Arthrocentesis for the Treatment of Internal Derangement of the Temporomandibular Joint

Objective  

The study aims to evaluate the efficacy of arthrocentesis in the treatment of internal derangement of the temporomandibular joint (TMJ).     

Temporomandibular Joint Arthrocentesis for Internal Derangement with Disc Displacement Without Reduction

Temporomandibular joint (TMJ) disc derangement is defined as a malpositioning of the articular disc relative to the condyle and eminence. Arthrocentesis of the TMJ is a minimally invasive chair side procedure for the patients with TMJ internal derangement. This case report presents convincing results to keep arthrocentesis as an imperative procedure to relieve such patients of their acute symptoms. TMJ dynamics has also been discussed for an in-depth understanding of the pathology in cases with internal derangement.     

颞下颌关节骨关节病关节下腔透明质酸钠治疗对滑液一氧化氮的影响

目的 :研究一氧化氮与颞下颌关节骨关节病的关系以及评价关节下腔透明质酸钠治疗骨关节病的疗效。方法 :采用硝酸还原酶法测定 2 0例颞下颌关节骨关节病造影前、透明质酸钠下腔治疗后滑液一氧化氮水平。临床指标选择开口度和疼痛程度。结果 :无症状志愿者关节滑液未能检测出一氧化氮 ,骨关节病疼痛组滑液一氧化氮水平显著高于无疼痛组 (t =2 .118,P <0 .0 5 )。颞下颌关节下腔透明质酸钠治疗后关节功能得到了改善 ,无疼痛组、疼痛组滑液一氧化氮水平显著下降 (t=2 .839,P <0 .0 5 ;t =3.132 ,P <0 .0 5 )。结论 :一氧化氮可能参与了颞下颌关节骨关节病的病理过程 ,关节下腔透明质酸钠治疗颞下颌关节骨关节病疗效明显     

关节冲洗术治疗颞下颌关节紊乱病的临床研究

目的　观察和评价关节冲洗术治疗颞下颌关节紊乱病 (TMD)的临床效果。方法　对 86例出现急性疼痛、开口受限的TMD患者采用关节冲洗疗法进行治疗 ,比较治疗前后患者张口度和疼痛程度的变化 ,并对两种冲洗方法的效果进行了比较。结果　关节冲洗对恢复张口度和缓解疼痛有显著的疗效 ,两种冲洗方法的疗效无显著差异。结论　关节冲洗对出现关节绞锁症状的TMD患者是一种简便、微创、有效的治疗方法。     

透明质酸钠治疗颞下颌关节不可复性盘前移位的临床观察

目的 探讨透明质酸钠治疗颞下颌关节不可复性盘前移位的临床疗效.方法 34例颞下颌关节不可复性盘前移位患者随机分为试验组和对照组,各17例.试验组关节上腔内注射透明质酸钠注射液1 mL,对照组关节上腔内注射强的松龙注射液12.5 mg.术后0.5 h、1个月观察患者开口度和疼痛情况.结果 张口度和疗效,术后0.5 h,试验组和对照组差异无统计学意义;术后1个月,试验组和对照组差异有统计学意义.结论 透明质酸钠和强的松龙治疗颞下颌关节不可复性盘前移位短期疗效均较好,但长期疗效,透明质酸钠明显优于强的松龙.     

关节腔注射治疗颞下颌关节上腔粘连的临床疗效分析

目的:探讨关节腔注射治疗对颞下颌关节上腔粘连的治疗效果.方法:回顾口腔外科门诊2006年7月至2007年10月接诊的14例进行关节腔注射治疗的颞下颌关节上腔粘连病例,测量治疗前后的最大开口度,进行配对t检验.结果:治愈率57.14%(8/14),有效率71.43%(10/14);治疗前后开口度配对t检验,t=4.441,P=0.001.结论:关节腔注射治疗对关节上腔粘连有一定疗效,长期效果有待进一步观察.     

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。     

透明质酸钠治疗颞下颌关节骨关节病的临床研究

目的:探讨透明质酸钠(Hyaluronate acid,HA)关节腔注射治疗骨关节病的临床效果.方法:选取经过颞下颌关节门诊治疗的早期OA患者20例行关节腔透明质酸钠注射治疗.20例患者中,男性8例,女性12例,年龄从16～68岁,平均年龄35.8岁.所有患者均进行颞下颌关节Fricton指数评价,进行术前及术后评分,并对所有患者术前进行颞下颌关节经颅侧位片及关节造影检查,治疗后6个月、12个月再进行侧位平片检查.结果:20例经HA治疗的早期OA患者,治疗前功能障碍指数0.358,治疗后功能障碍指数0.144,经统计学处理,有统计学意义(P<0.05);治疗前疼痛指数5.96,治疗后疼痛指数1.62,经统计学处理,有统计学意义(P<0.05).X线检查表明治疗前后关节间隙、骨质破坏等方面有明显好转.结论:HA关节腔注射能够有效地减轻早期OA患者的临床症状,阻止OA的进展,使其进入修复稳定期.     

