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中华损伤与修复杂志(电子版)

中华损伤与修复杂志(电子版) ›› 2018, Vol. 13 ›› Issue (02) : 100 -106. doi: 10.3877/cma.j.issn.1673-9450.2018.02.005

所属专题： 文献；

论著

复合组织瓣联合肋骨肋软骨移植重建颞下颌关节的临床应用
克依木·克里木1, 塔依尔·阿力甫2, 居来提·吐尔逊1, 姚志涛1, 阿迪力江·赛买提1, 姚运1, 买买提吐逊·吐尔地1,†()   
  1. 1. 830054　乌鲁木齐，新疆医科大学第一附属医院颌面部创伤正颌外科
    2. 834000　新疆克拉玛依市中心医院口腔科
  • 收稿日期:2018-02-05 出版日期:2018-04-01
  • 通信作者: 买买提吐逊·吐尔地
  • 基金资助:
    新疆维吾尔自治区自然科学基金(2016D01C249)

Clinical applications of multiple tissue flap combined with costochondral graft in the reconstruction of temporomandibular joint

Kelimu Keyimu·1, Ayifu Tayier·2, Tuerxun Julaiti·1, Zhitao Yao1, Saimaiti Adilijiang·1, Yun Yao1, Tuerdi Maimaitituxun·1,†()   

  1. 1. Department of Maxillofacial Trauma Orthognathic Surgery, First Affiliated Hospital of Xinjiang Medical University, Wulumuqi 830054, China
    2. Department of Stomatology, Karamay Central Hospital of Xinjiang, Karamay 834000, China
  • Received:2018-02-05 Published:2018-04-01
  • Corresponding author: Tuerdi Maimaitituxun·
  • About author:
    Corresponding author: Maimaitituxun·Tuerdi, Email:
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引用本文：

克依木·克里木, 塔依尔·阿力甫, 居来提·吐尔逊, 姚志涛, 阿迪力江·赛买提, 姚运, 买买提吐逊·吐尔地. 复合组织瓣联合肋骨肋软骨移植重建颞下颌关节的临床应用[J]. 中华损伤与修复杂志(电子版), 2018, 13(02): 100-106.

Kelimu Keyimu·, Ayifu Tayier·, Tuerxun Julaiti·, Zhitao Yao, Saimaiti Adilijiang·, Yun Yao, Tuerdi Maimaitituxun·. Clinical applications of multiple tissue flap combined with costochondral graft in the reconstruction of temporomandibular joint[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2018, 13(02): 100-106.

目的

探讨复合组织瓣[(颊脂垫瓣(BFPF)和颞肌筋膜瓣(TMF)]在肋骨肋软骨移植(CCG)重建颞下颌关节中的联合作用。

方法

收集2014年10月至2017年5月颞下颌关节强直(TMJA)患者20例，27侧，根据所实施术式不同分为两组，8例10侧患者为实验组，行TMF和BFPF作为双重间隔物和CCG为术式；12例17侧行TMF和间隙成形术或CCG患者作为对照，术前、术后进行曲面断层、头颅正侧位片和CT扫描三维重建病情评估，术前用交互式医学图像控制系统辅助手术设计。术后记录完成随访患者张口度测量，组间行两独立样本t检验。

结果

两组颞下颌关节重建术后无一例强直复发。术后1、3、6个月随访并行张口度测量、统计，实验组术后张口度34～41 mm，平均张口度为(36.78±0.61)mm，对照组术后张口度为30～35 mm，平均张口度为(31.56±0.58) mm，差异有统计学意义(P<0.05)。患者术后曲面断层、CT扫描均显示关节间隙清晰，无组织粘连，无明显咬合异常。术后无明显面神经损伤或功能减弱、咀嚼功能障碍。

结论

应用复合组织瓣联合肋软骨移植颞下颌关节重建TMJA的术后张口度长期保持、复发具有优越性。

关键词: 颞下颌关节, 关节强直, 骨移植, 颊脂垫瓣, 颞肌筋膜瓣
Objective

To discuss the using of multiple tissue flap(buccal fat pad flap and temporalis myofascial flap) on the inter-positional graft to combine effect of costochondral graft for temporomandibular joint reconstruction.

