Perez Daniel E, Wolford Larry M, Schneiderman Emet, Movahed Reza, Bourland Campbell, Gutierrez Enrique Perez
Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Texas, Health Science Center San Antonio, San Antonio, TX.
Clinical Professor, Departments of Oral and Maxillofacial Surgery and Orthodontics, Texas A&M University Baylor College of Dentistry; Private Practice, Baylor University Medical Center, Dallas, TX.
J Oral Maxillofac Surg. 2016 Aug;74(8):1539-47. doi: 10.1016/j.joms.2016.02.009. Epub 2016 Feb 23.
The purpose of this study was to evaluate patients requiring unilateral total temporomandibular joint (TMJ) reconstruction and the risk for development of postsurgical contralateral TMJ pain and dysfunction over time requiring subsequent contralateral total joint reconstruction. Long-term subjective and objective outcomes of unilateral TMJ reconstruction also were evaluated.
Seventy patients underwent unilateral total joint reconstruction using a patient-fitted total joint prosthesis from a single private practice from 1990 through 2012. The inclusion criteria were 1) unilateral TMJ reconstruction with TMJ Concepts or Techmedica patient-fitted total joint prosthesis; 2) operation performed by 1 surgeon (L.M.W.); 3) minimum 12-month follow-up; and 4) adequate records. There were no specific exclusion criteria. The primary outcome variable was to evaluate the effects of unilateral TMJ reconstruction with a total joint prosthesis on the contralateral TMJ relative to development of pain and dysfunction requiring subsequent contralateral reconstruction with a total joint prosthesis. Secondary outcome variables for all patients included TMJ pain, facial pain, headaches, diet, disability, quality of life, maximum incisal opening (MIO), and lateral excursion movements after unilateral TMJ reconstruction with the patient-fitted total joint prosthesis. Student t test and Wilcoxon test were used for statistical analyses, with a P value less than .01 for statistical significance.
Sixty-one of 70 patients (87%) met the inclusion criteria (47 women [77%] and 14 men [23%]; average age, 38 yr; age range, 11 to 69 yr; average follow-up, 44 months; range, 12 to 215 months). Eight of 61 patients (13%) subsequently required contralateral TMJ reconstruction with a total joint prosthesis related to contralateral pain, dysfunction, and arthritis, but all 8 (8 of 27 [29.6%]) had previous contralateral TMJ disc repositioning surgery. For the secondary outcomes, TMJ pain decreased 63%, jaw function improved 61%, facial pain decreased 59%, headaches decreased 57%, diet improved 52%, disability decreased 58.5%, and MIO increased from 31.4 to 38.8 mm (mean change, 7.4 mm). All subjective factors and MIO showed statistically significant improvements at longest follow-up (P < .01).
Patients requiring unilateral TMJ reconstruction with a patient-fitted total joint prosthesis have a strong probability of improving their clinical condition and do not require bilateral reconstruction if the contralateral TMJ is healthy. Patients with previous or concomitant contralateral TMJ surgery (articular disc repositioning) have an approximately 30% chance of requiring a total joint prosthesis in the future.
本研究旨在评估需要单侧全颞下颌关节（TMJ）重建的患者，以及随着时间推移出现术后对侧TMJ疼痛和功能障碍并需要随后进行对侧全关节重建的风险。还评估了单侧TMJ重建的长期主观和客观结果。
1990年至2012年期间，70例患者在一家私人诊所使用定制的全关节假体进行了单侧全关节重建。纳入标准为：1）使用TMJ Concepts或Techmedica定制全关节假体进行单侧TMJ重建；2）由1名外科医生（L.M.W.）实施手术；3）至少随访12个月；4）记录完整。无特定排除标准。主要结局变量是评估使用全关节假体进行单侧TMJ重建对对侧TMJ的影响，相对于出现疼痛和功能障碍并需要随后使用全关节假体进行对侧重建的情况。所有患者的次要结局变量包括TMJ疼痛、面部疼痛、头痛、饮食、残疾程度、生活质量、最大切牙开口度（MIO）以及使用定制全关节假体进行单侧TMJ重建后的侧向运动。采用学生t检验和Wilcoxon检验进行统计分析，P值小于0.01具有统计学意义。
70例患者中有61例（87%）符合纳入标准（47例女性[77%]，14例男性[23%]；平均年龄38岁；年龄范围11至69岁；平均随访44个月；范围12至215个月）。61例患者中有8例（13%）随后因对侧疼痛、功能障碍和关节炎需要使用全关节假体进行对侧TMJ重建，但所有8例（27例中的8例[29.6%]）之前都进行过对侧TMJ盘复位手术。对于次要结局，TMJ疼痛减轻了63%，下颌功能改善了61%，面部疼痛减轻了59%，头痛减轻了57%，饮食改善了52%，残疾程度降低了58.5%，MIO从31.4毫米增加到38.8毫米（平均变化7.4毫米）。所有主观因素和MIO在最长随访时均显示出统计学上的显著改善（P < 0.01）。
需要使用定制全关节假体进行单侧TMJ重建的患者临床状况有很大概率得到改善，如果对侧TMJ健康则无需进行双侧重建。之前或同时进行过对侧TMJ手术（关节盘复位）的患者未来有大约30%的几率需要全关节假体。
