Long-term study of temporomandibular joint surgery with alloplastic implants compared with nonimplant surgery and nonsurgical rehabilitation for painful temporomandibular joint disc displacement
Long-term study of temporomandibular joint surgery with alloplastic implants compared with nonimplant surgery and nonsurgical rehabilitation for painful temporomandibular joint disc displacement
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DOI：
10.1053/joms.2002.36091
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发表时间：
2002-12-01
影响因子：
1.9
通讯作者：
Swift, J
中科院分区：
文献类型：
--
作者：
Fricton, JR;Look, JO;Swift, J
目的：本研究的目的是确定颞下颌关节（TMJ）植入手术的长期客观和主观结局，以使用临时Silastic（Dow Corning Corporation，米德兰，NU）、永久Silastic或Proplast（Vitek，Houston，TX）植入物置换关节盘，治疗疼痛性TMJ关节盘移位。这些病例进行了比较，与其他情况下，相同的诊断治疗与非手术康复或非植入手术涉及椎间盘切除术或椎间盘repair procedures.Materials and Methods：一个横断面研究进行了466例接受治疗的单侧或双侧颞下颌关节盘移位1990年1月1日之前。比较上述5个治疗组的长期结局，使用校准的检查者和颅下颌指数（CMI）进行下颌功能的客观结局测量。主观（自我报告）获得了与颌骨功能相关的结局（下颌功能损害问卷[MFIQ]），症状严重程度（症状严重程度指数[SSI]）和疼痛的影响（全球疼痛影响[GPI]量表）。结果：根据性别、基线断层扫描评分和基线症状评分调整后的结果，结果显示，非手术康复组（n = 159）和未使用植入物的TMJ手术组（n = 149）的结果在统计学上优于使用Proplast植入物的手术组（n = 94）。这些组间差异包括客观体征（CMI）和颌功能（MFIQ）、症状严重程度（SSI）和整体疼痛影响（GPI）的主观报告。非手术康复组的MFIQ评分在统计学上也优于硅橡胶种植体组，包括临时（n = 31）和永久（n = 33）种植体。组间的临床差异是轻微的。结论：这项研究表明，使用间置椎间盘植入物在颞下颌关节手术是不相关的改善结果相比，非植入手术或非手术康复。(C)2002年美国口腔颌面外科医师协会。
Purpose: The purpose of this study was to determine the long-term objective and subjective outcomes of temporomandibular joint (TMJ) implant surgery for the treatment of painful TMJ disc displacement using temporary Silastic (Dow Corning Corporation, Midland, NU), permanent Silastic, or Proplast (Vitek, Houston, TX) implants to replace the disc. These cases were compared with other cases of the same diagnosis treated with either nonsurgical rehabilitation or nonimplant surgery involving discectomy or disc repair procedures.Materials and Methods: A cross-sectional study was conducted among 466 patients who received treatment for unilateral or bilateral TMJ disc displacement before January 1, 1990. The 5 treatment groups noted above were compared for long-term outcomes, Objective Outcome measurements for jaw function were performed using a calibrated examiner and the Craniomandibular Index (CMI). Subjective (self-reported) outcomes were obtained relative to jaw function (Mandibular Function Impairment Questionnaire [MFIQ]), symptom severity (Symptom Severity Index [SSI]),and the impact of pain (Global Pain Impact [GPI] scale).Results: The results, adjusted for gender, baseline tomogram score, and baseline symptom scores, showed that the nonsurgical rehabilitation group (n = 159) and the group having TMJ Surgery without implants (n = 149) had statistically better results than the group who underwent Surgery with a Proplast implant (n = 94). These between-group differences included both objective signs (CMI), and subjective reports of jaw function (MFIQ), symptom severity (SSI), and global pain impact (GPI), The MFIQ score associated with the nonsurgical rehabilitation group was also statistically better than for the Silastic implant groups, including both the temporary (n = 31) and permanent (n = 33) implants. Clinical difference between groups were slight.Conclusion: This study suggests that the use of interpositional disc implants in TMJ Surgery is not associated with improved outcomes when compared with nonimplant surgery or nonsurgical rehabilitation. (C) 2002 American Association of Oral and Maxillofacial Surgeons.