目的:评价肋软骨移植(CCG)治疗颞下颌关节强直(TMJA)的疗效。
方法:将2010.5至2021.7接受CCG治疗的TMJA患儿纳入研究。手术前后进行CT扫描,随访至少1年。下颌支的高度,menton偏差或缩回,截骨间隙,等。采用ProPlanCMF1.4软件进行测量。CCG增长,再吸收,和复发的影响因素进行评估和分析,如年龄,手术间隙,等。通过广义估计方程。
结果:研究中有24名患者(29个关节),平均年龄为6.30±3.13岁。手术后,下颌支延长5.97±3.53毫米。下颌偏斜或前缩分别校正4.82±2.84mm和3.76±2.97mm。平均随访38.91±29.20个月,CCG增长58.62%(4.18±7.70mm),吸收20.69%(2.23±1.16mm),和20.69%的人重新安稳。强直与截骨间隙呈负相关(OR:0.348,0.172-0.70295CI,临界值=6.10mm)。CCG吸收与CCG支伸长距离呈正相关(OR:3.353,1.173-9.58695CI,临界值=7.40mm)。
结论:足够的截骨间隙和CCG支延伸距离是成功治疗TMJA伴颌骨畸形患者的关键因素。
结论:TMJA影响小儿患者的张口和颌骨发育。儿童患者最常见的自体骨移植物是CCG,由于其生长潜力,方便的访问和容易的轮廓。此外,它可以通过延长下颌支同时重建TMJ并改善颌骨畸形。但是CCG的增长是不可预测的。在这项研究中,我们探讨了可能影响CCG吸收和再强直的几个因素,以期为今后CCG治疗提供几点改进建议。
OBJECTIVE: To evaluate the effects of costochondral grafting (CCG) used for temporomandibular joint ankylosis (TMJA) in growing patients.
METHODS: Pediatric patients with TMJA treated by CCG from 2010.5 to 2021.7 were included in the study. CT scans were performed before and after operations with at least 1 year follow-up. The height of the mandibular ramus, menton deviation or retraction, osteotomy gap, etc. were measured by ProPlan CMF1.4 software. CCG growth, resorption, and relapse were evaluated and analyzed with influencing factors such as age, ostectomy gap, etc. by generalized estimating equation.
RESULTS: There were 24 patients (29 joints) with an average age of 6.30 ± 3.13 years in the study. After operation, the mandibular ramus was elongated by 5.97 ± 3.53 mm. Mandibular deviation or retrusion was corrected by 4.82 ± 2.84 mm and 3.76 ± 2.97 mm respectively. After a mean follow-up of 38.91 ± 29.20 months, 58.62% CCG grew (4.18 ± 7.70 mm), 20.69% absorbed (2.23 ± 1.16 mm), and 20.69% re-ankylosed. The re-ankylosis was negatively correlated with the osteotomy gap (OR:0.348,0.172-0.702 95%CI, critical value = 6.10 mm). CCG resorption was positively correlated with the distance of CCG ramus elongation (OR:3.353,1.173-9.586 95%CI, critical value = 7.40 mm).
CONCLUSIONS: An adequate osteotomy gap and CCG ramus elongation distance are the key factors for successful treatment of TMJA with jaw deformities in growing patients.
CONCLUSIONS: TMJA affects mouth opening and jaw development in pediatric patients. The most common autogenous bone graft for pediatric patients is CCG due to its growth potential, convenient access and easy contouring. Also, it can simultaneously reconstruct the TMJ and improve jaw deformity by lengthening the mandibular ramus. But the growth of CCG is unpredictable. In this study, we explored several factors that may affect the absorption and re-ankylosis of CCG, expecting to provide several suggestions to improve future CCG treatment.