Bakke Merete, Eriksson Lars, Thorsen Niels Max, Sewerin Ib, Petersson Arne, Wagner Aase
Department of Oral Medicine, Clinical Oral Physiology, Oral Pathology and Anatomy, School of Dentistry, Faculty of Health Sciences, University of Copenhagen, 20 Nörre Allé, 2200, Copenhagen, Denmark.
Clin Oral Investig. 2008 Dec;12(4):353-9. doi: 10.1007/s00784-008-0204-x. Epub 2008 Jun 12.
Modified condylotomy may be relevant in severe painful reciprocal clicking of the temporomandibular joint (TMJ) where conservative treatment is insufficient. The effect of the modified condylotomy was analyzed and compared with conventional nonsurgical treatment in a randomized pilot study of eight patients, 19-44 years of age, with severe painful reciprocal clicking. Before and after treatment, assessments were performed by subjective reports, clinical recordings, and blinded evaluations of radiography and magnetic resonance imaging (MRI). Based on the clinical evaluations before treatment, all conditions were disc displacements with reduction and arthralgia (Research diagnostic criteria for temporomandibular disorders), but based on MRI, one patient had disc displacement without reduction and another had normal disc position. The treatment effect was significantly better and the disorders were significantly more reduced with condylotomy than with conventional nonsurgical treatment (P < 0.05, Mann-Whitney U test). In the surgical group, the clicking and locking had disappeared, the pain during function was significantly reduced (P < 0.05, Friedman ANOVA), and in two patients the disc position was normalized. The clicking still persisted in the nonsurgical patients and the disc position was unchanged. Our conclusion is that modified condylotomy is a promising option to reduce symptoms and signs in severe painful reciprocal clicking.
对于保守治疗效果不佳的颞下颌关节（TMJ）重度疼痛性相互弹响，改良髁突截骨术可能是一种有效的治疗方法。在一项针对8例年龄在19至44岁之间、患有重度疼痛性相互弹响的患者的随机试验研究中，分析了改良髁突截骨术的效果，并与传统非手术治疗进行了比较。治疗前后，通过主观报告、临床记录以及对X线片和磁共振成像（MRI）的盲法评估进行了评估。根据治疗前的临床评估，所有病例均为可复性盘移位伴关节痛（颞下颌关节紊乱病研究诊断标准），但根据MRI检查，有1例患者为不可复性盘移位，另1例患者盘位置正常。与传统非手术治疗相比，髁突截骨术的治疗效果明显更好，紊乱症状明显减轻（P < 0.05，Mann-Whitney U检验）。在手术组中，弹响和绞锁消失，功能时疼痛明显减轻（P < 0.05，Friedman方差分析），2例患者的盘位置恢复正常。非手术组患者的弹响仍然存在，盘位置未改变。我们的结论是，改良髁突截骨术是减轻重度疼痛性相互弹响症状和体征的一种有前景的选择。
