Arthroscopic surgery for the patients of internal derangement with closed lock of the temporomandibular joint

顎関節内障クローズドロック症例にたいして顎関節鏡を使用し良好な結果を得た。対象は3例4関節で男性1例, 女性2例, 平均年齢は23.7歳でありこれらはすべて少なくとも3ヵ月間の保存療法が無効であった症例で術前MR1検査により復位を伴わない関節円板前方転位と診断された。用いた顎関節鏡はストライカー社製のTMJ miniscope systemで, 手術は全例経鼻挿管による全身麻酔下に関節鏡視下剥離授動術を施行した。関節腔内を生食水灌流下に観察し, 癒着病変の除去と同時に下顎の授動操作を十分に行なった後, 関節腔内を生食水にて灌流洗浄し手術を終了した。結果は3症例4関節の全例において関節円板前方転位が認められ, また全例において滑膜炎が認められた。線維性癒着, 軟骨軟化症は1例2関節にみとめられた。いずれの症例でも円板穿孔は認められなかった。術後のMR1所見では関節円板の復位を認めたのは検索した3例中1例のみであった。術前30mm未満であった開口量は術後45mm以上となり, 関節痛は術後ほとんど消失した。顎関節鏡は手術侵襲も少なくクローズドロックに対しその診断ならびに治療に有用であると考えられた。Arthroscopic examination and surgery was performed on 4 joints of the 3 patients with persistent closed lock of the temporomandibular joint (TMJ).The subjects consisted of one male and two females with ages ranging from 16 to 33 years.These patients were diagnosed as internal derangement with anterior disc displacement without reduction that is closed lock by preoperative MRI.They had received nonsurgical treatment at least 3 months before arthroscopic surgery in vain. Lysis and lavage of the upper compartment of the temporomandibular joint was performed on all joints under general anesthesia.Results were as follows : 1.Synovitis as well as anterior disc displacement was noted in all joints.Adhesive lesion or chondromalasia was noted in one case 2 joints. Noperforation of the disc was noted 2.Postoperatively, mean data of range of opening motion was increased from 30 mm to more than 45 mm and functional pain of the TMJ were almost disappeared in all cases.In conclusion, arthroscopy was not only valuable in the treatment of the patients with persistent closed lock but also in the diagnosis and investigation of the joint pathology