摘要　目的：为颞下颌关节肿瘤的治疗及关节重建提供一定的理论依据。材料和方法：对16只未成年日本大耳白兔的右侧髁状突施行了冷冻再植术。术后所有动物正常存活，第2、4、8、12周分别处死4只动物。采用常规组织学、扫描电镜及微血管显像等对髁状突和关节盘进行观察。结果：组织学检查发现随着血供逐渐恢复，失去活力的骨被新骨“爬行替代”，而髁状突软骨的结构未完全恢复；扫描电镜检查证明了关节盘下腔面的表面结构基本正常，实验后期髁状突的表面较光滑，但无明显胶冻样物；微血管显像显示冷冻再植髁状突逐渐再血管化。16只动物中有3只的手术侧颞下颌关节发生轻度粘连。 结论 这些结果证明:髁状突冷冻再植在颞下颌关节重建时有应用的可行性。

The changes of temporomandibular joint following reimplantaion

　　of freeze-treated mandibular condyles.

Fang Pingke, Zhao Yifang.

　　College of Stomatology, Hubei Medical University, Wuhan, 430070

　　Abstract Objective：This study was undertook to provide one of the rationale for reconstruction of temporomandibular joint suffering from tumor.Materials and Methods： Sixteen juvenile Japanese large ear rabbits were used in this study. The right mandibular condyles of the animals were resected, freeze-treated and reimplantated. All the animals survived without postoperative complications. The animals were sacrificed at the 2, 4, 8 and 12 weeks after the operation, respectively, and each group included four animals. Condyles and discs were examined by histopathology, scanning electron microscopy and microangiography.Results： The histologic examination exhibited creeping substitution of the newly formed bone for devitalized bone and incomplete reconstruction of the condylar cartilage layers as the implanted condyles were gradually revascularized. The scanning electron microscopy examination displayed no significant changes of the inferior surface of the discs, and smoother surface of the condyles with a little gelatinous substance at the later period of the experiment. Slight fibrous adhesions between the disc and condyle of the operated side occurred in three animals. The microangiography demonstrated the revasularization of the frozen and reimplanted condyles.Conclusion: These results indicate that the technique in this experiment is practicable for reconstruction of the temporomadibular joint.

　　Key words　Condyle　Freezing　Reimplantation

　　颞下颌关节髁状突的肿瘤并非罕见，主要包括来源于髁状突本身的原发性良、恶性肿瘤［1，2］，也有原发于下颌骨体及升支部扩展至髁状突的肿瘤。鉴于冷冻在治疗身体其他部位肿瘤有肯定的疗效［3～6］，因而，如果能将发生肿瘤或被肿瘤侵及的髁状突切除，体外冷冻后再植入体内，维持其良好的解剖结构，则可能为一部分颞下颌关节肿瘤的治疗及关节重建开辟一个新方法。

　　本实验的目的是探讨髁状突切除、冷冻、再植入体内后的愈合机理，为该区肿瘤的治疗及关节重建提供一个理论依据。

　　材料和方法

　　1. 动物及手术方法

　　16只同窝群的日本大耳白兔，兔龄为3个月，体重约为2.0公斤。右侧颞下颌关节为实验侧，左侧为对照侧。戊巴比妥钠（30mg/公斤体重）静脉麻醉，术区脱毛及常规消毒铺巾后，右侧颌后颌下皮肤切口，分离颊侧软组织及骨膜，暴露出下颌升支外侧面及后缘。自乙状切迹中点至下颌角稍上方设计一斜行截骨线。在其两侧分别钻孔以供骨间固定，然后截骨，游离并取出髁状突，液氮（-196.6℃）冷冻10分钟，室温下解冻15分钟，共两个冻融周期。第二次复温后再植入原位，不锈钢丝骨间栓结，分层缝合伤口。术后第七天拆线。

责任编辑：韩晓炜