颞下颌关节脱位医学PPT课件.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,颞 下 颌 关 节 脱 位,Dislocation of,Condyle,髁突,dis,+location,髁突滑出关节窝,超越了正常限度,不能自行复位,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,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,Acute forward dislocation,正常关节运动,关节脱位,急性前脱位,临床表现,双侧脱位,单侧脱位,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,耳屏前凹陷,X-ray,双侧脱位,单侧脱位,video,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,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,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）,治疗原则,及时复位,手法复位,:,口内复位,口外复位,固定,手法复位,1,：患者体位,手法复位,2,：医生体位,口内法复位,1,口内法复位,2,1,4,3,2,口内法复位,3,复位前,复位后,口外,手法复位,习惯性脱位,Habitual,dislocation,复发性脱位,病 因,Recurrent dislocation,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,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,关节镜滑膜下硬化疗法,Normal,OA,ID(stage,III,),Normal,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,Withdraw needle out of dick or,retrodickal,tissue(do not out of the lateral capsule),Insert needle posterior recess,Insert needle with suture hock(now)or forceps(before)though ear canal incision,Push suture hock,capture suture,and rotate suture hock,and lock suture.,Withdraw needle of suture hock with suture out of ear canal incision,Complete whole one suture procedure,and then,do second suture.,If necessary,third suture is carried out.,first,Second,Pre-,Post-,first,first,second,Put suture tires below the auricular cartilage,Pre-operative disk position,Post-,Question 1:,how to evaluate pre-and post-operation disc positions by MRI,Sagittal,:Lateral 1/3 or central 1/3 or medial 1/3,Choose any one to compare,or two,or,three(my favor),Coronal:which 1/3?,Central(my favor),关节结节凿平术,关节结节增高术,关节结节,“,骨折”术,（,Dautrey,Procedure,）,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,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,治 疗,手术复位,下颌制动,N,D,P,思考题,简述颞下颌关节脱位的定义和分类,试述急性前脱位的病因、临床表现和治疗方法,请谈谈口内法关节复位的操作注意点,