Deveropmental study on the clinical technic of arthroscopic suture and fixation of temporomandibular joint disc.

我们通过使用Nd-YAG激光和通过关节镜缝合病变，开发了一种处理颞下颌关节病变的新方法。1)技术的尸体研究：该关节镜缝合术主要针对关节腔上区，主要针对滑膜区从后壁延伸至前椎间盘后侧的斜突。对于复发性脱位和活动过度，手术在该区域深处进行。在椎间盘移位的情况下，使用Nd-YAG激光蒸发表面形成一个新的伤口，然后在关节盘的新鲜自由边缘进行关节镜缝合。2)关节镜缝合针的研制本手术采用了一种新设计的实验性不锈钢关节镜缝合针。它由两部分组成：针和针座。全长21厘米，大约一半是针本身。针眼的尖端直径为1.0毫米。根据手术情况，使用1/2圈或1/3圈针尖。3)临床应用：采用关节镜下激光手术治疗80例（138个颞下颌关节），包括关节镜下缝合，术后通过体格检查、关节摄影、关节镜联合评估。采用Nd-YAG激光治疗30例习惯性脱位患者和24例闭锁性脱位患者，使其活动范围恢复正常。总的来说，54例患者中有92%的患者在关节镜激光和/或缝合技术联合治疗后症状得到缓解。

We have developed, through the use of a Nd-YAG laser and suturing of the lesion through the arthroscope, a new method for dealing with temporomandibular joint lesions.1) Cadaver study on the technic: This arthroscopic suturing procedure, aimed mainly at the superior area of the articular cavity was performed primarily on the oblique protuberance in the synovial area extending from the posterior wall to the posterior aspect of the anterior disc. For recurrent dislocation and hypermobility, the procedure was performed deep within the area. In cases of disc displacement, a fresh wound was created by using the Nd-YAG laser to evaporate the surface, and then arthroscopic suturing was performed on the freshened free edge of the articular disc.2) Development of the arthroscopic suture needle A newly devised, experimental arthroscopic suture needle made of stainless steel was used in the procedure. It consists of two parts: a needle and its holder.The full length is 21 cm, approximately half of which is the needle itself. The eye of the needle is 1.0 mm in diameter at the tip. Depending on the operative case, either 1/2 circle or 1/3 circle needle tips were used.3) Clinical application: Eighty patients (138 temporomandibular joints) were treated by arthroscopic laser surgery including arthroscopic suturing and were postoperatively evaluated by combinations of physical examination, arthrography, and arthroscopy. There ware 30 patients with habitual dislocation and 24 patients with closed-lock condition who were treated with the Nd-YAG laser to reduce the range of motion to normal. Overall, 92% of the 54 patients treated with combinations of arthroscopic laser and/or suture techniques were relieved of their symptoms.