Clinical and Experimental Research on Indication, Effect and Complication of Temporomandibular Joint Arthroscopy

1. 临床研究(1)关节镜诊断比较50例颞下颌关节（TMJ）内部紊乱患者的关节镜表现及临床体征、症状，其中2个关节镜特征与粘连程度、最大开口、滑膜炎程度、关节痛视觉模拟评分呈统计学负相关。在11例习惯性脱位的16例颞下颌关节的关节镜检查中，发现典型的关节隆起特征，这被解释为主要病因之一。(2)关节镜下手术回顾性分析100例闭锁患者123例TMJs，经关节镜下松解洗胃后，平均指间开放度由31.3mm增加至42.7mm， 106例中度以上关节痛恢复消失，81例，轻度关节痛35例，平均随访时间9.7个月。总成功率95.9%，无明显并发症。(1)诊断性关节镜对10只羊进行诊断性关节镜术后组织学检查，术后2周~ 3个月观察下颌窝滑膜增生及滑膜下骨重塑。虽然软骨再生没有完成，但没有进一步的退行性改变。(2)关节镜手术10例羊TMJs前外侧囊松解后组织学检查，电切前囊术后1周纤维增生，术后3周基本愈合，伴轻度瘢痕。对20只羊进行关节镜下小切口成形术后的TMJs观察发现，术后出现滑膜增生和松质骨纤维增生，但术后3个月仍观察到隆起软骨再生不完全

1. Clinical Research(1) Diagnostic ArthroscopyIn comparison of arthroscopic findings and clinical signs and symptoms in 50 cases with internal derangements of the temporomandibular joint (TMJ), 2 arthroscopic features were demonstrated the statistically negative correlations between the degeree of adhesion and maximum opening mouth, and the degree of synovitis and visual analogue scale of arthralgia. In artliroscopic examination in 16 TMJs of 11 cases with habitual luxation, typical feature of bulging of the articular eminence was detected, which was interpreted as one of the main etiology.(2) Arthroscopic SurgeryRetrospective analysis of 123 TMJs in 100 cases with closed lock, who underwent arthroscopic lysis and lavage, the averaged interincisal opening degree increased from 31.3mm to 42.7mm, and 106 TMJs with more than moderate degree of arthralgia recovered into disappeared in 81 joints and mild in 35 joints, at averaged follow-up period with 9.7 months. The overall success rate was 95.9% without significant complication.2. Experimental Research(1) Diagnostic ArthroscopyHistologic examination following diagnostic arthroscopy in 10 sheep TMJs, synovial hyperplasia and subsynovial bone remodeling of the mandibular fossa were observed through 2 weeks to 3 months postoperatively. Although, the cartilage regeneration did not completed, there was no further degenerative change.(2) Arthroscopic SurgeryHistologic examination following antero-lateral capsular release in 10 sheep TMJs, the anterior capsule cut by electric cautery showed fibrous hyperplasia at 1 week after surgery, and completed the almost healing process at 3 weeks postopratively associated with mild scar.The postoperative process after arthroscopic eminoplasty in 20 sheep TMJs revealed onset of healing with synovial hyperplasia and fibrous hyperplasia in the cancellous bone, however, incomplete regeneration of cartilage of the eminence was still observed at 3 months postoperative period