Tripathi Richik, Sharma Naresh, Dwivedi Amit Nandan, Kumar Sanjeev
Service Senior Resident, Oral Maxillofacial Surgery Division, Faculty of Dental Sciences, Institute of Medical Science, Banaras Hindu University, Varanasi, India.
Professor, Oral Maxillofacial Surgery Division, Faculty of Dental Sciences, Institute of Medical Science, Banaras Hindu University, Varanasi, India.
J Oral Maxillofac Surg. 2015 Dec;73(12):2379.e1-7. doi: 10.1016/j.joms.2015.09.003. Epub 2015 Sep 21.
This study aimed to quantify articular soft tissue injury in condylar fractures based on magnetic resonance imaging (MRI) findings and investigate the impact of severity of articular soft tissue injury on the development of postoperative complications after functional reduction of a condylar fracture.
Fifty-four patients 18 to 60 years old with unilateral undisplaced, deviated, or displaced condylar fractures were included in this prospective study. Articular soft tissue within the temporomandibular joint (TMJ) was evaluated using MRI within 7 days after the condylar fracture. Based on MRI findings, such injuries were classified as grade I (hemarthrosis only), grade II (hemarthrosis and disc displacement), grade III (hemarthrosis, disc displacement, and capsular tear), or grade IV (disc perforation in association with grade I, II, or III). All condylar fractures were treated conservatively using a standardized functional reduction method and patients were followed for 1 year.
In 37 of 54 TMJs, MRI diagnosis of disc displacement was established, and capsular tear was observed in 12 joints and hemarthrosis was present in 42 joints. Disc perforation was present in only 5 cases. Patients with hemarthrosis alone (grade I) had the best outcome after functional reduction, whereas patients with hemarthrosis and disc displacement (grade II) had comparatively poorer results. Fifty percent of patients with grade II injury and 66.6% of patients with associated capsular tear (grade III) had limited mouth opening and restricted movement at the end of the follow-up period. One hundred percent of patients with disc perforation (grade IV) had restricted joint movement and joint noise.
Results suggest that serious injury to the articular disc and capsule of the TMJ is a major contributing factor toward the development of complications after closed reduction of a condylar fracture.
本研究旨在基于磁共振成像（MRI）结果对髁突骨折的关节软组织损伤进行量化，并探讨关节软组织损伤严重程度对髁突骨折功能复位术后并发症发生的影响。
本前瞻性研究纳入了54例年龄在18至60岁之间的单侧无移位、偏斜或移位髁突骨折患者。在髁突骨折后7天内，使用MRI对颞下颌关节（TMJ）内的关节软组织进行评估。根据MRI结果，此类损伤分为I级（仅关节积血）、II级（关节积血和盘移位）、III级（关节积血、盘移位和关节囊撕裂）或IV级（与I级、II级或III级相关的盘穿孔）。所有髁突骨折均采用标准化功能复位方法进行保守治疗，并对患者进行了1年的随访。
在54个TMJ中的37个中，通过MRI确诊了盘移位，在12个关节中观察到关节囊撕裂，42个关节存在关节积血。仅5例存在盘穿孔。单纯关节积血（I级）的患者在功能复位后预后最佳，而关节积血和盘移位（II级）的患者结果相对较差。在随访期末，50%的II级损伤患者和66.6%的伴有关节囊撕裂（III级）的患者张口受限且活动受限。100%的盘穿孔（IV级）患者存在关节活动受限和关节弹响。
结果表明，TMJ关节盘和关节囊的严重损伤是髁突骨折闭合复位后并发症发生的主要促成因素。
