Liu Meng, He Yang, Lei Jie, Zhao Yuming, An Jingang, Zhang Yi
Resident, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China.
Associate Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China.
J Oral Maxillofac Surg. 2019 Dec;77(12):2503-2511. doi: 10.1016/j.joms.2019.07.003. Epub 2019 Jul 16.
An intra-articular injury in growing patients should be well understood because it can interfere with normal temporomandibular joint (TMJ) function and even mandibular growth. The present study evaluated TMJ soft tissue injury after acute nondislocated and dislocated intracapsular condylar fractures (ICFs) in children.
In the present cross-sectional study, we enrolled a sample of children younger than 12 years old with acute ICFs. The predictor variable was the position of the ICF in relationship to the articular fossa, grouped as nondislocated and dislocated. The primary outcome variable was the injury type, including anterior displacement and deformity of the disc, joint effusion, and retrodiscal attachment tear. The second outcome variable was the injury score classified according to the injury type. Other study variables included age, gender, laterality, and the presence of concomitant fractures. The data were analyzed using the χ test and logistic regression analysis. P values < .05 were considered to indicate statistical significance.
A total of 44 children with 63 ICFs were included, of which 28 and 35 were nondislocated and dislocated fractures, respectively. Of the 63 ICFs, 56 (88.9%) had anterior disc displacement, 2 (3.2%) had disc deformity, 59 (93.7%) had joint effusion, and 11 (17.5%) had a retrodiscal attachment tear. According to the injury type, 4 joints were given a score of as 0, 3 a score of 1, 45 a score of 2, and 11 a score of 3. The injury type and score were significantly associated with fracture dislocation (P < .05).
In children with ICF, the presence of a retrodiscal attachment tear and disc deformity were less frequent. The type and severity of the soft tissue injury were associated with fracture dislocation. Additional studies are warranted to evaluate how soft tissue injuries affect TMJ function and fracture healing.
生长发育期患者的关节内损伤应得到充分了解，因为它可能会干扰颞下颌关节（TMJ）的正常功能，甚至影响下颌骨生长。本研究评估了儿童急性非脱位和脱位型囊内髁突骨折（ICF）后的颞下颌关节软组织损伤情况。
在本横断面研究中，我们纳入了12岁以下患有急性ICF的儿童样本。预测变量是ICF相对于关节窝的位置，分为非脱位型和脱位型。主要结局变量是损伤类型，包括盘前移位和变形、关节积液以及盘后附着撕裂。第二个结局变量是根据损伤类型分类的损伤评分。其他研究变量包括年龄、性别、患侧以及是否存在合并骨折。数据采用χ检验和逻辑回归分析。P值<0.05被认为具有统计学意义。
共纳入44例患有63处ICF的儿童，其中非脱位骨折28例，脱位骨折35例。在63处ICF中，56处（88.9%）有盘前移位，2处（3.2%）有盘变形，59处（93.7%）有关节积液，11处（17.5%）有盘后附着撕裂。根据损伤类型，4个关节评分为0分，3个关节评分为1分，45个关节评分为2分，11个关节评分为3分。损伤类型和评分与骨折脱位显著相关（P<0.05）。
在患有ICF的儿童中，盘后附着撕裂和盘变形的情况较少见。软组织损伤的类型和严重程度与骨折脱位有关。有必要进行更多研究以评估软组织损伤如何影响颞下颌关节功能和骨折愈合。
