PDF(Pubmed)
Abstract：
OBJECTIVE: Open suturing (OSu) and mini-screw anchor (MsA) are two commonly used open disc repositioning surgeries for anterior disc displacement (ADD) of the temporomandibular joint (TMJ). This study assesses the differences in disc position stability (DPS) and condylar bone remodelling (CBR) between these two surgical procedures in a single centre.
METHODS: A retrospective cohort study using MRI scans (pre-operation, 1 week and 12 months post-operation) of all patients who had open TMJ disc repositioning surgery from January 2016 to June 2021 at one centre through two surgical techniques (OSu and MsA) was performed. The predictor variable was technique (OSu and MsA). Outcome variables were DPS and CBR. During follow-up, DPS was rated as good, acceptable and poor, and CBR was graded as improved, unchanged, and degenerated. Multivariate analysis was used to compare the DPS and CBR at 12 months after adjusting five factors including age, sex, Wilkes stage, preoperative bone status (normal, mild/moderate abnormal) and the degree of disc repositioning (normal, overcorrected, and posteriorly repositioned). Relative risk (RR) for DPS and CBR was calculated by multivariate logistic regression.
RESULTS: Three hundred eighty-five patients with 583 joints were included in the study. MRIs at 12 months showed that 514 joints (93.5%) had good DPS, and 344 joints (62.5%) had improved CBR. Multivariate analysis revealed that OSu had higher DPS (RR=2.95; 95% CI, 1.27-6.85) and better CBR (RR=1.58; 95% CI, 1.02-2.46) than MsA. Among the factors affecting DPS, females had better results than males (RR=2.63; 95% CI, 1.11-6.26) and overcorrected or posteriorly repositioned discs were more stable than normally repositioned discs (RR=5.84; 95% CI, 2.58-13.20). The improvement in CBR decreased with age increasing (RR=0.91; 95% CI, 0.89-0.93). Preoperative mild/moderate abnormal bone status had a higher probability of improved CBR compared to normal preoperative bone status (RR=2.60; 95% CI, 1.76-3.83).
CONCLUSIONS: OSu had better DPS and CBR than MsA. Sex and the degree of disc repositioning impacted DPS, while age and preoperative bone status affected CBR.
METHODS: A retrospective cohort study using MRI scans (pre-operation, 1 week and 12 months post-operation) of all patients who had open TMJ disc repositioning surgery from January 2016 to June 2021 at one centre through two surgical techniques (OSu and MsA) was performed. The predictor variable was technique (OSu and MsA). Outcome variables were DPS and CBR. During follow-up, DPS was rated as good, acceptable and poor, and CBR was graded as improved, unchanged, and degenerated. Multivariate analysis was used to compare the DPS and CBR at 12 months after adjusting five factors including age, sex, Wilkes stage, preoperative bone status (normal, mild/moderate abnormal) and the degree of disc repositioning (normal, overcorrected, and posteriorly repositioned). Relative risk (RR) for DPS and CBR was calculated by multivariate logistic regression.
RESULTS: Three hundred eighty-five patients with 583 joints were included in the study. MRIs at 12 months showed that 514 joints (93.5%) had good DPS, and 344 joints (62.5%) had improved CBR. Multivariate analysis revealed that OSu had higher DPS (RR=2.95; 95% CI, 1.27-6.85) and better CBR (RR=1.58; 95% CI, 1.02-2.46) than MsA. Among the factors affecting DPS, females had better results than males (RR=2.63; 95% CI, 1.11-6.26) and overcorrected or posteriorly repositioned discs were more stable than normally repositioned discs (RR=5.84; 95% CI, 2.58-13.20). The improvement in CBR decreased with age increasing (RR=0.91; 95% CI, 0.89-0.93). Preoperative mild/moderate abnormal bone status had a higher probability of improved CBR compared to normal preoperative bone status (RR=2.60; 95% CI, 1.76-3.83).
