髁突高度比术前平均增加（1.33±1.29）mm，B组增加（1.79±1.14）mm，B组患者随访髁突高度增加大于A组（P=0.036）。B组患者关节盘前移位程度大于A组（P=0.002），但2组术前关节盘长度没有明显差异（P=0.585）。结论·对于行颞下颌关节盘锚固术的青少年患者，经历快速生长发育期可能是影响手术效果的因素，使用锚固钉进行复位固定的术后效果可能受到髁突快速生长发育的影响。

关键词: 青少年, 颞下颌关节盘锚固术, 髁突高度, 磁共振, 复发

Abstract:

Objective·Based on magnetic resonance imaging (MRI), adolescents with anterior disc displacement (ADD) of temporomandibular joint treated by temporomandibular joint disc repositioning surgery with miniscrew anchor were studied retrospectively to analyze the difference of postoperative recurrence rate among adolescents at different developmental stages.

Methods·Adolescent patients (12 years old≤age≤18 years old ) who received disc repositioning from January 2015 to January 2020 in the Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine were selected and the patients were divided into 2 groups defined by the age of 15. MRIs during at least 6 months follow-up were used to evaluate changes in the disc position and condylar bone. During follow-up, ADD without reduction was considered relapse. The position, length of disc and height of condylar were analyzed quantitatively by modified three-circle method on MRI images and compared by statistical analysis via Software SPSS 25.0. Difference of recurrence rates between the 2 groups was compared by using chi-square test. T test was performed for the difference of condylar growth height between the 2 groups.

Results·Totally 90 cases were included, including 64 females and 26 males, with the average age of (14.2±1.2) years and follow-up interval of (16.0±12.0) months. Postoperative MRIs showed that all the discs were repositioned. During follow-up, 96.4% (54/56) of the discs in group A (>15 years old) were still in position, whereas 3.6% (2/56) of the discs had relapsed anteriorly. In group B (≤15 years old), 85.2% (75/88) of the discs were still in position, whereas 14.8% (13/88) of the discs had relapsed anteriorly, which was higher than that in group A (P=0.032). The condylar height in group A increased by (1.33±1.29) mm compared with that in group B [(1.79±1.14) mm)]. The condylar height in group B increased more during follow-ups (P=0.036). The degree of anterior disc displacement in group B was greater than that in group A (P=0.002), but there was no significant difference in preoperative disc length between the 2 groups (P=0.585).

Conclusion·For adolescent patients who received temporomandibular joint disc repositioning surgery with miniscrew anchor, experiencing rapid growth might be a factor affecting the effect of the operation. The postoperative effect of repositioning surgery with miniscrew anchor may be affected by the rapid growth and development of condyle.

Key words: adolescent, temporomandibular joint disc repositioning with miniscrew anchor, condylar height, magnetic resonance imaging (MRI), recurrence

中图分类号:

R782.6

王学宏, 陈旭卓, 毛懿, 沈达, 张善勇. 青少年不同发育阶段颞下颌关节盘锚固术后复发率的差异[J]. 上海交通大学学报(医学版), 2022, 42(2): 173-177.

Xuehong WANG, Xuzhuo CHEN, Yi MAO, Da SHEN, Shanyong ZHANG. Difference in recurrence rates after temporomandibular joint disc repositioning surgery with miniscrew anchor at different developmental stages in adolescents[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2022, 42(2): 173-177.

图/表 7

图1 关节盘长度、关节盘移位距离和髁突高度测量方法

Fig 1 Measurement methods of disc length, displacement distance and condylar height

图2 MRI显示关节盘锚固术后复发示例（男性，14岁）Note： A. Preoperative anterior disc displacement. B. Postoperative disc reduction. C.Anterior disc displacement relapsed after 12 months of surgery.

Fig 2 MRI showed the discs had relapsed after surgery (male, 14 years old)

图3 MRI显示关节盘锚固术后位置稳定示例（女性，16岁）Note： A. Preoperative anterior disc displacement. B. Postoperative disc reduction. C. Disc position was stable after 19 months of surgery, condylar new bone formation was observed.

Fig 3 MRI showed the discs position was stable during follow-up（female, 16 years old）

表1 不同年龄段复发率

Tab 1 Recurrence rates in different age groups

Group	Postoperative recurrence/n （%）	No recurrence after surgery/n （%）	Total/n	P value
A （>15 year）	2 （3.6）	54 （96.4）	56
B （≤15 year）	13 （14.8）	75 （85.2）	88
Total	15 （10.4）	129 （89.6）	144	0.032

表2 不同年龄段髁突高度变化

Tab 2 Condylar height growth of different age groups

Group	Average follow up period/month	Condylar height increased/mm	P value
A （>15 year）	15.0±7.4	1.33±1.29
B （≤15 year）	17.0±14.0	1.79±1.14
Total	16.0±12.0	1.61±1.23	0.036

表3 不同年龄段术前关节盘前移位距离

Tab 3 Preoperative TMJ disc displacement distance in different age groups

Group	TMJ disc displacement distance/mm	P value
A （>15 year）	4.52±1.80	0.002
B （≤15 year）	5.55±1.93	0.002

表4 不同年龄段手术前关节盘长度

Tab 4 Preoperative disc length in different age groups

Group	Preoperative disc length/mm	P value
A （>15 year）	9.03±2.04	0.585
B （≤15 year）	8.82±2.18	0.585

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青少年不同发育阶段颞下颌关节盘锚固术后复发率的差异

Difference in recurrence rates after temporomandibular joint disc repositioning surgery with miniscrew anchor at different developmental stages in adolescents

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