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

1.临床研究(1)关节镜诊断：对50例TMJ内错位患者的关节镜下表现与临床症状、体征进行对照分析，发现2个关节镜征象与关节粘连程度、滑膜炎程度、关节疼痛视觉模拟评分呈显著负相关。(2)关节镜手术对100例闭锁患者123侧TMJ进行了关节镜下松解灌洗，平均切迹间张开度由31.3 mm增至42.7 mm，关节疼痛中度以上106个关节恢复消失，35个关节轻度消失，平均随访9.7个月。总成功率为95.9%，无明显并发症。实验研究(1)诊断性关节镜检查10只绵羊TMJ，术后2周~3个月观察滑膜增生及滑膜下骨改建情况。(2)关节镜手术10只绵羊TMJ前外侧囊松解后的组织学检查，术后1周电灼切开的前囊呈纤维性增生，术后3周基本愈合，伴有轻度骨缺失。20只绵羊TMJ关节镜下椎管成形术后，关节镜下松质骨滑膜和纤维组织均已愈合，但术后3个月隆起软骨仍未完全再生

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