慢性再発性顎関節脱臼に対する関節穿刺と自己血注入の臨床的およびX線学的結果

Clinical and radiological outcome of arthrocentesis followed by autologous blood injection for treatment of chronic recurrent temporomandibular joint dislocation.

抄録

背景:

本研究は、慢性再発性顎関節脱臼の管理に対する関節腔への自己血注入(ABI)に続く関節包埋術の機能的転帰とMRI所見を評価するために実施された。

BACKGROUND: This study was conducted to evaluate the functional outcome and MRI findings of arthrocentsis followed by autologous blood injection (ABI) into the joint space for management of chronic recurrent TMJ dislocation.

材料と方法:

両側慢性再発性顆部脱臼患者計10名を対象とした。各患者に対して両顎関節穿刺を行い、その後、上関節区画に2ml、関節包外表面に1mlの自己血液を注入した。術前および術後の評価として、病歴聴取、顎関節の臨床検査、最大開口度、脱臼の頻度、顎関節X線写真（開口位および閉口位）、MRI、再発および顔面神経麻痺の有無を行った。

MATERIAL AND METHODS: Total ten patients with bilateral chronic recurrent condylar dislocation were included in the study. Arthrocentesis of both TMJ was performed on each patient, followed by the injection of 2 ml of autologous blood into the superior joint compartment and 1 ml onto the outer surface of the joint capsule. Preoperative and postoperative assessment included; thorough history, clinical examination of TMJ, maximal mouth opening, frequency of dislocation, TMJ radiographs (open and closed mouth position), MRI, recurrence and presence of facial nerve paralysis.

結果:

3ヵ月後の経過観察では、8例（80％）がそれ以降脱臼を起こすことなく良好な結果を得たが、2例は再発を認めた。術後MRIでは、術前MRIと比較してABI後の有意な改善が認められた。顎関節の骨および軟部組織に退行性変化は認められなかった。

RESULTS: At the end of 3 months follow-up 8 patients (80%) had successful outcome with no further episodes of dislocation, whereas two patients reported with recurrence. Post-operative MRI showed significant improvement after ABI, compared to pre-operative MRI. There were no degenerative changes to the bony and soft tissue components of TMJ.

結論:

ABIは、慢性再発性顎関節脱臼の治療において、簡便、安全、低侵襲で費用対効果の高い手技である。MRI評価では、顎関節の骨性組織と軟部組織の解剖学的および空間的関係の改善が認められた。顎関節洗浄、脱臼、線維症、MRI。

CONCLUSIONS: ABI is a simple, safe, minimally invasive and cost-effective technique for treatment of chronic recurrent TMJ dislocation. MRI evaluation showed an improvement in the anatomical and spatial relationship of the osseous and soft tissue components of the TMJ. TMJ lavage, luxation, fibrosis, magnetic resonance imaging.