无髁突骨折颞下颌关节急性创伤后的变化:影像学和手术所见

目的:通过CT、MRI及手术探查观察无髁突骨折颞下颌关节急性创伤后的变化,为该疾患的早期诊治提供依据。方法:上海交通大学医学院附属第九人民医院口腔颌面外科关节组2009—2010年收治的无髁突骨折颞下颌关节急性创伤患者7例11侧关节纳入研究。所有患者伤前均无关节症状,但在伤后出现长时间的关节区疼痛和开口受限,其中6例合并面部骨折,曾在其他医院或由其他医师手术治疗。所有患者均进行了关节区的MRI检查,对受伤后即刻和再次就诊的CT进行比较。所有病例进行了手术探查,术中所见进一步证实影像学的变化。结果:CT显示,87.5%(7/8)的髁突在受伤即刻表面骨质"完好",而伤后1个月至1a出现骨质破坏。伤后1个月至1a的MRI检查显示,所有11侧关节均出现盘前移位,90.9%(10/11)的髁突伴骨质破坏。手术探查显示,2侧关节出现骨性黏连,3侧关节髁突表面骨质破坏与关节窝纤维性黏连,5侧关节髁突表面软骨变性伴黏连,1侧关节髁突表面软骨无明显破坏,关节盘前移位但形态尚可。结论:无髁突骨折的颞下颌关节急性创伤如伴关节盘前移位,可导致骨关节病和(或)关节强直。

Temporomandibular joint changes after acute trauma to the mandible without condylar fracture: radiographic and surgical findings

PURPOSE：To demonstrate temporomandibular joint（TMJ） changes after acute trauma to the mandible without condylar fracture by radiography and surgical exploration.METHODS：Seven patients with 11 joints who had acute trauma to the mandible without condylar fracture complained of mouth opening limitation from 1 month to 1 year after trauma were treated in the temporomandibular joint（TMJ） division of Shanghai Ninth People＇s Hospital from 2009 to 2010.Six patients had combined facial fractures which were treated in other hospitals or by other surgeons in this hospital before.CT scans with coronal reconstruction through the condyle immediately after injury and few months later when they came to the TMJ division for treatment were compared.MRI was taken before treatment to check the TMJ changes.Surgical treatment was performed for all patients.RESULTS：CT scan showed 87.5%（7/8） of the joints with ＂intact＂ condylar surface bone immediately after injury developed bone destruction 1 month to 1 year later.MRI showed all 11 joints had TMJ disc displaced anteriorly.Ninety percentage（10/11） of the joints also had condylar surface bone destruction.Surgical exploration showed bony ankylosis in 2 joints;fibrous ankylosis with destroyed condyle stuck to the fossa in 3 joints;TMJ osteoarthritis with degenerated condylar surface bone and fibrous adhesion in 5 joints;and internal derangement with relatively normal condylar surface cartilage and disk shape in 1 joint.CONCLUSIONS：Acute trauma to the mandible without condylar fracture may develop TMJ ankylosis and/or osteoarthritis when the disc is displaced anteriorly.