颞下颌关节脱位PPT课件

.,1,颞下颌关节脱位,2,.,DislocationofCondyle,髁突,dis+location,髁突滑出关节窝超越了正常限度不能自行复位,3,.,部位,单侧双侧,性质,急性复发性陈旧性,髁突脱出方向,前方后方上方侧方,外力损伤,分类,4,.,急性前脱位,病因etiology,颞下颌关节紊乱病咀嚼肌紊乱关节结构紊乱关节解剖异常关节结节过高关节结节前斜面过陡外力作用关节部颏部医源性因素全麻插管,Acuteforwarddislocation,5,.,正常关节运动,6,.,关节脱位,7,.,急性前脱位,临床表现,双侧脱位单侧脱位,8,.,开口状不能闭口垂涎欲滴语音、咀嚼、吞咽障碍,前牙开合、反合后牙早接触,脸型变长,video,双侧脱位,9,.,耳屏前凹陷,X-ray,双侧脱位,10,.,单侧脱位,video,11,.,脸型变长颏中线偏健侧,耳屏前凹陷,下颌中线偏健侧合关系紊乱,单侧脱位,12,.,13,.,鉴别诊断,下颌骨髁颈骨折,外伤史临床症状,髁颈压痛皮下血肿单侧骨折下牙中线偏患侧双侧骨折前牙开合,X线检查可确诊,14,.,囊内（移位，脱位）,颈部（移位，脱位）,颈部（移位少）,颈下（无移位）,颈下（脱位）,15,.,治疗原则,及时复位手法复位:口内复位口外复位固定,16,.,手法复位1：患者体位,17,.,手法复位2：医生体位,18,.,口内法复位1,19,.,口内法复位2,20,.,1,4,3,2,口内法复位3,21,.,复位前,复位后,22,.,口外手法复位,23,.,习惯性脱位Habitualdislocation,复发性脱位,病因,Recurrentdislocation,急性脱位未正确治疗长期翼外肌功能亢进关节结构松弛老、弱、病患,24,.,硬化疗法注射疗法-5%鱼肝油酸钠50%葡萄糖关节上腔滑膜下注射-关节镜手术治疗,复发性脱位的治疗,25,.,关节镜滑膜下硬化疗法,26,.,Normal,OA,ID(stageIII),Normal,27,.,双线平行缝合技术-关节盘复位固定（特有，107/137，02）射频消融术（21/137）,28,.,29,.,Withdrawneedleoutofdickorretrodickaltissue(donotoutofthelateralcapsule)InsertneedleposteriorrecessInsertneedlewithsuturehock(now)orforceps(before)thoughearcanalincision,Pushsuturehock,capturesuture,androtatesuturehock,andlocksuture.Withdrawneedleofsuturehockwithsutureoutofearcanalincision,Completewholeonesutureprocedure,andthen,dosecondsuture.Ifnecessary,thirdsutureiscarriedout.,first,Second,30,.,Pre-,Post-,31,.,first,first,second,Putsuturetiresbelowtheauricularcartilage,32,.,33,.,Pre-operativediskposition,Post-,Question1:howtoevaluatepre-andpost-operationdiscpositionsbyMRISagittal:Lateral1/3orcentral1/3ormedial1/3Chooseanyonetocompare,ortwo,orthree(myfavor)Coronal:which1/3?Central(myfavor),34,.,关节结节凿平术,35,.,关节结节增高术,关节结节“骨折”术,（DautreyProcedure）,36,.,关节镜手术,限制髁突运动,翼外肌切断术,去除解剖性阻挡因子,关节结节骨折(Dautrey),关节结节凿平术,关节结节增高术(植骨或钛板),复发性脱位,硬化疗法缝合牵引复位,37,.,陈旧性脱位,急性脱位数周未复位关节周围软组织增生咀嚼肌痉挛,病因,