Long-term results and clinical evaluation of TMJ surgery for internal derangements of the temporomandibular joint.

我们调查了TMJ开放手术或关节镜手术的远期结果，并评价了与1989年Wilkes术后TMJ内错乱分期相关的功能结果。关节镜手术：41例患者连续56个关节受累，并进行了至少3年至5年以上(平均4.4年)的随访。所有患者均采用视觉模拟评分法对疼痛程度进行评分，并在术前、术后填写疼痛、颌骨功能障碍、日常活动受限问卷。患者的颌骨张开程度也进行了测量。根据上述问卷的成功标准计算成功率。结果：手术成功率为90.2%。在细分的分期组中，III期占85.7%，IV期占91.7%，V期占93.3%。开放手术：对31例患者的38个关节进行至少5年的随访评估。间歇性锁定4例，闭合性锁定22例，Fibe开放锁定1例。远期放射学评估显示有可接受的骨改建，但没有严重的髁状突吸收。结果：总成功率为90.3%。结论：对于不同阶段的关节内紊乱患者，只要适当的非手术治疗不能治愈，TMJ镜手术和开放手术都是一种有效、可靠的手术方式。

We investigated the long-term results of temporomandibular joint (TMJ) open surgery or arthroscopic surgery, and evaluated the functional outcome correlate to the stages of TMJ internal derangement after Wilkes in 1989.Arthroscopic surgery : Consecutive 56 joints in 41 patient were involved and assessed at least three-years to over five years (4.4 years in an average)follow-up basis. All patients rated their pain level in visual analogue scale, and filled pain, jaw dysfunction, and activity daily limiting questionnaire before, and postoperatives after the surgery. The patients's jaw opening was also scaled. The success rate was also calculated according to our success criteria based on above questionnaire. Results : The overall surgical success rate was 90.2%. In an subdivided staging groups, stage III group showed 85.7%, stage IV-91.7% and stage V-93.3%.Open surgery : Cumulative 38 joints in 31 patient were assessed at least five-years follow-up basis. The patients consisted with four intermittent locking cases, 22 closed locking cases, and fibe open locking cases. Long-term radiographic assessment revealed that there was acceptable bone remodeling, but there were no severe condylar resorption. Results : The overall success rate was 90.3%.Conclusion : Both TMJ arthroscopic and open surgery was considered as an effective and reliable surgery for various stage of internal derangement in a long run when appropriate nonsurgical treatment failed to cure the patient.