CONCLUSIONS: OSu had better DPS and CBR than MsA. Sex and the degree of disc repositioning impacted DPS, while age and preoperative bone status affected CBR.
摘要：
目的：开放式缝合（OSu）和微型螺钉锚固（MsA）是两种常用的开放式椎间盘复位手术，用于颞下颌关节（TMJ）的前椎间盘移位（ADD）。这项研究评估了单中心两种外科手术之间的椎间盘位置稳定性（DPS）和髁突骨骼重塑（CBR）的差异。
方法：使用磁共振成像（MRI）扫描的回顾性队列研究（术前，术后1周和12个月），对2016年1月至2021年6月在一个中心通过两种手术技术（OSu和MsA）进行了开放TMJ椎间盘复位手术的所有患者进行了手术。预测变量是技术(OSu和MsA)。结果变量为DPS和CBR。随访期间,DPS被评为良好，可接受和差，CBR被评为改进，不变,退化。采用多因素分析比较12个月时的DPS和CBR,包括年龄,性别,威尔克斯舞台,术前骨骼状态（正常，轻度/中度异常）和椎间盘重新定位的程度（正常，过度校正,并向后重新定位)。DPS和CBR的相对风险（RR）通过多变量逻辑回归计算。
结果：385名583个关节的患者被纳入研究。12个月时MRI显示514个关节（93.5%）有良好的DPS，344个关节（62.5%）的CBR有所改善。多变量分析显示，OSu的DPS较高(RR=2.95；95%置信区间[CI]，1.27至6.85）和比MsA更好的CBR（RR=1.58；95CI，1.02至2.46）。在影响DPS的因素中，女性比男性有更好的结果(RR=2.63;95CI,1.11~6.26),并且过度矫正或向后重新定位的椎间盘比正常重新定位的椎间盘更稳定(RR=5.84;95CI,2.58~13.20).CBR的改善随着年龄的增加而降低（RR=0.91；95CI，0.89至0.93）。术前轻度/中度异常骨状态与正常术前骨状态相比，CBR改善的可能性更高（RR=2.60；95CI，1.76至3.83）。
结论：OSu的DPS和CBR优于MsA。性别和椎间盘重新定位的程度影响了DPS，年龄和术前骨骼状态影响CBR。
方法：使用磁共振成像（MRI）扫描的回顾性队列研究（术前，术后1周和12个月），对2016年1月至2021年6月在一个中心通过两种手术技术（OSu和MsA）进行了开放TMJ椎间盘复位手术的所有患者进行了手术。预测变量是技术(OSu和MsA)。结果变量为DPS和CBR。随访期间,DPS被评为良好，可接受和差，CBR被评为改进，不变,退化。采用多因素分析比较12个月时的DPS和CBR,包括年龄,性别,威尔克斯舞台,术前骨骼状态（正常，轻度/中度异常）和椎间盘重新定位的程度（正常，过度校正,并向后重新定位)。DPS和CBR的相对风险（RR）通过多变量逻辑回归计算。
结果：385名583个关节的患者被纳入研究。12个月时MRI显示514个关节（93.5%）有良好的DPS，344个关节（62.5%）的CBR有所改善。多变量分析显示，OSu的DPS较高(RR=2.95；95%置信区间[CI]，1.27至6.85）和比MsA更好的CBR（RR=1.58；95CI，1.02至2.46）。在影响DPS的因素中，女性比男性有更好的结果(RR=2.63;95CI,1.11~6.26),并且过度矫正或向后重新定位的椎间盘比正常重新定位的椎间盘更稳定(RR=5.84;95CI,2.58~13.20).CBR的改善随着年龄的增加而降低（RR=0.91；95CI，0.89至0.93）。术前轻度/中度异常骨状态与正常术前骨状态相比，CBR改善的可能性更高（RR=2.60；95CI，1.76至3.83）。
结论：OSu的DPS和CBR优于MsA。性别和椎间盘重新定位的程度影响了DPS，年龄和术前骨骼状态影响CBR。
