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[颞下颌关节镜下盘固定术对青少年髁突生长的影响:一项回顾性队列研究]

[Impact of temporomandibular joint arthroscopic discopexy on condylar growth in adolescents: a retrospective cohort study].

作者信息

Yuan M, Shen P, Yang C

机构信息

Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai 200011, China.

出版信息

Zhonghua Kou Qiang Yi Xue Za Zhi. 2021 Feb 9;56(2):158-163. doi: 10.3760/cma.j.cn112144-20200718-00427.

Abstract

To compare changes of condylar height, disc length and displaced distance in adolescent temporomandibular joint (TMJ) disc displacement with or without arthroscopic discopexy. From September 2015 to November 2018, adolescents with magnetic resonance image (MRI) comfirmed disc displacement without reduction (DDwoR) were recruited in operation group (OG) and control group (CG) and were classified into five subgroups according to age (11-14 years, 15-16 years, 17-18 years, 19-20 years and 21-24 years). Changes of condylar height, disc length and displaced distance were measured before and after follow-up MRI. Student's test, Welch's test, Mann-Whitney test, Wilcoxon signed-rank test, One-way ANOVA and Kruskal-Wallis test were used; -value less than 0.05 was considered statistically significant. One hundred and seventy two patients were recruited in the present study. One hundred and twenty six cases patients (183 joints, 17 males, 109 females, mean age 17.4±3.0 years) were in OG and 119 patients (175 joints, 20 male, 99 females, mean age 17.1±3.1) in CG. The mean follow-up time were 8.4 (2.7-22.0) and 9.5 (3.0-22.1) months respectively. Average condylar height changes of OG were significantly greater than CG (1.3±1.8 mm -0.6±1.5 mm, 0.001) and differences were also seen in each age group (0.001). In terms of age variations, average increase of condylar height in OG were (2.4±2.2) mm, (1.3±1.7) mm, (1.6±1.7) mm, (0.8±1.9) mm, (0.4±1.1) mm respectively (0.001), differences were observed between 11-14 years 19-20 years (<0.05), 11-14 years 21-24 years (<0.01) and 17-18 years 21-24 years (<0.01) subgroups; and average changes in CG were (-0.7±1.6) mm, (-0.4±1.6) mm, (-0.8±1.5) mm, (-0.3±1.4) mm and (-0.9±1.5) mm respectively (0.05). After follow-up in CG, further displaced disc was observed (0.05) while disc length remained unchanged (0.05). DDwoR in adolescents resulted in decreased TMJ condylar height while arthroscopic discopexy restored growth potential and promoted condylar new bone formation which was most prominent during growth period.

摘要

比较青少年颞下颌关节(TMJ)盘移位伴或不伴关节镜下盘固定术时髁突高度、盘长度及移位距离的变化。2015年9月至2018年11月,将磁共振成像(MRI)证实为不可复性盘移位(DDwoR)的青少年纳入手术组(OG)和对照组(CG),并根据年龄分为五个亚组(11 - 14岁、15 - 16岁、17 - 18岁、19 - 20岁和21 - 24岁)。在随访MRI前后测量髁突高度、盘长度及移位距离的变化。采用学生检验、韦尔奇检验、曼 - 惠特尼检验、威尔科克森符号秩检验、单因素方差分析和克鲁斯卡尔 - 沃利斯检验;P值小于0.05被认为具有统计学意义。本研究共纳入172例患者。手术组有126例患者(183个关节,男性17例,女性109例,平均年龄17.4±3.0岁),对照组有119例患者(175个关节,男性20例,女性99例,平均年龄17.1±3.1岁)。平均随访时间分别为8.4(2.7 - 22.0)个月和9.5(3.0 - 22.1)个月。手术组髁突高度的平均变化显著大于对照组(1.3±1.8mm对 - 0.6±1.5mm,P = <0.001),且各年龄组也存在差异(P = <0.001)。在年龄差异方面,手术组髁突高度的平均增加分别为(2.4±2.2)mm、(1.3±1.7)mm、(1.6±1.7)mm、(0.8±1.9)mm、(0.4±1.1)mm(P = <0.001),在11 - 14岁与19 - 20岁(P<0.05)、11 - 14岁与21 - 24岁(P<0.01)以及17 - 18岁与21 - 24岁(P<0.01)亚组间观察到差异;对照组的平均变化分别为( - 0.7±1.6)mm、( - 0.4±1.6)mm、( - 0.8±1.5)mm、( - 0.3±1.4)mm和( - 0.9±1.5)mm(P>0.05)。对照组随访后观察到盘进一步移位(P = <0.05),而盘长度保持不变(P>0.05)。青少年不可复性盘移位导致颞下颌关节髁突高度降低,而关节镜下盘固定术恢复了生长潜力并促进了髁突新骨形成,这在生长期最为显著。

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