Kirk W S
Cranio. 1998 Jul;16(3):154-61. doi: 10.1080/08869634.1998.11746053.
Studies exist which support the efficacy of TM joint arthrotomy, arthroplasty and arthroscopic surgery. Few, if any, studies have evaluated failures of arthroplasty and/or diskectomy and specific risk factors that might invite initial surgical failure. This paper is a retrospective review of 210 patients operated with arthrotomy/arthroplasty for painful and dysfunctional TM joint derangement. There were 303 surgical procedures evaluated over a follow-up period of 4-9 years. Patient ages ranged from 16-72 years. There was no age correlation seen with degree of joint derangement. All cases were operated by one surgeon. There were no cases of alloplastic materials in this group of patients. There were no cases of autograph such as auricular cartilage for dermal grafting or other disc substitution materials. Operations consisted of capsular arthroplasty in Wilkes' stage II, III, and IV. Diskectomy was performed in Wilkes' stages IV and V. Comparisons are made among staged groups and operation performed. Two hundred seventy-three of 303 operated joints met the criteria for surgical success for a technical success rate of 90.1%. Potential risk factors of missing molar teeth, preoperative joint collapse, and skeletal malocclusion were evaluated. The frequency of their presence in successful and non-successful surgical outcomes is noted. Patients with imaging confirmed osteoporosis were evaluated as group with potential systemic disease or a result of systemic disease that may influence long term surgical outcome. Predictable preoperative risk factors that may influence initial surgical outcome do appear to be significant in long term success. There were 30 cases of failure to evaluate. It is concluded that reconstructive arthroplasty is a stage specific operation with excellent results in Wilkes' stage II and good results in stage III derangement. Attempted arthroplasty failed significantly (50%) in a small number of attempts in stage IV cases. However, diskectomy was successful in stage IV and V cases. Osteoporosis may be the most significant risk factor and the presence of risk factors studied may jeopardize initial surgical outcomes. Preoperative staging of joint derangement is strongly suggested and evaluation of risk factors may necessitate selection of specific initial surgical procedures that minimize the influence of concomitant risk factors to long term success.
已有研究支持颞下颌关节切开术、关节成形术和关节镜手术的疗效。但几乎没有研究评估关节成形术和/或椎间盘切除术的失败情况以及可能导致初次手术失败的特定风险因素。本文对210例因疼痛和功能障碍性颞下颌关节紊乱而行切开术/关节成形术的患者进行了回顾性研究。在4至9年的随访期内共评估了303例手术。患者年龄在16至72岁之间。未发现年龄与关节紊乱程度之间存在相关性。所有病例均由一名外科医生实施手术。该组患者中未使用异体材料。也没有使用如耳软骨进行真皮移植或其他椎间盘替代材料的自体移植病例。手术包括威尔克斯II期、III期和IV期的关节囊成形术。威尔克斯IV期和V期行椎间盘切除术。对分期组和所施行的手术进行了比较。303例手术关节中有273例达到手术成功标准，技术成功率为90.1%。评估了缺失磨牙、术前关节塌陷和骨骼错合等潜在风险因素。记录了它们在成功和不成功手术结果中的出现频率。影像学证实患有骨质疏松症的患者被评估为可能患有潜在全身性疾病或作为可能影响长期手术结果的全身性疾病结果的一组。可能影响初次手术结果的可预测术前风险因素在长期成功中似乎确实具有重要意义。有30例未进行评估。得出的结论是，重建性关节成形术是一种分期特定的手术，在威尔克斯II期效果极佳，在III期紊乱中效果良好。在IV期病例中，少数尝试的关节成形术显著失败（50%）。然而，椎间盘切除术在IV期和V期病例中是成功的。骨质疏松症可能是最显著的风险因素，所研究的风险因素的存在可能危及初次手术结果。强烈建议对关节紊乱进行术前分期，对风险因素的评估可能需要选择特定的初次手术程序，以尽量减少伴随风险因素对长期成功的影响。
