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[治疗方法]稳定咬合夹板联合或不联合关节镜下盘复位对青少年患者髁突骨重塑的影响。

Effect of occlusal stabilisation splint with or without arthroscopic disc repositioning on condylar bone remodelling in adolescent patients.

机构信息

Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, Zhejiang, China.

The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China.

出版信息

Int J Oral Maxillofac Surg. 2024 Feb;53(2):156-164. doi: 10.1016/j.ijom.2023.06.005. Epub 2023 Jun 24.

Abstract

The aim of this study was to investigate the treatment effects of a stabilisation splint (SS) with and without arthroscopic disc repositioning (ADR) on condylar bone remodelling in adolescent patients with anterior disc displacement without reduction (ADDwoR). Cone beam computed tomography and magnetic resonance imaging were used to analyse condylar bone remodelling, condyle position, and disc position. Twenty-two temporomandibular joints of 14 patients who underwent ADR (age range 12-20 years; mean follow-up 12.5 ± 7.8 months) and 21 temporomandibular joints of 14 patients who did not undergo ADR (age range 13-20 years; mean follow-up 11.1 ± 5.1 months) were included. The change in bone volume (P < 0.001), rate of bone volume change (P < 0.001), and change in condyle height (P = 0.031) were significantly greater in patients with ADR than in those without ADR. The changes in posterior joint space (P = 0.013), superior joint space (P = 0.020), and ratio of condyle sagittal position (P = 0.013) were significantly greater in patients with ADR than in those without ADR. All discs in patients who underwent ADR and one disc in those who did not undergo ADR were backward repositioned. In conclusion, in adolescent patients with ADDwoR, ADR with SS therapy achieved better condyle and disc position than SS therapy alone, and also induced bone generation.

摘要

本研究旨在探讨稳定夹板(SS)联合与不联合关节镜下盘复位(ADR)治疗对无复位的前盘移位(ADDwoR)青少年患者髁状骨重塑的治疗效果。采用锥形束 CT 和磁共振成像分析髁状骨重塑、髁突位置和盘位置。纳入 14 例患者的 22 个颞下颌关节接受了 ADR(年龄 12-20 岁;平均随访 12.5±7.8 个月),以及 14 例患者的 21 个颞下颌关节未接受 ADR(年龄 13-20 岁;平均随访 11.1±5.1 个月)。接受 ADR 的患者的骨量变化(P<0.001)、骨量变化率(P<0.001)和髁突高度变化(P=0.031)明显大于未接受 ADR 的患者。接受 ADR 的患者的后关节间隙变化(P=0.013)、上关节间隙变化(P=0.020)和髁突矢状位置比变化(P=0.013)明显大于未接受 ADR 的患者。接受 ADR 的患者所有的盘均向后复位,未接受 ADR 的患者中有一个盘向后复位。总之,在 ADDwoR 的青少年患者中,SS 联合 ADR 治疗比单独 SS 治疗获得更好的髁突和盘位置,并诱导骨生成。

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