Dimitroulis George
Oral and Maxillofacial Surgeon, Department of Surgery, St Vincents Hospital, Unviersity of Melbourne, Melbourne, Australia.
J Oral Maxillofac Surg. 2002 May;60(5):519-24; discussion 525. doi: 10.1053/joms.2002.31848.
The aims of this prospective clinical study were to look at the features that constitute chronic closed lock of the temporomandibular joint (TMJ) and to assess the effectiveness of TMJ arthroscopic lavage and lysis in the management of this condition.
Sixty joints in 56 patients who presented with mandibular hypomobility suggestive of chronic closed lock were prospectively examined and treated with TMJ arthroscopic lavage and lysis during a 3-year period from 1996 to 1999.
Eighty-seven percent (49 of 56) of patients were found to have chronic closed lock of the TMJ. The most common intra-articular findings were fibrillation (76%) and synovitis (54%). TMJ arthroscopic lavage and lysis were found to be effective in the management of chronic closed lock in 84% (47 of 56) of patients, with an average 66% reduction in pain levels and a mean improvement of 9.8 mm in interincisal mouth opening up to 6 weeks after the procedure.
Chronic mandibular hypomobility is a clinical sign that is often but not always caused by chronic closed lock of the TMJ. The intra-articular findings of this study suggest that cartilage degradation and synovial inflammation are important components of chronic closed lock of the TMJ that respond well to arthroscopic lavage. Patients with mandibular hypomobility not caused by closed lock of the TMJ (ie, myofascial pain and dysfunction, osteoarthrosis, and others) are less likely to derive benefit from arthroscopic lavage and lysis, so other treatment methods should be considered.
这项前瞻性临床研究的目的是观察构成颞下颌关节（TMJ）慢性闭锁的特征，并评估TMJ关节镜灌洗和松解术在治疗这种疾病中的有效性。
在1996年至1999年的3年期间，对56例表现出提示慢性闭锁的下颌运动受限的患者的60个关节进行了前瞻性检查，并采用TMJ关节镜灌洗和松解术进行治疗。
发现87%（56例中的49例）的患者患有TMJ慢性闭锁。最常见的关节内表现是纤维性变（76%）和滑膜炎（54%）。发现TMJ关节镜灌洗和松解术对84%（56例中的47例）的慢性闭锁患者有效，术后6周内疼痛水平平均降低66%，切牙间开口平均改善9.8毫米。
慢性下颌运动受限是一种临床体征，常但不总是由TMJ慢性闭锁引起。本研究的关节内表现表明，软骨退变和滑膜炎症是TMJ慢性闭锁的重要组成部分，对关节镜灌洗反应良好。由TMJ闭锁以外的原因（即肌筋膜疼痛和功能障碍、骨关节炎等）引起下颌运动受限的患者，从关节镜灌洗和松解术中获益的可能性较小，因此应考虑其他治疗方法。
