Department of Surgery, St. Vincent's Hospital, The University of Melbourne, Melbourne, Australia.
Int J Oral Maxillofac Surg. 2011 Feb;40(2):177-83. doi: 10.1016/j.ijom.2010.09.022. Epub 2010 Nov 2.
The histological fate of abdominal dermis-fat grafts implanted into the temporomandibular joint (TMJ) following condylectomy was studied. 21 rabbits underwent left TMJ discectomies and condylectomies; 6 were controls (Group A; no graft used); 15 (Group B) had autogenous abdominal grafts transplanted into the left TMJ. Animals were killed after 4, 12 and 20 weeks. Specimens of the TMJ were histologically and histomorphometrically evaluated. At 4 weeks, fat necrosis was clear in all specimens. The dermis component survived and formed cysts with no necrosis. By 12 weeks, viable fat deposits appeared with no evidence of necrotic fat. At 20 weeks, large amounts of viable fat were present in Group B specimens. Group A had no fat, although the missing condyles regenerated. In the presence of viable fat, Group B showed little condyle regeneration 20 weeks after condylectomy. Non-vascularised fat grafts do not survive transplantation, but stimulate neoadipogenesis. The fate of the dermis component of the graft is independent of the fat component. Fat in the joint space disrupts the regeneration of a new condylar head. Neoadipogensis inhibits growth of new bone and cartilage. This has clinical implications for TMJ ankylosis management and preventing heterotopic bone formation around prosthetic joints.
研究了切除髁突后腹部真皮-脂肪移植物在颞下颌关节（TMJ）中的组织学命运。21 只兔子接受了左侧 TMJ 关节切开术和髁突切除术；6 只为对照组（A 组；未使用移植物）；15 只（B 组）有自体腹部移植物移植到左侧 TMJ。动物在 4、12 和 20 周后被处死。对 TMJ 标本进行组织学和组织形态计量学评估。在 4 周时，所有标本均可见明显的脂肪坏死。真皮成分存活并形成无坏死的囊肿。12 周时，可见有活力的脂肪沉积，无坏死脂肪的证据。20 周时，B 组标本中有大量有活力的脂肪。A 组没有脂肪，尽管缺失的髁突再生了。在有活力的脂肪存在的情况下，B 组在髁突切除后 20 周时显示出很少的髁突再生。非血管化的脂肪移植物不能在移植后存活，但会刺激新脂肪生成。移植物真皮成分的命运与脂肪成分无关。关节腔内的脂肪会破坏新髁突头的再生。新骨和软骨的生长受到抑制。这对 TMJ 强直症的管理和预防假体关节周围异位骨形成具有临床意义。
