Ward Christopher K B, Cheung Johnson, Troost Jonathan P, Aronovich Sharon, Hakim Mohamed A
Former TMJ Surgery Fellow, Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI.
Former TMJ Surgery Fellow, Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI.
J Oral Maxillofac Surg. 2025 May;83(5):510-527. doi: 10.1016/j.joms.2025.02.004. Epub 2025 Feb 17.
Temporomandibular joint intra-articular pain and dysfunction (IPD) can arise from abnormal disc position. Arthroscopic double-suture discopexy (A-DSD) aims to restore disc position, but the association between disc position and patient-reported pain and quality of life (QoL) is unclear.
This study investigated the relationship between postoperative disc position and subject QoL and pain following A-DSD.
STUDY DESIGN, SETTING, SAMPLE: This retrospective cohort study included subjects at the University of Michigan who required arthroscopy for IPD between November 2020 and July 2023. Eligibility included subjects aged ≥18 to 75 years with Wilkes II-V IPD who underwent A-DSD with preoperative and postoperative magnetic resonance imagings (3 months minimum).
The predictor variable was postoperative magnetic resonance imaging-based disc position: normal (ND), anteriorly displaced with reduction (ADDwR), anteriorly displaced without reduction (ADDwoR), or posteriorly displaced.
MAIN OUTCOME VARIABLE(S): Main outcomes are changes in QoL (Jaw Functional Limitation Scale [JFLS]) and pain (visual analog scale-100) at baseline and ≥3 months post-arthroscopy.
Covariates included demographics, perioperative variables, and arthroscopic findings.
Paired t-tests evaluated changes in perioperative outcomes stratified by postoperative disc position. For analysis of covariates and outcomes, linear regression was applied for JFLS (subject-level analysis); linear mixed-effects models, adjusting for nonindependent observations for bilateral cases, were used for pain (joint-level analysis). Statistical significance was P < .05.
A total of 240 subjects were screened and 37 were included with mean age 33 (±14.3) years and all were female sex (100%). Median follow-up was 9 months (interquartile range, 8 to 12). Postoperative disc positions were ND (70.2%), ADDwR (15.8%), ADDwoR (8.8%), and posteriorly displaced (5.3%). Postoperative disc position was associated with JFLS (P = .026) and pain (P = .0002), with worse outcomes for ADDwR. ND subjects experienced significant decreases in JFLS (36.3 ± 34.6, P < .0001) and pain (28.7 ± 27.8, P < .0001). ADDwoR subjects showed significant reduction in JFLS (47.1 ± 32.0, P = .03), but not pain. ADDwR subjects showed no significant outcome improvements. Subjects with systemic arthropathies (P = .01), closed lock (P = .03), and indirect trauma (P = .03) were associated with worse JFLS.
Postoperative ND and ADDwoR after A-DSD were associated with improved QoL and/or pain reduction, but postoperative ADDwR and the above comorbidities were associated with poorer outcomes.
颞下颌关节关节内疼痛和功能障碍（IPD）可能由盘状软骨位置异常引起。关节镜下双缝盘状软骨固定术（A-DSD）旨在恢复盘状软骨位置，但盘状软骨位置与患者报告的疼痛和生活质量（QoL）之间的关联尚不清楚。
本研究调查了A-DSD术后盘状软骨位置与受试者QoL及疼痛之间的关系。
研究设计、设置、样本：这项回顾性队列研究纳入了2020年11月至2023年7月期间在密歇根大学因IPD需要进行关节镜检查的受试者。纳入标准包括年龄≥18至75岁、患有威尔克斯II-V级IPD且接受了A-DSD并进行了术前和术后磁共振成像（至少3个月）的受试者。
预测变量是基于术后磁共振成像的盘状软骨位置：正常（ND）、前移位伴复位（ADDwR）、前移位未复位（ADDwoR）或后移位。
主要结局是关节镜检查前及术后≥3个月时QoL（下颌功能受限量表[JFLS]）和疼痛（视觉模拟量表-100）的变化。
协变量包括人口统计学、围手术期变量和关节镜检查结果。
配对t检验评估了按术后盘状软骨位置分层的围手术期结局变化。对于协变量和结局分析，JFLS采用线性回归（受试者水平分析）；疼痛采用线性混合效应模型，并对双侧病例的非独立观察进行调整（关节水平分析）。统计学显著性为P <.05。
共筛选出240名受试者，纳入37名，平均年龄33（±14.3）岁，均为女性（100%）。中位随访时间为9个月（四分位间距，8至12个月）。术后盘状软骨位置为ND（70.2%）、ADDwR（15.8%）、ADDwoR（8.8%）和后移位（5.3%）。术后盘状软骨位置与JFLS（P =.026）和疼痛（P =.0002）相关，ADDwR的结局更差。ND受试者的JFLS（36.3 ± 34.6，P <.0001）和疼痛（28.7 ± 27.8，P <.0001）显著降低。ADDwoR受试者的JFLS显著降低（47.1 ± 32.0，P =.03），但疼痛未降低。ADDwR受试者的结局无显著改善。患有全身性关节病（P =.01）、闭锁（P =.03）和间接创伤（P =.03）的受试者JFLS更差。
A-DSD术后的ND和ADDwoR与QoL改善和/或疼痛减轻相关，但术后ADDwR及上述合并症与较差的结局相关。
