关节腔冲洗并透明质酸钠注射治疗TMD临床观察

目的：观察颞颌关节上腔冲洗加透明质酸钠注射治疗颞下颌关节紊乱病(TMD)的疗效。方法：对46例TMD患者关节上腔使用生理盐水反复加压冲洗，然后注射透明质酸钠4～6ml。2周后复诊、观察治疗效果。结果：结构紊乱类显效10例；好转6例，无效2例；骨关节病类显效2例，好转3例，无效1例。炎性疾病类显效6例，好转12例，无效4例。结论：该疗法对结构紊乱类疾病，骨关节病的疗效较好，对炎性疾病的疗效欠佳。     

关节上腔留注透明质酸钠治疗TMJID的疗效观察

目的 观察颞颌关节内紊乱(TMJID)病例行关节上腔灌洗后留注透明质酸钠的疗效,并与强的松龙作对照。方法 80例颞颌关节内紊乱病例随机分为两组,生理盐水关节上腔灌洗后吸干,分别注入1ml透明质酸钠和强的松龙,术前,术后1周和4周各记录最大开口度,疼痛指数,弹响及饮食习惯。结果 基于上述四项指标的总有效率,术后1周透明质酸钠组为97.5％(39/40),强的松龙组为82.5％(33/40),统计学上有显著差异(P<0.05);术后4周透明质酸钠组为97.5％(39/40),强的松龙组为77.5％(31/40),统计学有非常显著差异(P<0.01)。透明质酸钠组无1例术后疼痛加剧,强的松龙组有70％(24/40)术后1～3天内出现疼痛加重。结论透明质酸钠是一种可替代类固醇,安全而副作用少的关节功能改善剂。     

透明质酸钠在治疗颞下颌关节紊乱综合征中的作用

透明质酸是关节液的主要成分之一.本研究采用透明质酸钠作关节上腔注射治疗了31例颞下颌关节紊乱综合征患者,取得了良好的治疗效果.以生理盐水上腔注射作为对照.两者差异有高度显著性(P<0.01),其中透明质酸对早期的不可复性关节盘移位的疗效尤为满意.作者认为,这除了因为透明质酸减少了关节内摩擦力外,还可能与它阻止软骨基质蛋白多糖分解,促进了滑膜功能恢复等作用有关.     

透明质酸钠关节腔内注射治疗颞下颌关节紊乱病的疗效分析

目的　比较透明质酸钠颞下颌关节上腔注射和上下腔注射对颞下颌关节紊乱病的疗效。方法　纳入294 例颞下颌关节紊乱病患者,随机分为两组。一组186例采用颞下颌关节上腔注射透明质酸钠,另一组108例采用上下腔注射。用回顾性队列研究方法比较两组疗效的差异。结果　上下腔注射组患者开口度平均增加6·29 mm,上腔注射组平均增加3·82 mm,两组间有显著差异(P=0·001)。上下腔注射组患者关节疼痛平均缓解44%,关节上腔注射组平均缓解37%,两组间有显著差异(P=0·039)。结论　透明质酸钠注射对颞下颌关节紊乱病确有疗效,其中关节上下腔同时注射较单纯上腔注射可更有效缓解患者的关节疼痛和改善张口度,该趋势在骨关节炎和关节盘不可复性前移位患者更为明显。     

关节上腔冲洗加封闭治疗颞下颌关节紊乱病的疗效观察

目的　评价关节上腔冲洗加封闭治疗颞下颌关节紊乱病的临床疗效。方法　用生理盐水反复冲洗关节上腔 ,然后注射糖皮质激素。共治疗 35例 TMD患者。结果　随访 6— 40个月 ,张口度平均增加 7.5 mm(P<0 .0 1) ,88.2 % (30 / 34)的病人疼痛缓解 ,72 .2 % (13/ 18)的病人弹响消失 (或好转 )。总有效率为 82 .9% (2 9/ 35 )。结论　关节上腔冲洗加封闭治疗颞下颌关节紊乱病是种有效的治疗方法。     

