髁突矢状骨折手术中关节盘复位的应用

目的 探讨髁突囊内骨折开放手术中关节盘复位及固定方法的选择及疗效评判。方法 选择因髁突骨折接受手术治疗,且随访期超过6个月的36例患者为研究对象,骨折类型以髁突矢状骨折为主;术中采用长螺钉内固定,依据关节盘移位及损伤程度分别对关节盘采用缝合法（22侧）及锚固法（14侧）进行复位。术后1、3、6个月及1年进行随访,选择手术前及手术后6个月为时间点详细记录Fricton颞下颌关节紊乱指数（CMI）相关的各项指标,从临床和颞下颌关节（TMJ）功能两方面评估术后恢复情况。结果 两组患者术后TMJ功能改善,CMI分别从治疗前的0.213±0.162和0.273±0.154下降到0.059±0.072和0.064±0.068（P<0.05）。两组不同关节盘复位及固定方法之间比较,CMI、肌肉压痛指数和TMJ功能障碍指数差异无统计学意义（P>0.05）。结论 2种方法处理关节盘均可以有效地改善创伤导致的TMJ功能障碍,关节盘复位及固定方法的选择以关节盘移位及损伤程度作为参考。

Application of temporomandibular joint dics reduction in the operation of condylar sagittal fracture

Objective To explore the selection of temporomandibular joint(TMJ) disc reduction and fixation methods in condylar sagittal fracture surgery. Methods A total of 36 patients with condylar fractures were chosen. The follow-up period was more 6 months. All 36 cases of condylar sagittal fracture were fixed with long screw. In the operation, the displaced joint disc was repositioned and fixed. The fixed method included direct suture (22 cases) and anchorage (14 cases). Clinical followups were performed before surgery and 1 month, 3 months, 6 months and 1 year after surgery. Clinicians recorded data related to the Fricton craniomandibular index (CMI) and evaluated the postoperative joint function during followup before surgery and 6 months after surgery. Results In both groups, function of TMJ significantly improved after surgery. The CMI decreased from 0.213±0.162 and 0.273±0.154 to 0.059±0.072 and 0.064±0.068 (P<0.05), respectively. No statistical difference was observed between the two groups in palpation index (PI), dysfunction index (DI) and CMI (P>0.05) before or after surgery. Conclusion Both methods could effectively improve the dysfunction of the TMJ caused by trauma. The selection of joint disc reduction and fixation methods is based on the displacement and damage degree of the joint disc.