Zhang Shan-Yong, Liu Xiu-Ming, Yang Chi, Cai Xie-Yi, Chen Min-Jie, Haddad Majd S, Yun Bai, Chen Zhuo-Zhi
Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Collage of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
J Oral Maxillofac Surg. 2010 Aug;68(8):1813-7. doi: 10.1016/j.joms.2009.08.012. Epub 2009 Dec 30.
To evaluate the efficiency of an arthroscopic suturing technique for stabilizing anteriorly displaced discs in patients with internal derangement of the temporomandibular joint (TMJ) by magnetic resonance (MR) imaging.
Six hundred thirty-nine patients (764 joints) diagnosed as having stages II to V of internal derangement were treated with arthroscopic disc repositioning and suturing from August 2004 to March 2007. Consecutive MR images were used to evaluate internal derangement before and approximately 1 to 7 days after the operation for all 639 patients. The disc position of the TMJ was judged according to the success criteria, which included 3 different sagittal planes (lateral, central, and medial). Operative efficiency in those patients, whose discs of the TMJ were affirmed to be in a normal position in all 3 planes, was evaluated to be excellent. Those patients whose discs were in a normal position in 2 planes were evaluated to be good. The others were evaluated to be poor. Cases evaluated as excellent and good were considered success cases (if the disc is displaced only in 1 or 2 planes before operation, the efficiency of the operation would be evaluated as a success only if the whole disc was in normal position).
Postoperative consecutive MR images for all 764 joints confirmed that 95.42% (729/764) of the joints were excellent, 3.14% (24/764) were good, and only 1.44% (11/764) were poor. Repeated arthroscopic surgery or open surgery was carried out for the joints that were evaluated as poor.
This study indicates that the TMJ arthroscopic suturing technique is effective in repositioning the TMJ disc as confirmed by an MR imaging examination, but long-term follow-up is necessary.
通过磁共振成像（MR）评估关节镜缝合技术在稳定颞下颌关节（TMJ）内紊乱患者向前移位盘状软骨方面的效果。
2004年8月至2007年3月，对639例（764个关节）诊断为II至V期内紊乱的患者进行关节镜下盘状软骨复位及缝合治疗。对所有639例患者，采用连续MR图像评估术前及术后约1至7天的内紊乱情况。根据成功标准判断TMJ的盘状软骨位置，该标准包括3个不同的矢状面（外侧、中央和内侧）。TMJ盘状软骨在所有3个平面均处于正常位置的患者，手术效果评估为优秀；盘状软骨在2个平面处于正常位置的患者，评估为良好；其他患者评估为差。评估为优秀和良好的病例视为成功病例（如果术前盘状软骨仅在1个或2个平面移位，只有当整个盘状软骨处于正常位置时，手术效果才评估为成功）。
所有764个关节术后的连续MR图像证实，95.42%（729/764）的关节效果优秀，3.14%（24/764）的关节效果良好，只有1.44%（11/764）的关节效果差。对评估为差的关节进行了重复关节镜手术或开放手术。
本研究表明，经MR成像检查证实，TMJ关节镜缝合技术在重新定位TMJ盘状软骨方面有效，但需要长期随访。