关节腔冲洗治疗颞下颌关节紊乱病疗效观察

目的 观察关节腔冲洗治疗颞下颌关节紊乱病的疗效。方法 对68例颞下颌关节紊乱病患者的关节腔内使用大量生理盐水反复冲洗后，注入1％醋酸曲安缩松0．5ml和2％利多卡因0．5ml混合液，两周后复查，观察治疗效果。结果 结构紊乱病显效3例，好转11例，无效4例；滑膜炎显效8例，好转14例，无效1例；骨关节病显效5例，好转11例，无效3例。结论 该疗法对结构紊乱病患者疼痛和开口受限有较好的疗效，但对盘移位引起的弹响则效果欠佳。激素的使用不宜次数过多，应有一定的适应症。     

透明质酸钠关节下腔注射治疗颞下颌关节盘前移位的疗效分析

目的：探讨透明质酸钠治疗颞下颌关节盘前移位的临床疗效。方法：50例患者临床表现与核磁共振成像检查确诊为颞下颌关节盘前移位（可复性或不可复性）,进行关节下腔灌洗及透明质酸钠注射治疗.观察分析治疗前、治疗1、2、3次和治疗后3个月临床疗效和Helkimo指数分析。结果：治疗1、2、3次、治疗后3个月与治疗前相比较,临床疗效及Helkimo指数差异有统计学意义（P〈0.05）,治疗3次与治疗后3个月差异无统计学意义。结论：应用透明质酸钠关节腔注射治疗颞下颌关节盘前移位具有良好的效果,治疗效果稳定。     

(牙合)垫合并透明质酸钠关节腔注射治疗TMD的初步临床研究

目的：观察殆垫对于治疗TMD的疗效。关节腔内药物注射治疗对于he垫治疗的影响。方法：记录TMD病人口内he情况及咀嚼习惯，取模，记录并转移颌位关系。然后在模型上制作稳定型及诱导型he垫，戴人患者口内。部分患者同时进行药物注射治疗。通过短期随访观察疗效。结果：1)单纯采用he垫治疗的患者中，70．3％的TMD症状都有不同程度的好转。2)采用殆垫和药物共同治疗的患者，其效果比单纯用he垫治疗效果好(89．7％／70.3％)。结论：1)殆垫治疗TMD是一种较为有效的方法。2)殆垫与药物共同治疗TMD可能具有协同作用。     

关节内封闭治疗TMD疗效对比

颞下颌关节紊乱病是颞下颌关节常发疾病之一。临床治疗多以全身用药及理疗封闭为主。笔者自2001～2005年采用醋酸强的松龙与透明质酸钠关节内封闭治疗80余例颞下颌关节紊乱病，疗效显著。临床效果明显优予传统方法，现报告如下：     

氦-氖激光与关节上腔封闭治疗颞下颌关节紊乱病疗效观察

目的:总结He-Ne激光照射与关节上腔加翼外肌痛点封闭交替治疗颞下颌关节紊乱病的临床疗效。方法:采用低功率He-Ne激光照射与关节上腔加翼外肌痛点封闭交替治疗颞下颌关节紊乱病80例,分析治疗效果。并与传统的翼外肌痛点封闭治疗40例进行疗效对比观察。结果:激光结合关节上腔加翼外肌痛点封闭的治疗效果(95`0％)明显优于传统的翼外肌痛点封闭治疗组(80.0％),两组间痊愈率及总有效率统计学差异显著(P<0.05)。结论:He-Ne激光照射与关节上腔加翼外肌痛点封闭交替进行是治疗颞下颌关节紊乱病的有效方法。     

Relationship between the TMJ disc and condyle position on MRI and occlusal contacts on lateral excursions in TMD patients

Confusion about the relationship between dental occlusion and the temporomandibular disorders (TMD) has been evident in the literature for many years. Previous studies have supported the concept of a multifactorial aetiology of TMD, the occlusal factor in general being of minor importance. The purpose of the study was to investigate the relationship between condyle and disc positions and occlusal contacts on lateral excursions of the mandible in patients with TMD. A total of 122 temporomandibular joints (TMJs) of 61 patients with TMD were evaluated using magnetic resonance imaging (MRI) and occlusal analyses were made clinically. Non-working-side contacts were found to be statistically significant in TMJ anterior disc displacement. No significant statistical correlation was found between the severity of anterior disc displacement and non-working-side contacts in both canine guidance and group function occlusions. There was no correlation between non-working-side contacts and condyle positions in both occlusion types in the present study. It was concluded that non-working-side contacts had some effect on disc position in TMD, however the presence of these contacts in both canine guidance and group function occlusions did not correlate with anterior disc displacement in TMD statistically. Therefore, non-working-side contacts are not to be regarded as the prime cause of anterior disc displacement.     

