A prospective study of 138 arthroscopies of the temporomandibular joint

INTRODUCTION: Internal derangements (ID) of the temporomandibular joint (TMJ) have a multifactorial etiology and are most often treated conservatively by splints, physical therapy and medications. Only in 2-5% of cases are the treatment surgical, either by arthroscopy or arthrotomy.OBJECTIVE: To evaluate improvement of mouth opening, pain relief during function, position of the articular disk and complications following Arthroscopic Lyse and Lavage (ALL).METHODS: A prospective study of 78 patients (138 TMJs) with TMJ ID, 5 males and 73 females, mean age 29.7 years, treated between January 2010 and April 2013, who were refractory to conservative treatment, had limited mouth opening and pain localized to the TMJ during function, and who were submitted to TMJ ALL and followed for a period of 12 months, with periodic reviews.RESULTS: ALL was effective in 93.6% of cases, with 85.3% experiencing improvement in mouth opening and 91.2% in pain reduction during function, 63% improvement in disk position and a rate of complications of 6.2%.CONCLUSION: In this study the ALL exhibited a high rate of success with low morbidity in internal derangements of the TMJ.

引言：颞下颌关节（temporomandibular joint, TMJ）内紊乱（internal derangements, ID）病因复杂多样，临床多采用夹板疗法、物理治疗与药物治疗等保守方案进行干预。仅2%~5%的病例需接受外科手术治疗，手术方式包括关节镜术或关节切开术。
研究目的：评估关节镜下松解冲洗术（Arthroscopic Lyse and Lavage, ALL）对患者开口度改善、功能性疼痛缓解、关节盘位置恢复及术后并发症的改善效果。
研究方法：本研究为前瞻性队列研究，纳入2010年1月至2013年4月期间收治的78例患者（共138个颞下颌关节），均确诊为颞下颌关节内紊乱，其中男性5例、女性73例，平均年龄29.7岁。所有患者均经保守治疗无效，存在开口受限及功能性颞下颌关节局部疼痛，均接受颞下颌关节镜下松解冲洗术治疗，并完成为期12个月的定期随访。
研究结果：本研究显示，ALL总体有效率达93.6%：其中85.3%的患者开口度得到改善，91.2%的患者功能性疼痛得以缓解，63%的患者关节盘位置恢复良好，术后并发症发生率为6.2%。
结论：本研究结果表明，针对颞下颌关节内紊乱患者实施关节镜下松解冲洗术，可获得较高的手术成功率与较低的术后并发症发生率。