牵张成骨序列治疗颞下颌关节强直及继发畸形

摘要

目的:回顾我院应用牵张成骨序列治疗颞下颌关节强直及继发颌面部畸形的效果.方法:40例关节强直患者,平均年龄24.5岁(9～53岁),其中单侧强直11例,双侧29例,伴发OSAHS者27例.所有患者一期手术牵张成骨,二期手术拆除牵张器并同期行颞下颌关节成形术,同期或三期行正颌手术改善面部外形.通过术前术后最大张口度、面型及打鼾症状改善情况评估治疗效果.结果:关节成形术后40例患者张口度基本恢复正常,面型均得到显著改善,打鼾症状全部消失.经过4～72个月(平均20.5个月)的随访,4例患者关节强直复发.结论:应用一期牵张成骨二期关节成形治疗颞下颌关节强直及继发畸形能够精确控制面型和气道的改变.%[Abstact] Objective:To evaluate the effects of the treatment of temporomandibular joint ankylosis (TJA) with secondary deformities by sequential treatment including distraction osteogenesis.Methods:40 patients aged 9 to 53 years old(average 24.5) with TJA were retrospectively analysed.11 patients were with unilateral and 29 with bilateral TJA.27 patients were companied with OSAHS.All patients underwent distraction osteogenesis as the initial surgery,followed by arthroplasty.The orthognathic treatment was performed along with or after the arthroplasty.The therapeutic effects were evaluated by the improvement of maximum mouth opening,face profile and snoring.Results:After the treatment procedure was ended,the mouth opening and face profile of all patients were improved remarkably,and the snoring disappeared.The patients were followed up for 4 to 72 months (average 20.5 months),the joint ankylosis recurrence was found in 4 patients.Conclusion:Treatment of TJA with secondary deformities by the sequential treatment including distraction osteogenesis,arthroplasty and orthognathic surgery can improve the face profile and airway accurately.