中国实用口腔科杂志

中国实用口腔科杂志 ›› 2026, Vol. 19 ›› Issue (2): 177-182.DOI: 10.19538/j.kq.2026.02.008

• 论著 • 上一篇    下一篇

两种颞下颌关节盘复位固定术治疗不可复性盘前移位效果比较研究

牛    强，李云鹏，张浚睿，李治冶，周善洛，吕曜光   

  1. 口颌系统重建与再生全国重点实验室，国家口腔疾病临床医学研究中心，陕西省口腔疾病临床医学研究中心，空军军医大学口腔医院颌面外科，陕西 西安 710032
  • 出版日期:2026-03-30 发布日期:2026-03-30
  • 通讯作者: 吕曜光
  • 基金资助:
    国家口腔疾病临床医学研究中心课题（LCB202005）；陕西省卫生健康科研创新平台建设计划项目（2024PT-04）

  • Online:2026-03-30 Published:2026-03-30

摘要： 目的    对比研究颞下颌关节盘锚固术（temporomandibular joint disc anchorage，TMJ-DA）与颞下颌关节盘复位缝合术（temporomandibular joint disc reduction and suture，TMJ-DRS）治疗不可复性盘前移位（anterior disc displacement without reduction，ADDWoR）效果。方法    收集2023年1月至2024年6月于空军军医大学口腔医院颌面外科行颞下颌关节盘复位固定术的67例ADDWoR患者（88侧术区）临床和影像学资料行回顾性分析，根据术式分为TMJ-DA组32例患者（41侧术区）和TMJ-DRS组35例患者（47侧术区）。比较2组患者术中指标和术后恢复情况（手术时间、术中出血量、术后引流量、术后住院时间、面神经损伤发生率和暂时性咬合紊乱发生率），以及术前和术后1年颞下颌关节运动指标（最大张口度、前伸运动度、左侧方运动度、右侧方运动度）和疼痛视觉模拟评分量表（visual analog scales，VAS）评分；基于MRI比较2组术前和术后1年关节盘长度、髁突高度及关节盘复位效果（优、良、差术区占比）。结果    TMJ-DA组暂时性面神经颞支损伤发生率为18.75%（6/32），其大于TMJ-DRS组［2.86%（1/35）］，差异有统计学意义（χ2 = 4.434，P = 0.035）；2组其他术中指标和术后恢复情况比较，差异均无统计学意义（均P > 0.05）。2组术前和术后1年相同时间各项颞下颌关节运动指标及VAS评分比较，差异均无统计学意义（均P > 0.05）；与术前比较，2组术后1年各项颞下颌关节运动指标及VAS评分均明显改善，差异均有统计学意义（均P < 0.05）。2组术前关节盘长度、髁突高度比较，差异均无统计学意义（均P > 0.05）；与术前相比，2组术后1年关节盘长度、髁突高度均明显改善，差异均有统计学意义（均P < 0.05）。术后1年，2组关节盘长度、关节盘复位效果比较，差异均无统计学意义（均P > 0.05）；TMJ-DA组髁突高度［（22.15 ± 1.91）mm ］小于TMJ-DRS组［（23.06 ± 1.58）mm ］，差异有统计学意义（t = -2.428，P = 0.017）。结论    应用TMJ-DA和TMJ-DRS治疗ADDWoR均能取得良好的效果；相较于TMJ-DA，TMJ-DRS在保护面神经及髁突高度改建方面更有优势。

关键词: 颞下颌关节, 不可复性盘前移位, 颞下颌关节盘锚固术, 颞下颌关节盘复位缝合术

Abstract: Objective    To compare the efficacy of temporomandibular joint disc anchorage（TMJ-DA）with that of temporomandibular joint disc reduction and suture（TMJ-DRS）in the treatment of anterior disc displacement without reduction（ADDWoR）. Methods    A retrospective analysis of the clinical and imaging data of 67 ADDWoR patients（88 surgical sides) was conducted，who underwent disc repositioning and fixation surgery of temporomandibular joint in the Department of Oral and Maxillofacial Surgery，Hospital of Stomatology，the Air Force Military Medical University from January 2023 to June 2024. Based on the surgical technique，patients were divided into the TMJ-DA group（32 patients，41 surgical sides）and the TMJ-DRS group（35 patients，47 surgical sides）. Intraoperative parameters and postoperative recovery indices - including operative time，intraoperative blood loss，postoperative drainage volume，postoperative hospitalization days，incidence of facial nerve injury and incidence of temporary occlusal disorder - were compared between the two groups. Temporomandibular joint（TMJ）mobility parameters（maximum mouth opening，protrusive movement，left lateral movement，right lateral movement）and visual analog scale（VAS）pain scores were also compared；disc length，condylar height，and disc repositioning outcomes（categorized as excellent，good，or poor）were compared preoperatively and at the 1-year follow-up. Results    The incidence of temporary temporal branch injury of the facial nerve was higher in the TMJ-DA group（18.75%，6/32）than in the TMJ-DRS group（2.86%，1/35）（χ2 = 4.434，P = 0.035）. No statistically significant differences were found between the two groups in other intraoperative or postoperative recovery indices（all P > 0.05）. No significant differences were observed in TMJ mobility parameters or VAS scores between the two groups at the same time points（preoperatively or 1 year postoperatively）（all P > 0.05）. However，both groups showed significant improvement in all TMJ mobility parameters and VAS scores at 1 year postoperatively compared to their preoperative baselines（all P < 0.05）. Preoperative disc length and condylar height showed no significant intergroup differences（all P > 0.05）. Both parameters improved significantly at 1 year postoperatively compared to preoperative values within each group（all P < 0.05）. At the 1-year follow-up，no significant intergroup differences were found in disc length or disc repositioning outcomes（P > 0.05）. However，condylar height in the TMJ-DA group［（22.15 ± 1.91）mm］ was smaller than that in the TMJ-DRS group ［（23.06 ± 1.58）mm］（t = -2.428，P = 0.017）. Conclusion     Both TMJ-DA and TMJ-DRS are effective surgical techniques for managing ADDWoR. Compared to TMJ-DA，the TMJ-DRS technique demonstrates advantages in preserving facial nerve function and condylar height remodeling.

Key words: temporomandibular joint, anterior disc displacement without reduction, temporomandibular joint disc anchorage, temporomandibular joint disc reduction and suture