收稿日期: 2021-08-31
网络出版日期: 2022-03-17
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
Received date: 2021-08-31
Online published: 2022-03-17
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)
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。
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 . DOI: 10.3969/j.issn.1674-8115.2022.02.006
·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.
·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.
·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).
·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.
| 1 | RAMMELSBERG P, POSPIECH P R, JAGER L, et al. Variability of disk position in asymptomatic volunteers and patients with internal derangements of the TMJ[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontology, 1997, 83(3): 393-399. |
| 2 | RIBEIRO R F, TALLENTS R H, KATZBERG R W, et al. The prevalence of disc displacement in symptomatic and asymptomatic volunteers aged 6 to 25 years[J]. J Orofac Pain, 1997, 11(1): 37-47. |
| 3 | HU Y K, YANG C, CAI X Y, et al. Does condylar height decrease more in temporomandibular joint nonreducing disc displacement than reducing disc displacement?[J]. Medicine, 2016, 95(35): e4715. |
| 4 | XIE Q, YANG C, HE D M, et al. Is mandibular asymmetry more frequent and severe with unilateral disc displacement?[J]. J Craniomaxillofac Surg, 2015, 43(1): 81-86. |
| 5 | XIE Q Y, YANG C, HE D M, et al. Will unilateral temporomandibular joint anterior disc displacement in teenagers lead to asymmetry of condyle and mandible? A longitudinal study[J]. J Craniomaxillofac Surg, 2016, 44(5): 590-596. |
| 6 | HU Y K, ABDELREHEM A, YANG C, et al. Changes in temporomandibular joint spaces after arthroscopic disc repositioning: a self-control study[J]. Sci Rep, 2017, 7: 45513. |
| 7 | LEI J, LIU M Q, YAP A U, et al. Condylar subchondral formation of cortical bone in adolescents and young adults[J]. Br J Oral Maxillofac Surg, 2013, 51(1): 63-68. |
| 8 | WOLFORD L M. Temporomandibular joint devices: treatment factors and outcomes[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1997, 83(1): 143-149. |
| 9 | YANG C, ZHANG S Y, WANG X D, et al. Magnetic resonance arthrography applied to the diagnosis of intraarticular adhesions of the temporomandibular joint[J]. Int J Oral Maxillofac Surg, 2005, 34(7): 733-738. |
| 10 | LIU Z Y, XIE Q Y, CHEN M J, et al. Measurement of mandibular condylar height based on magnetic resonance imaging[J]. J Craniofacial Surg, 2020, 31(4): e415-e418. |
| 11 | LIU Z, XIE Q, YANG C, et al. The effect of arthroscopic disc repositioning on facial growth in juvenile patients with unilateral anterior disc displacement[J]. J Craniomaxillofac Surg, 2020, 48(8): 765-771. |
| 12 | WOLFORD L M, KARRAS S C, MEHRA P. Considerations for orthognathic surgery during growth, part 1: mandibular deformities[J]. Am J Orthod Dentofacial Orthop, 2001, 119(2): 95-101. |
| 13 | WOLFORD L M, KARRAS S C, MEHRA P. Considerations for orthognathic surgery during growth, part 2: maxillary deformities[J]. Am J Orthod Dentofacial Orthop, 2001, 119(2): 102-105. |
| 14 | 朱慧敏, 周琴, 何冬梅, 等. 关节盘复位锚固术术后稳定性的影像学评价[J]. 中国实用口腔科杂志, 2018, 11(12): 731-734. |
| 15 | LIU X, SHEN P, WANG X, et al. A prognostic nomogram for postoperative bone remodeling in patients with ADDWoR[J]. Sci Rep, 2018, 8(1): 4361. |
| 16 | ZHU H, HE D, YANG Z, et al. The effect of disc repositioning and post-operative functional splint for the treatment of anterior disc displacement in juvenile patients with Class Ⅱ malocclusion[J]. J Craniomaxillofac Surg, 2019, 47(1): 66-72. |
/
| 〈 |
|
〉 |