Closed lock (MRI fixed disc):: a comparison of arthrocentesis and arthroscopy
Closed lock (MRI fixed disc):: a comparison of arthrocentesis and arthroscopy
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DOI：
10.1016/j.ijom.2003.10.005
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发表时间：
2004-06-01
影响因子：
2.4
通讯作者：
Sanromán, JF
中科院分区：
文献类型：
--
作者：
Sanromán, JF
本文研究了26例突发性持续性张嘴受限并伴有关节盘固定于关节盂窝的MRI征象的患者。非手术治疗不成功后，16个关节行透明质酸钠灌注关节镜检查。随访24 ~ 60个月（平均30.3个月）。所有患者术前及术后1、3、6、9、12、18、24个月进行临床评估。临床变量分析为：关节疼痛（VAS）（1-15）、关节噪音（咔嗒声、肌声或无）、锁定史、症状持续时间、最大指间开口（MIO）、最大前伸运动（MP）和最大对侧运动（ML）。术前获得MRI图像，分析颞下颌关节的形态学和动力学特征。其中8名拒绝接受关节镜检查的患者接受了关节穿刺治疗。这些患者按照上述相同的标准进行研究。患者平均年龄24.3岁（16 ~ 35岁）。女性20例，男性6例。术前mri检查显示16例关节椎间盘位置正常，10例椎间盘前移位。所有椎间盘均固定于盂窝，防止髁突头前移位。非手术治疗后，只有2例患者得到改善，而所有其他患者MIO（平均23.3 +/- 2.2 mm）， LM（3.8 +/- 1.4）和高疼痛水平（9.7分）严重下降。16例患者行关节镜检查。关节镜检查后疼痛明显减轻。此外，术后MMO和LM明显增加。关节镜检查结果包括粘连和滑膜炎。8例拒绝关节镜检查的患者接受TMJ关节穿刺治疗。所有患者术后症状均得到改善。结论TMJ关节镜和关节穿刺治疗椎间盘锚定现象（ADP）效果良好。
Twenty-six patients with a sudden-onset of persistent limited mouth opening and with MRI signs of articular discs fixed to the glenoid fossa were studied. After unsuccessful non-surgical treatment, arthroscopy with sodium hyaluronate infusion was performed in 16 joints. Follow-up ranged from 24 to 60 months (mean: 30.3 months). All patients were clinically assessed preoperatively, and at 1, 3, 6, 9, 12, 18 and 24 months postoperatively. The clinical variables analysed were: joint pain using a visual analogue scale (VAS) (1-15), joint noises (clicking, crepitus or none), history of locking, duration of the symptoms, maximal interincisal opening (MIO), maximal protrusive movement (MP) and maximal contra-lateral movement (ML). MRI images were obtained preoperatively to analyse the morphological and dynamic characteristics of the temporomandibular joint. Eight of the patients who refused to undergo arthroscopy were treated with arthrocentesis. These patients were studied following the same criteria as stated above. Mean age of the group was 24.3 years (16-35 years). 20 patients were female and 6 male. The preop-MRI examination revealed a normal disc position in 16 joints and an anteriorly displaced disc in 10 cases. All of the discs were fixed to the glenoid fossa preventing an anterior translation of the condylar head. After non-surgical treatment only two patients improved while all the other patients showed a severe decrease in the MIO (mean 23.3 +/- 2.2 mm), LM (3.8 +/- 1.4) and a high pain level (9.7 scale). Sixteen patients underwent arthroscopy. A significant reduction in pain was noted after arthroscopy. Furthermore, a significant increase in MMO and LM was demonstrated postoperatively. Arthroscopic findings included the presence of adherences and synovitis. Eight patients who refused arthroscopy were treated with TMJ arthrocentesis. All such patients improved their symptoms postoperatively. In conclusion both TMJ arthroscopy and arthrocentesis give good results upon treating patients with anchored disc phenomenon (ADP).