两种颞下颌关节盘复位固定术治疗不可复性盘前移位效果比较研究OA

Objective To compare the efficacy of temporomandibular joint disc anchorage(TMJ-DA)with that of tem-poromandibular joint disc reduction and suture(TMJ-DRS)in the treatment of anterior disc displacement with-out reduction(ADDWoR).Methods A retrospective analysis of the clinical and imaging data of 67 ADDWoR patients(88 surgical sides)was conducted,who underwent disc repositioning and fixation surgery of temporomandib-ular joint in the Department of Oral and Maxillofacial Sur-gery,Hospital of Stomatology,the Air Force Military Medical University from January 2023 to June 2024.Based on the surgical technique,patients were divided into the TMJ-DA group(32 patients,41 surgical sides)and the TMJ-DRS group(35 patients,47 surgical sides).Intraoperative parameters and postoperative recovery indices-including operative time,intraoperative blood loss,postoperative drainage volume,postoperative hospitalization days,incidence of facial nerve in-jury and incidence of temporary occlusal disorder-were compared between the two groups.Temporomandibular joint(TMJ)mobility parameters(maximum mouth opening,protrusive movement,left lateral movement,right lateral move-ment)and visual analog scale(VAS)pain scores were also compared;disc length,condylar height,and disc repositioning outcomes(categorized as excellent,good,or poor)were compared preoperatively and at the 1-year follow-up.Results The incidence of temporary temporal branch injury of the facial nerve was higher in the TMJ-DA group(18.75％,6/32)than in the TMJ-DRS group(2.86％,1/35)(x2=4.434,P=0.035).No statistically significant differences were found be-tween the two groups in other intraoperative or postoperative recovery indices(all P＞0.05).No significant differences were observed in TMJ mobility parameters or VAS scores between the two groups at the same time points(preoperatively or 1 year postoperatively)(all P＞0.05).However,both groups showed significant improvement in all TMJ mobility pa-rameters and VAS scores at 1 year postoperatively compared to their preoperative baselines(all P＜0.05).Preoperative disc length and condylar height showed no significant intergroup differences(all P＞0.05).Both parameters improved significantly at 1 year postoperatively compared to preoperative values within each group(all P＜0.05).At the 1-year fol-low-up,no significant intergroup differences were found in disc length or disc repositioning outcomes(P＞0.05).Howev-er,condylar height in the TMJ-DA group[(22.15±1.91)mm]was smaller than that in the TMJ-DRS group[(23.06±1.58)mm](t=-2.428,P=0.017).Conclusion Both TMJ-DA and TMJ-DRS are effective surgical techniques for managing ADDWoR.Compared to TMJ-DA,the TMJ-DRS technique demonstrates advantages in preserving facial nerve function and condylar height remodeling.