| 摘要 |
FIELD: medicine.SUBSTANCE: diagnose a patient with internal disorders of the temporomandibular joint with the determination method of magnetic resonance imaging of soft tissue structures, the image of the masticatory muscles and the meniscus with its borders, relations intra-disk and condyle, the provisions of the joint head in the glenoid fossa, displaceability intra-articular disc and condyle lower jaw, as well as the optimal position of presaturation area. Administered to a patient per day before the surgery as sedation receiving seduxen or phenazepam in the amount of 0.001 g twice a day, as well as in severe pain for non-narcotic analgesics, perform preoperative sedation in the normal way. Carry on the skin marking points of the introduction of two joint lavage needle drawn through the middle of the tragus of the ear tragoorbital line to the outer edge of the eye socket. Perform local anesthetic in the projection of the head of TMJ subcutaneous administration of 0.5-1.5 ml of 2% lidocaine solution containing 0.5 ml of 0.1% solution of adrenaline. With the patient lying on his back joint lavage introduced the first needle into the cavity of the temporomandibular joint in the back of the upper joint space by 12 mm front and 2 mm below tragoorbital line and filling the cavity of 0.5-1.5 ml of 2% lidocaine hydrochloride containing 0.5 ml of a 0.1% solution of epinephrine. Enter the second joint lavage needle into the upper joint space of the temporomandibular joint in the front and 20-22 mm 8-10 mm below tragoorbital line in front of the superior articular spaces. Carry out basic joint lavage the active movement of the lower jaw of the patient with 200-400 ml of Ringer's solution. Enter into a processed joint lavage TMJ implant joint fluid, perform positioning in the patient's mouth occlusion stabilizing device with the imposition of a pressure bandage for up to 6 hours after surgery. Thus use two joint lavage needle. Perform an extra joint lavage cavity TMJ Ringer's solution in an amount of 20 ml, containing 0.05% solution of cyanocobalamin in the amount of 0.5 ml. An implant articular fluid prepared before use from previously taken from the patient's vein for 1-1.5 hours before surgery 17-19 ml of autologous blood, which is centrifuged at 2300 rev / min for 7-8 minutes to release the supernatant as autologous patient plasma enriched in growth factors for synoviocytes. Then, from the top half of the depleted synoviocytes growth factors, the volume of the supernatant was taken 4-6 ml and perform final joint lavage cavity of the temporomandibular joint. Remove from the cavity of the temporomandibular joint second joint lavage needle and the cavity of the temporomandibular joint immediately fill just made gel implant joint fluid, and the gel implant joint fluid contains taken from the lower half of the enriched growth factors synoviocyte amount of supernatant in a volume of 2 ml, to which was further added 1% calcium chloride solution in an amount of 0.01 ml to obtain ready for immediate use gel implant articular fluid.EFFECT: method can reliably reduce the risk of manifestation of the main symptoms of temporomandibular joints, to ensure a sufficient degree of recovery of own layer of synoviocytes temporomandibular joint, restore the balance of degenerative and regenerative processes in the cavity of the temporomandibular joint, as well as reliably reconstruct the kinematics of the movement of the lower jaw of the patient.2 cl, 3 ex |
