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山东大学学报 (医学版) ›› 2025, Vol. 63 ›› Issue (7): 54-61.doi: 10.6040/j.issn.1671-7554.0.2025.0626

• 临床医学 • 上一篇    下一篇

ADDWoR关节镜下盘复位术盘-髁运动的定量分析

金晨曦1,2,沈薇1,2,李娜2,孙建锋2,杨驰3,郭泾1,2   

  1. 1.浙江中医药大学口腔医学院, 浙江 杭州 310053;2.杭州医学院附属宁波口腔医院正畸科, 浙江 宁波 315016;3.上海交通大学医学院附属第九人民医院口腔外科, 上海交通大学口腔医学院, 国家口腔医学中心, 国家口腔疾病临床医学研究中心, 上海市口腔医学重点实验室, 上海 20001l
  • 发布日期:2025-07-08
  • 通讯作者: 郭泾. E-mail:guojing@sdu.edu.cn
  • 基金资助:
    宁波市重点研发计划暨“揭榜挂帅”项目(2023Z172)

Quantitative analysis of disc-condyle movement following arthroscopic disc repositioning operation for ADDWoR

JIN Chenxi1,2, SHEN Wei1,2, LI Na2, SUN Jianfeng2, YANG Chi3, GUO Jing1,2   

  1. 1. School of Stomatology, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang, China;
    2. Department of Orthodontics, Ningbo Stomatology Hospital Affiliated to Hangzhou Medical College, Ningbo 315016, Zhejiang, China;
    3. Department of Oral Surgery, Shanghai Ninth Peoples Hospital, Shanghai Jiao Tong University School of Medicine;
    College of Stomatology, Shanghai Jiao Tong University;
    National Center for Stomatology;
    National Clinical Research Center for Oral Diseases;
    Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
  • Published:2025-07-08

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摘要： 目的 评估不可复性关节盘前移位(anterior disc displacement without reduction, ADDWoR)关节镜下盘复位术(arthroscopic disc repositioning operation, ADRO)后关节盘位置及盘-髁运动特征。 方法 选取2021年1月至2024年6月宁波口腔医院就诊的以颞下颌关节紊乱病症状体征、或嘴突、下巴后缩或/和偏斜等为主诉的患者108例,并以核磁共振成像(magnetic resonance imaging, MRI)作为确定盘髁关系的金标准。经四步筛选,其中,31例(62侧关节)为无关节盘前移位(正常组),由于ADDWoR与可复性关节盘前移位(anterior disc displacement with reduction, ADDWR)盘-髁异质性,48例(83侧ADDWoR关节)并行ADRO(手术组)。术前(A0组)及术后1(A1M组)、3(A3M组)、6(A6M组)个月随访,测量视觉模拟评分法(visual analogue scale, VAS)疼痛评分、盘髁角、盘-髁动度、冠状位内外侧移位。 结果 (1)A0组VAS疼痛评分高于正常组,且差异有统计学意义(P<0.001)。A0组、A1M组、A3M组、A6M组组间VAS疼痛评分差异均有统计学意义(P<0.05)。(2)冠状位,正常组罕见关节盘移位,侧移率9.68%;A0组关节盘不可见。A6M组可见关节盘20/83侧,伴发侧移6/20侧。矢状位,无论闭口还是开口位,正常组盘髁角与A0组、A6M组差异均有统计学意义(P<0.001)。开闭口运动正常组与A0组、A6M组差异均有统计学意义(P<0.001)。(3)冠状位,术后各组盘可见数及侧移数均增加。矢状位,盘髁角随时间推移逐渐增大,但增加量减少,A0组与A1M组、A3M组、A6M组盘髁角差异均有统计学意义(P<0.05)。术后各组盘-髁动度均逐渐增大(P<0.05)。(4)Spearman相关性分析显示,闭口位盘动度与盘手术位呈负相关(rs=-0.486,P<0.001;rs=-0.550,P<0.001)。 结论 ADRO显著改善ADDWoR盘位置(矢状位复位尤佳)及功能,术后疼痛症状缓解。0°~-30°为有利的过矫正手术位,以促进盘-髁动度最大化。

关键词: 关节镜下盘复位术, 不可复性关节盘前移位, 盘髁角, 盘-髁动度, 核磁共振成像

Abstract: Objective To assess the location of the disc and the movement characteristics of the disc-condyle following arthroscopic disc repositioning operation(ADRO)for the anterior disc displacement without reduction(ADDWoR). Methods A total of 108 patients were enrolled in Ningbo Stomatology Hospital during Jan. 2021 and Jun. 2024, who were with symptoms/signs of temporomandibular disorders(TMD), or protrusive mouth, mandibular retrusion or deviation as the main complaint. Magnetic resonance imaging(MRI)served as the gold standard for determining disc-condyle relationships. Through a four-step screening process, 31 patients(62 joints)without anterior disc displacement were classified as the normal group. Due to disc-condyle heterogeneity between ADDWoR and anterior disc displacement with reduction(ADDWR), 48 patients(83 ADDWoR joints)underwent an ADRO and comprised the surgical group. Assessments were performed preoperatively(group A0)and at 1(group A1M), 3(group A3M), and 6(group A6M)months postoperatively, measuring visual analogue scale(VAS)pain scores, disc-condyle angle, disc-condyle mobility, and coronal mesial-lateral displacement. Results (1)The VAS pain score in group A0 was significantly higher than that in the normal group(P<0.001). The differences in VAS pain scores between the groups A0, A1M, A3M, and A6M were all statistically significant(P<0.05). (2) In the coronal view, disc displacement was rare in the normal group(lateral shift rate: 9.68%). The discs were invisible in the group A0. At A6M, the discs were visualized in 20/83 joints, with lateral shift in 6/20 joints. In the sagittal view, significant differences in the disc-condyle angle existed between the normal group and both the groups A0/A6M during closed-mouth and open-mouth positions. Significant differences in open-close movement were also found between the normal group and the groups A0/A6M(P<0.001). (3) In the coronal view, the number of visualized discs and laterally shifted discs increased progressively across the postoperative groups. Sagittally, the disc-condyle angle gradually increased over time, though the rate of increase decreased. Statistically significant differences were found in the median disc-condyle angle between group A0 and groups A1M, A3M, and A6M(P<0.05). The disc-condyle mobility progressively increased in all postoperative groups (P<0.05). (4) Spearman correlation analysis: closed-mouth disc mobility demonstrated a significant negative correlation with the surgical disc position(rs=-0.486, P<0.001; rs=-0.550, P<0.001). Conclusion ADRO significantly improved disc position(particularly sagittal reduction)and functional mobility in ADDWoR, concomitant with postoperative pain relief. A surgical disc position between 0° to -30° represents a favorable range for overcorrection to maximize postoperative disc-condyle mobility.

Key words: Arthroscopic disc repositioning operation, Anterior disc displacement without reduction, Disc-condyle angle, Disc-condyle mobility, Magnetic resonance imaging

中图分类号: 

  • R783.5
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