Wolford Larry M, Mercuri Louis G, Schneiderman Emet D, Movahed Reza, Allen Will
Clinical Professor, Departments of Oral and Maxillofacial Surgery and Orthodontics, Texas A&M University Health Science Center, Baylor College of Dentistry, Dallas; Private Practice, Baylor University Medical Center, Dallas, TX.
Visiting Professor, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL; Clinical Consultant, TMJ Concepts, Ventura, CA.
J Oral Maxillofac Surg. 2015 May;73(5):952-60. doi: 10.1016/j.joms.2014.10.032. Epub 2014 Nov 14.
To evaluate subjective and objective outcomes of patients receiving Techmedica (currently TMJ Concepts) patient-fitted temporomandibular joint (TMJ) total joint replacement (TJR) devices after 19 to 24 years of service.
This prospective cohort study evaluated 111 patients operated on by 2 surgeons using Techmedica (Camarillo, CA) patient-fitted TMJ TJR devices from November 1989 to July 1993. Patients were evaluated before surgery and at least 19 years after surgery. Subjective evaluations used standard forms and questions with a Likert scale for 1) TMJ pain (0, no pain; 10, worst pain imaginable), 2) jaw function (0, normal function; 10, no movement), 3) diet (0, no restriction; 10, liquid only), and 4) quality of life (QoL; improved, the same, or worse). Objective assessment measured maximum incisal opening (MIO). Comparison analysis of presurgical and longest follow-up data used nonparametric Mann-Whitney and Wilcoxon signed rank tests. Spearman correlations evaluated the number of prior surgeries in relation to objective and subjective variables.
Of the 111 patients, 56 (50.5%) could be contacted and had adequate records for inclusion in the study. Median follow-up was 21 years (interquartile range [IQR], 20 to 22 yr). Mean age at surgery was 38.6 years (standard deviation, 10 yr). Median number of previous TMJ surgeries was 3 (IQR, 4). Presurgical and longest follow-up data comparison showed statistically significant improvement (P < .001) for MIO, TMJ pain, jaw function, and diet. At longest follow-up, 48 patients reported improved QoL, 6 patients reported the same QoL, and 2 patients reported worse QoL. Spearman correlations showed that an increased number of previous surgeries resulted in lower levels of improvement for TMJ pain and MIO.
At a median of 21 years after surgery, the Techmedica/TMJ Concepts TJR continued to function well. More previous TMJ surgeries indicated a lesser degree of improvement. No devices were removed owing to material wear.
评估使用Techmedica（现为TMJ Concepts）患者适配型颞下颌关节（TMJ）全关节置换（TJR）装置19至24年后患者的主观和客观结果。
这项前瞻性队列研究评估了1989年11月至1993年7月期间由2名外科医生使用Techmedica（加利福尼亚州卡马里奥）患者适配型TMJ TJR装置进行手术的111例患者。在手术前和手术后至少19年对患者进行评估。主观评估使用标准表格和问题，采用李克特量表评估1）TMJ疼痛（0，无疼痛；10，可想象的最严重疼痛），2）下颌功能（0，正常功能；10，无活动），3）饮食（0，无限制；10，仅流食），以及4）生活质量（QoL；改善、相同或恶化）。客观评估测量最大切牙开口度（MIO）。术前和最长随访数据的比较分析使用非参数曼 - 惠特尼检验和威尔科克森符号秩检验。Spearman相关性评估既往手术次数与客观和主观变量的关系。
111例患者中，56例（50.5%）能够取得联系且有足够记录纳入研究。中位随访时间为21年（四分位间距[IQR]，20至22年）。手术时的平均年龄为38.6岁（标准差，10岁）。既往TMJ手术的中位次数为3次（IQR，4次）。术前和最长随访数据比较显示，MIO、TMJ疼痛、下颌功能和饮食方面有统计学显著改善（P <.001）。在最长随访时，48例患者报告生活质量改善，6例患者报告生活质量相同，2例患者报告生活质量恶化。Spearman相关性显示，既往手术次数增加导致TMJ疼痛和MIO的改善程度降低。
术后中位21年时，Techmedica/TMJ Concepts TJR仍功能良好。既往TMJ手术次数越多，改善程度越小。未因材料磨损而取出任何装置。
