Miloro Michael, Henriksen Brent
Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago College of Dentistry, Chicago, IL 60612-7211, USA.
J Oral Maxillofac Surg. 2010 Apr;68(4):782-9. doi: 10.1016/j.joms.2009.09.091. Epub 2010 Jan 15.
The goal of this study was to evaluate outcomes of patients who underwent temporomandibular joint (TMJ) discectomy without replacement as the primary treatment for internal derangement after failure of nonsurgical therapy.
Thirty consecutive patients with TMJ internal derangement were treated with discectomy from 2001 to 2007. Four patients were lost to follow-up, and 2 were excluded because of prior joint surgery. Using the standardized Helkimo Anamnestic and Clinical Dysfunction Indexes, 24 patients, or 32 joint surgeries, were evaluated postoperatively, with an average follow-up of 30.8 months (range, 2 to 60 months).
All 24 patients showed improvement in mandibular mobility and joint function, as well as reduction in TMJ and muscular facial pain, represented by a clinical dysfunction index of DiO, DiI, or DiII. Preoperatively, all patients had an anamnestic index of AiII, which represented moderate to severe pain in the TMJ and masticatory muscles, and/or locking of the joint before surgery. Postsurgically, 20 of the 24 patients scored an index of DiO or DiI, which correlated with a clinically symptom-free state or only a small, minor dysfunction. TMJ pain, muscle pain, and pain with mobility scored the lowest point index, indicating a subjectively successful outcome.
Discectomy of the TMJ as a primary surgical option significantly reduces pain and improves function.
本研究的目的是评估在非手术治疗失败后，接受颞下颌关节（TMJ）盘切除术且不进行置换作为内紊乱主要治疗方法的患者的治疗结果。
2001年至2007年，连续30例TMJ内紊乱患者接受了盘切除术。4例患者失访，2例因既往有关节手术而被排除。使用标准化的赫尔基莫记忆和临床功能障碍指数，对24例患者（即32次关节手术）进行术后评估，平均随访30.8个月（范围为2至60个月）。
所有24例患者的下颌运动度和关节功能均有改善，TMJ和面部肌肉疼痛也有所减轻，临床功能障碍指数为DiO、DiI或DiII。术前，所有患者的记忆指数均为AiII，这代表TMJ和咀嚼肌中度至重度疼痛，和/或术前关节锁定。术后，24例患者中有20例的指数为DiO或DiI，这与临床无症状状态或仅存在轻微功能障碍相关。TMJ疼痛、肌肉疼痛和运动时疼痛的指数得分最低，表明主观治疗结果成功。
TMJ盘切除术作为主要手术选择可显著减轻疼痛并改善功能。