Methods

Twenty patients with temporomandibular joint ankylosis, 27 sides, in the first Affiliated Hospital of Xinjiang Medical University were enrolled in this study. Patients were divided into two groups according to the different surgical methods. The experimental group, including 8 patients, 10 sides, and the control group, including 12 patients, 17 sides. In the experimental group, the temporalis myofascial flap and buccal fat pad flap were used as double spacer, which were transferred to the region of temporomandibular joint ankylosis combined with costochondral graft, while the control group was reconstructed by gap arthroplasty and temporalis myofascial flap transplantation. All patients were performed with pro-operative and postoperative panaroma, CT scanning image of 3D reconstruction to evaluate the ankylosis and measure resection, and interactive medical image control system was used to assist in surgical design before surgery. Recording the size of postoperative maximum mouth opening data, two independent samples t tests between groups were carried out.

Results

The mouth opening of experimental group after surgery was 34-41 mm, the average mouth opening was (36.78±0.61)mm. The mouth opening of control group after surgery was 30-35 mm, the average mouth opening was(31.56±0.58)mm. The difference between the two groups was statistically significant (P<0.05). Chewing function was satisfaction on the all patients, postoperative panaroma and CT scan showed clear joint clearance, no tissue adhesion, no obvious malocclusion. There was no obvious facial nerve injury or functional impairment or chewing dysfunction after surgery.

Conclusion

The reconstruction of temporomandibular joint with composite tissue flap combining with rib cartilage grafting was superior in the treatment of postoperative temporomandibular joint ankylosis recovery of normal mouth opening and prevention of recurrence.

Key words: Temporomandibular joint, Ankylosis, Bone transplantation, Buccal fat pad flap, Temporalis myofascial flap
表1 两组TMJA患者术后张口度随访统计结果(mm)
序号 性别 年龄(岁) 术式 术后随访结果 平均值
术后1个月 术后3个月 术后6个月
1 男 33 关节成形术＋TMF 30 31 35 32.0
2 男 28 成形术＋CCG＋TMF 31 30 33 31.3
3 女 35 关节成形术＋TMF 29 30 34 31.0
4 男 24 成形术＋CCG＋TMF 30 32 32 31.3
5 女 21 成形术＋CCG＋TMF 30 31 33 31.3
6 女 28 关节成形术＋TMF 28 29 35 30.6
7 男 45 成形术＋CCG＋TMF 30 30 35 31.6
8 男 40 关节成形术＋TMF 29 32 36 32.3
9 男 26 成形术＋CCG＋TMF 32 31 33 32.0
10 女 34 关节成形术＋TMF 31 32 34 32.3
11 女 22 CCG＋TMF＋BFPF 34 36 39 36.3
12 男 21 CCG＋TMF＋BFPF 35 36 39 36.6
13 女 28 CCG＋TMF＋BFPF 34 37 41 37.3
14 男 40 CCG＋TMF＋BFPF 33 36 40 36.3
15 男 33 CCG＋TMF＋BFPF 32 38 39 36.3
16 男 31 CCG＋TMF＋BFPF 35 39 39 37.6
17 女 35 CCG＋TMF＋BFPF 32 37 40 36.3
18 男 44 CCG＋TMF＋BFPF 35 38 40 37.6
图1 术前诊断。A为冠状位CT；B为术前张口度(蓝色箭头示张口度)
图2 术中接受颞下颌关节肋骨肋软骨移植联合颞肌筋膜瓣、颊脂垫瓣复合组织瓣手术重建。A示骨球切除、颅底关节窝成形后受区预备；B示受区移植肋骨肋软骨及颞肌筋膜瓣(黄色箭头示移植肋骨肋软骨，绿色箭头示颞肌筋膜瓣)；C示颊脂垫瓣制备及转移至关节间隙作为第二间隔物(绿色箭头示颊脂垫瓣)
图3 术后CT及张口度。A示术后冠状位CT；B示术后随访1个月后张口度(黄色箭头示张口度)
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