山羊颞下颌关节盘细胞肌动蛋白骨架的研究

目的:通过激光扫描共聚焦显微镜(Laser Scanning Confocal Microscope,LSCM)研究原代及传代山羊颞下颌关节盘细胞骨架(Cytoskeleton,CSK)蛋白-肌动蛋白的形态及蛋白量的改变,以说明关节盘细胞随着传代的发生,细胞骨架蛋白-肌动蛋白的差异。方法:原代(P0)山羊颞下颌关节盘细胞及传代1、2、3、4(P1、P2、P3、P4)代的关节盘细胞,分别接种在有方形盖玻片的6孔板中制作细胞爬片。对各代关节盘细胞肌动蛋白骨架进行免疫荧光染色,利用激光共聚焦显微镜获取各代关节盘细胞肌动蛋白的形态,同时利用荧光强度测定软件对各代关节盘细胞肌动蛋白荧光量进行测定。结果:丝状的肌动蛋白主要沿着细胞膜外围均匀排列,随着传代丝状结构逐渐清晰,且逐渐增粗,P4代时形成较粗的纤维束。荧光强度整体趋势是随着传代荧光量表达是递增的,P3代以内没有统计学差异,而在P4代时统计学差异明显。结论:肌动蛋白骨架随着传代过程形态学上发生了改变,在P4代时可见骨架蛋白形成较粗的纤维束,荧光量表达同其他代细胞差异明显,这为以后工程化颞下颌关节盘种子细胞的选择提供了依据。     

Relationship between horizontal condylar angle and radiographically detectable morphological changes of the condyle in asymptomatic and symptomatic patients with TMD

BackgroundThe relationship between horizontal condylar angle (HCA) measurements and radiographically detectable morphological changes of the condyle in patients with temporomandibular disorder (TMD) is an area of controversy in dentistry.AimThis study sought to determine the effect of the HCA on radiographically morphological changes in the condyles of asymptomatic and symptomatic patients with TMD.Material & methodsCone beam computed tomography (CBCT) scans were used of patients with 146 temporomandibular joints (TMJ) with and without symptoms of TMD. The reconstructed axial plane was adjusted to depict the condyle in maximum width. The HCA was established and measured as the angle formed between the condylar long axis intersecting with the coronal plane. Each condyle long axial was determined independently from the other joint by two oral and maxillofacial radiologists. The average of the readings from the two examiners was used for statistical analysis.ResultsBased on the clinical symptoms, the mean of the HCA in the symptomatic joint was 27.69°, which was slightly greater than the angle measured in asymptomatic patients of 25.6°; however, this was not a statistical difference. No significant differences existed in the mean of the HCA between the joint with and without radiographic arthritic findings in both groups. In both groups, none of the arthritic findings manifested in the affected joint that had influenced the HCA.ConclusionThe HCA was increased in the symptomatic group but had no direct influence on joint's morphological changes in the asymptomatic and symptomatic patients.     

The Effect of Experimental Anesthetization of the Temporomandibular Joint Superior Cavity on Bite Force Discrimination

The purpose of this study was to determine whether bilateral experimental sensory impairment of the temporomandibular joints (TMJs), as induced by injecting 1.5 ml of two percent mepivacaine into the superior cavity of the TMJs would alter the subject's ability to discriminate among differences in their bite force. Assessment of bite force was measured isometrically, using the strain gauge scale, and isotonically, using the mechanical swing beam scale. Resistance forces of 500 and 1000 gms were selected as standards. For each task, subjects were given a series of paired resistance settings, one at a time, the first of each pair being the standard resistance and the second being a comparator resistance of some greater amount. Subjects reported whether biting against the comparator resistance was equal to, greater than, or less than the standard resistance. This procedure of paired comparisons was continued until the subject's threshold of discrimination (difference limen value) between two biting forces was established. The results revealed that the subject's ability to discriminate differences in their bite force, either isometrically or isotonically, was not significantly (p > 0.05) affected following anesthetization of the superior cavity of the TMJs. These findings suggest that the sensory receptors within the TMJ capsules are not significantly involved in the detection of forces that play a role in monitoring biting force.