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使用定制假体进行颞下颌关节置换的临床分析

Clinical Analysis of TMJ Replacement Using a Customized Prosthesis.

作者信息

Olate Sergio, Ravelo Víctor, Muñoz Gonzalo, Gaete Carlos, Goya Rodrigo, Valente Rômulo

机构信息

Center for Research in Morphology and Surgery (CEMyQ), Universidad de La Frontera, Temuco 4780000, Chile.

Department of Oral Diagnosis, Division of Oral and Maxillofacial Surgery, State University of Campinas, Piracicaba 13414-903, SP, Brazil.

出版信息

J Clin Med. 2025 Jul 28;14(15):5314. doi: 10.3390/jcm14155314.

Abstract

This study aims to uncover the variables related to the success of the intervention. A retrospective study was conducted on patients who underwent joint replacement surgery utilizing a customized alloplastic system between 2018 and 2023, comprising subjects with complete records for both the planning and follow-up phases. The Student's -test was applied with a significance threshold of < 0.05. Forty-eight subjects were admitted for initial analysis, and 31 subjects were evaluated with a minimum follow-up of 1 year and a maximum of 7 years, with a mean age of 36.37 ± 15.53. The TMJ diagnosis was mainly with degenerative TMJ disease, followed by ankylosis and craniofacial syndromes, and an average of 2.1 ± 1.2 previous surgeries were noted. Degenerative joint disease correlated with increased pain ( < 0.0001) and a higher prevalence of prior joint surgery ( < 0.0001). Thirty-one subjects were followed up with 47 prostheses installed; 74.4% underwent complementary surgery with other facial osteotomies. Significant improvements ( < 0.0001) were observed when comparing pain levels pre- and postoperatively, with a decrease from 5.5 (±2.3) to 2.2 (±0.4). Concerning the interincisal opening, there was a significant increase ( < 0001) from 25.85 (±10.2) mm to 35.93 (±4.2) mm in mouth opening. TMJ replacement treatment is efficient and effective, demonstrating stability in follow-up assessments for up to 7 years. The indications for replacement are diverse and may benefit patients who have not yet progressed to end-stage TMJ disease.

摘要

本研究旨在揭示与干预成功相关的变量。对2018年至2023年间使用定制异体塑料系统进行关节置换手术的患者进行了一项回顾性研究,纳入了计划和随访阶段记录完整的受试者。采用Student's检验,显著性阈值设定为<0.05。48名受试者被纳入初始分析,31名受试者接受了评估,随访时间最短1年,最长7年,平均年龄为36.37±15.53岁。颞下颌关节诊断主要为退行性颞下颌关节疾病,其次是关节强直和颅面综合征,平均有2.1±1.2次既往手术史。退行性关节疾病与疼痛增加(<0.0001)和既往关节手术患病率较高(<0.0001)相关。31名受试者接受了随访,共安装了47个假体;74.4%的患者接受了其他面部截骨的补充手术。比较术前和术后疼痛水平时观察到显著改善(<0.0001),疼痛从5.5(±2.3)降至2.2(±0.4)。关于切牙间开口,开口度从25.85(±10.2)mm显著增加(<0.0001)至35.93(±4.2)mm。颞下颌关节置换治疗有效,在长达7年的随访评估中显示出稳定性。置换的适应症多种多样,可能使尚未发展到终末期颞下颌关节疾病的患者受益。

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