Xiang Guo-lin, Long Xing, Deng Mo-hong, Han Qian-chao, Meng Qing-gong, Li Bo
Department of Oral and Maxillofacial Surgery, Puai Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hanzheng Street 473, Wuhan 430033, PR China; The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine, Ministry of Education, Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wuhan University, Luoyu Road 237, Wuhan 430079, PR China.
The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine, Ministry of Education, Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wuhan University, Luoyu Road 237, Wuhan 430079, PR China.
Br J Oral Maxillofac Surg. 2014 Mar;52(3):270-4. doi: 10.1016/j.bjoms.2014.01.002. Epub 2014 Jan 30.
We investigated the incidence of ankylosis of the temporomandibular joint (TMJ) after open operations for fractures of the mandibular condyle, and analysed possible risk factors in a total of 385 patients with 492 condylar fractures who had been operated on in our department from 2001 to 2010. Sixteen patients developed postoperative ankylosis of the TMJ with 26 joints (5%) affected during a follow-up of 6 months-10 years. Of the 492 condylar fractures, the most common ones that were associated with postoperative ankylosis were those of the condylar head (20/248), followed by the condylar neck (6/193). Subcondylar fractures did not cause postoperative ankylosis (0/51). Among the 16 patients with postoperative ankylosis, 13 had associated anterior mandibular fractures. Long-screw (bicortical screw) fixation of fractures of the condylar head seemed to be associated with a lower incidence of postoperative ankylosis than fixation by miniplate and wire or removal of the fractured fragment. The articular discs were damaged in all ankylosed joints, and the remaining fractured fragment was found in 10 ankylosed joints after fractures of the condylar head. The results suggest that fractures of the condylar head are more prone to lead to postoperative ankylosis of the TMJ, and that the possible risk factors seem to include the technique used for fixation and damage to the disc, together with an anterior mandibular fracture with the fractured fragment remaining.
我们调查了下颌骨髁突骨折开放手术后颞下颌关节（TMJ）强直的发生率，并分析了2001年至2010年在我科接受手术的385例患者共492处髁突骨折的可能危险因素。16例患者出现TMJ术后强直，在6个月至10年的随访期间，26个关节（5%）受累。在492处髁突骨折中，与术后强直相关最常见的骨折类型是髁突头部骨折（20/248），其次是髁突颈部骨折（6/193）。髁突下骨折未导致术后强直（0/51）。在16例术后强直患者中，13例伴有下颌骨前部骨折。与微型钢板和钢丝固定或骨折碎片去除相比，髁突头部骨折采用长螺钉（双皮质螺钉）固定似乎术后强直发生率较低。所有强直关节的关节盘均受损，髁突头部骨折后，10个强直关节发现有残留骨折碎片。结果表明，髁突头部骨折更易导致TMJ术后强直，可能的危险因素似乎包括固定技术、关节盘损伤以及伴有残留骨折碎片的下颌骨前部骨折。