Meniscopexy for Internal Derangement of Temporomandibular Joint

The term internal derangement was first adopted to describe any pathologic entity that interfered with the smooth function of the temporomandibular joint (TMJ). The term is currently used exclusively to describe alterations in disc–fossa relations. Internal derangement of the TMJ does not always cause pain, although when the disc becomes displaced, noises and locking can occur and ligamentous, capsular or retrodiscal pain may dominate the clinical picture. Meniscopexy of TMJ was done in ten patients where clinical features suggest true internal derangement of the TMJ refractory to conservative treatment with restricted movement and pain identified as arising primarily from the joint. Magnetic resonance imaging was done to identify the cause of problem.     

关节冲洗术治疗颞下颌关节紊乱病的实验研究

目的 研究关节冲洗对兔颞下颌关节滑膜炎和骨关节病的治疗作用。方法 用基质金属蛋白酶-1腔内注射制备兔的颞下颌关节骨关节病的动物模型,分为滑膜炎组和骨关节病组,分别行左侧关节上腔冲洗治疗,在不同时期观察关节各成分的组织病理学变化。结果 滑膜炎组左侧关节各时期病变均明显轻于右侧。骨关节病组左侧关节各时期病变均与右侧同步,仅程度稍轻。结论 冲洗治疗对兔颞下颌关节的急性滑膜炎有良好的疗效,对早期骨关节病可抑制其病变发展,促进其自身修复。     

Pterygoid Disjunction for Internal Derangement of Temporomandibular Joint

Aim  

The aim of this study was to clinically evaluate the outcomes of pterygoid disjunction (PD) carried out as the primary treatment modality for reducing disc displacement type of internal derangement (ID) of temporomandibular joint (TMJ) refractory to conservative management and arthrocentesis.     

黏弹性补充疗法治疗颞下颌关节骨关节病的实验研究

目的　通过动物模型观察黏弹性补充疗法治疗颞下颌骨关节病的效果。方法　用基质金属蛋白酶 - 1腔内注射制备兔的双侧颞下颌关节骨关节病的动物模型 ,2 4只兔随机分为 3组。A组行冲洗治疗 ,B组行黏弹性补充治疗 ,C组二者联合应用。分别于建模后 2、3、4周对左侧关节治疗 3次 ,右侧为对照。第 8周末处死动物 ,切取双侧关节 ,苏木精 伊红染色 ,光镜观察。结果　A组左侧关节病变与右侧差异无显著性。B组和C组左侧关节病变明显轻于右侧。C组的病变比B组轻。结论　黏弹性补充疗法能抑制骨关节病的发展 ,与关节冲洗术联合应用有协同作用。     

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。     

Efficacy of Temporomandibular Joint Arthrocentesis with Sodium Hyaluronate in the Management of Temporomandibular Joint Disorders: A Prospective Randomized Control Trial

Purpose

This study was designed to investigate the efficacy of the temporomandibular joint arthrocentesis with and without injection of sodium hyaluronate (SH) in the treatment of temporomandibular joint disorders.

Patients and Methods

A total of sixty two TMJs in 34 males and 28 females aged 20–65 years comprised the study material. The patients’ complaints were limited mouth opening, TMJ pain, and joint noises during function. Patients were randomly divided into 2 groups in which arthrocentesis plus intra-articular injection of sodium hyaluronate was performed in 1 group and only arthrocentesis was performed in the other group. Both groups contained patients with disc displacement with reduction and without reduction. Clinical evaluation of the patients was done before the procedure, immediately after the procedure, at 1 week and 1, 3 and 6 months postoperatively. Intensity of TMJ pain was assessed using visual analog scales. Maximal mouth opening and lateral jaw movements also were recorded at each follow-up visit.

Results

Both techniques increased maximal mouth opening, lateral movements, and function, while reducing TMJ pain and noise.

Conclusions

Although patients benefitted from both techniques, arthrocentesis with injection of SH seemed to be superior to arthrocentesis alone.

     

透明质酸钠治疗颞下颌关节骨关节病的动物实验研究

目的:评价透明质酸钠对山羊颞下颌关节骨关节病的治疗效果。方法:对8只山羊的双侧颞下颌关节上腔一次性注射胶原酶而诱导骨关节病病变。分2组,4只/组。治疗组,透明质酸钠关节上腔封闭;对照组,关节上腔注射生理盐水。3月后处死,对髁突应用光镜和扫描电镜观察。结果:在光镜和扫描电镜下观察,对照组的髁突、关节盘、关节凹表现为骨关节病变化,治疗组骨关节病表现不明显。结论:通过3个月的观察和研究,证明透明质酸钠关节上腔封闭对颞下颌关节骨关节病具有显著疗效。