Eriksson L, Westesson P L
Swed Dent J. 1987;11(1-2):1-9.
There have been divergent opinions about the prognosis of temporomandibular joint diskectomy. Therefore we have retrospectively evaluated all diskectomies performed in Sweden during the period from 1965 to 1985. Eighty-seven patients had been operated upon with this technique and 69, with a follow-up time of 6 months or longer (median 20 months), were analyzed. The median of maximal opening increased and 74% of the patients had less frequent and less intensive pain at the follow-up examination than before surgery. The overall results of the operations were good in 51% of the patients (none or mild pain and opening greater than or equal to 35 mm and horizontal movements greater than or equal to 5 mm), acceptable in 22% of the patients (none or mild pain and opening greater than or equal to 30 mm) and bad in 28% of the patients (severe pain or opening less than 30 mm). The preoperative pain was found to be more diffuse in the patients with bad postoperative results than in the patients with good and acceptable results. This emphasizes the importance of avoiding operating on patients with sources of pain and functional limitation other than the temporomandibular joint proper. The operation should be used restrictively and only on accurately diagnosed patients with severe pain and functional limitation that originate in the joint and have not been alleviated by adequate nonsurgical treatment. The risk of residual pain or limitation of opening should be included in the preoperative evaluation.
关于颞下颌关节盘切除术的预后存在不同观点。因此，我们对1965年至1985年期间在瑞典进行的所有盘切除术进行了回顾性评估。87例患者接受了该手术，对其中69例随访时间达6个月或更长（中位时间20个月）的患者进行了分析。随访时，患者最大开口度的中位数增加，74%的患者疼痛发作频率降低且程度减轻。51%的患者手术总体效果良好（无疼痛或轻度疼痛，开口度大于或等于35毫米，水平移动大于或等于5毫米），22%的患者效果尚可（无疼痛或轻度疼痛，开口度大于或等于30毫米），28%的患者效果不佳（重度疼痛或开口度小于30毫米）。发现术后效果不佳的患者术前疼痛比效果良好和尚可的患者更弥散。这强调了避免对除颞下颌关节本身外存在疼痛源和功能受限的患者进行手术的重要性。该手术应谨慎使用，仅用于经准确诊断、患有源于关节的重度疼痛和功能受限且经充分非手术治疗未缓解的患者。术前评估应考虑残留疼痛或开口受限的风险。
