Prospective study of modified condylotomy for treatment of nonreducing disk displacement.
Prospective study of modified condylotomy for treatment of nonreducing disk displacement.
复制标题
改良髁切开术治疗非复位椎间盘移位的前瞻性研究。
DOI：
10.1067/moe.2000.102990
复制
发表时间：
2000
期刊：
影响因子：
--
通讯作者：
S. Gibbs
中科院分区：
文献类型：
--
作者：
H. Hall;E. Navarro;S. Gibbs
目的
本研究旨在客观评估改良髁突切开术治疗颞下颌关节疼痛伴非复位盘移位（Wilkes晚期III、IV、V期）的结局。
研究设计
对31例连续患者（43个关节）进行了前瞻性研究。所有患者通过椎间盘成像证实了非还原性椎间盘移位。进行独立评价，以评估疼痛、功能障碍和疾病进展。在改良髁突切开术前和术后1年内进行检查。18例患者（26个关节）完成了所需的检查。在手术后3年，对这18名患者中的15名（23个关节）完成了基于患者的疼痛和饮食评估。
结果
疼痛的视觉模拟量表（VAS）评分（平均值+/- SE）从改良髁突切开术前的7.4 ± 0.4改善到1年后的2.4 ± 0.5（P <0.05）。001）。与III期关节相比，退行性关节病（Wilkes IV、V期）关节的疼痛缓解效果较差（3. 6 +/- 0.9 vs 1.1 +/- 0.4，P = 0.05）和11倍的风险（P <0.05）。04)严重残余疼痛（VAS评分>4）。饮食限制从术前的平均VAS评分5.3 +/- 0.7改善至1年后的7.7 +/- 0.5（P = 0.02）。1年（2.1 +/- 0.5）和3年（2.1 +/- 0.5）时疼痛的平均VAS评分之间以及1年（7.4 +/- 0.6）和3年（8.1 +/- 0.6）时饮食的平均VAS评分之间的微小差异不显著。术前平均最大切缘间开口为36.7 ± 2.0 mm，1年后改善为40.1 ± 2.0 mm（P <0.02）。术前平均对侧移动8.3 ± 0.5 mm，术后1年平均对侧移动8.4 ± 0.6 mm（P > 0.05）。12个Wilkes晚期III关节均未进展为Wilkes IV或V，14个Wilkes IV、V关节均未显示进一步骨吸收的证据。再手术率为4%。5名患者发生轻微并发症，除1名患者外，其余患者均在一年后得到解决。以美国口腔颌面外科医师协会的7项内紊乱评估指标来判断这些结果时，平均良好结果率为87%。
结论
改良髁突切断术是治疗颞下颌关节盘非复位移位疼痛和功能减退的一种安全有效的手术方法。它似乎也是一种有效的治疗方法，用于减缓内部紊乱和相关病理状况的进一步进展。
OBJECTIVE
This study was performed to provide an objective assessment of the outcome of modified condylotomy for treatment of the painful temporomandibular joint with nonreducing disk displacement (Wilkes late stage III, IV, V).
STUDY DESIGN
A prospective study of 31 consecutive patients (43 joints) was conducted. All patients had nonreducing disk displacement verified by means of disk imaging. Independent evaluations were performed to assess pain, dysfunction, and progression of disease. The examinations were performed before modified condylotomy and at intervals up to 1 year after the operation. Eighteen patients (26 joints) completed the required examinations. Patient-based assessments were completed for pain and diet on 15 of these 18 patients (23 joints) 3 years after the operation.
RESULTS
Visual analog scale (VAS) scores (mean +/- SE) for pain improved from 7.4 +/- 0.4 before modified condylotomy to 2.4 +/- 0.5 1 year later (P <. 001). Joints with degenerative joint disease (Wilkes stage IV, V) had less satisfactory pain relief compared with stage III joints (3. 6 +/- 0.9 vs 1.1 +/- 0.4, P =.05) and an 11-fold higher risk (P <. 04) for serious residual pain (VAS score >4). Dietary restrictions improved from a mean VAS score of 5.3 +/- 0.7 before the operation to 7.7 +/- 0.5 1 year later (P =.02). Minor differences between mean VAS scores at 1 (2.1 +/- 0.5) and 3 (2.1 +/- 0.5) years for pain, and 1 (7.4 +/- 0.6) and 3 (8.1 +/- 0.6) years for diet, were not significant. Mean maximal interincisal opening was 36.7 +/- 2.0 mm before the operation, and this improved to 40.1 +/- 2.0 mm 1 year later (P <.02). Mean contralateral movement was 8.3 +/- 0.5 mm before the operation and 8.4 +/- 0.6 mm 1 year after the operation (P >.05). None of the 12 Wilkes late III joints progressed to Wilkes IV or V, and none of the 14 Wilkes IV, V joints showed evidence of further bone resorption. The rate for reoperation was 4%. Minor complications occurred in 5 patients and were resolved in all but 1 a year later. When these outcomes were judged by 7 American Association of Oral and Maxillofacial Surgeons assessment indices for internal derangement, the mean rate of favorable outcome was 87%.
CONCLUSION
Modified condylotomy is a safe and effective operation for treating pain and diminished function of temporomandibular joints with nonreducing disk displacement. It also seems to be an effective treatment for slowing further progression of the internal derangement and associated pathologic conditions.