使用II类弹性牵引治疗复发性库存颞下颌关节假体后脱位：一例病例报告及文献综述。
Management of recurrent posterior dislocation of a stock temporomandibular joint prosthesis using class II elastic traction: A case report and literature review.
文献信息
| PMID | 42826289 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Liwei Huang |
| 作者单位 | State Key Laboratory of Oral Diseases and National Center for Stomatology and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China. |
| 期刊 | Medicine |
| SCI 分区 | Q2 |
| IF | 2.1 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
理由： 全颞下颌关节置换术（TMJR）后下颌骨组件脱位不常见，但可能难以处理，因为手法复位可能失败，且可能复发。
患者关注： 一名25岁女性，患有双侧髁突吸收、下颌后缩、II类错𬌗和重度阻塞性睡眠呼吸暂停，接受了双侧库存TMJR及同期正颌手术。
诊断： 左侧下颌骨组件在术中发生后脱位，经手法复位。术后第1天和术后第37天后脱位复发。
干预： 手法复位失败后，进行了翻修手术以重新定位左侧下颌骨组件。在术后第37天复发后，连续应用II类弹性牵引22天。
结果： II类弹性牵引恢复了满意的咬合和下颌位置，无需进一步手术。在6个月随访时，患者维持了稳定的咬合和面部轮廓，最大开口度为35毫米，影像学显示髁突-窝假体位置稳定。文献综述确定了10篇出版物，涉及57例围手术期假体脱位患者；64.3%的脱位在术中检测到，35.7%在术后检测到。
教训： TMJR后可能发生复发性脱位，尤其是在广泛的下颌重新定位和术后肌肉不稳定之后。及时识别、适当的假体重新定位和术后弹性牵引可能降低复发风险并避免额外手术。
英文摘要
RATIONALE: Dislocation of the mandibular component after total temporomandibular joint replacement (TMJR) is uncommon but can be difficult to manage because manual reduction may fail, and recurrence can occur.
PATIENT CONCERNS: A 25-year-old woman with bilateral condylar resorption, mandibular retrognathia, class II malocclusion, and severe obstructive sleep apnea underwent bilateral stock TMJR and concomitant orthognathic surgery.
DIAGNOSES: Posterior dislocation of the left mandibular component occurred intraoperatively and was manually reduced. Posterior dislocation recurred on postoperative day 1 and again on postoperative day 37.
INTERVENTIONS: After unsuccessful manual reduction, revision surgery was performed to reposition the left mandibular component. Following the recurrence on postoperative day 37, continuous class II elastic traction was applied for 22 days.
OUTCOMES: Class II elastic traction restored satisfactory occlusion and mandibular position without the need for further surgery. At the 6-month follow-up, the patient maintained stable occlusion and facial profile, a maximum mouth opening of 35 mm, and stable condyle-fossa prosthesis positioning on imaging. The literature review identified 10 publications involving 57 patients with perioperative prosthesis dislocation; 64.3% of the dislocations were detected intraoperatively and 35.7% postoperatively.
LESSONS: Recurrent dislocation may occur after TMJR, particularly following extensive mandibular repositioning and postoperative muscular instability. Prompt recognition, appropriate prosthesis repositioning, and postoperative elastic traction may reduce the risk of recurrence and avoid additional surgery.