稳定性(牙合)垫治疗颞下颌关节可复性盘前移位的疗效分析

目的:分析稳定性(牙合)垫治疗颞下颌关节可复性盘前移位的疗效.方法:使用Michigan型稳定性(牙合)垫治疗颞下颌关节盘前移位患者32例,疗程为3个月,采用Fricton指数来评价治疗效果.治疗前后均拍摄许勒位X线片以及行关节上腔造影.结果:统计学分析表明治疗前后存在有显著性差异(P=0.02),Fricton颞下颌关节紊乱指数(CMI)从治疗前的0.21±0.04下降到治疗后的0.09±0.03.但造影显示并非所有弹响消失患者的盘-突关系均恢复正常.结论:稳定性牙合垫治疗颞下颌关节可复性盘前移位取得了良好的治疗效果,能有效地消除弹响,缓解疼痛,改善患者的下颌运动功能.     

2种不同牙合垫治疗颞下颌关节紊乱病的临床疗效分析

目的:对比分析稳定型牙合垫和再定位牙合垫对治疗颞下颌关节紊乱病的临床疗效。方法:对采用牙合垫治疗的32例颞下颌关节紊乱病患者进行随访分析,其中使用稳定型牙合垫治疗的病例18人,再定位牙合垫14人,对比分析2组患者在治疗前、治疗后、治疗后3个月、6个月、12个月时关节弹响、疼痛程度(VAS)的变化。结果:2组患者治疗后疼痛程度及关节弹响状况与术前比较均明显改善,差异均有统计学意义(P<0.05),两种牙合垫对关节弹响的治疗效果无显著性差异,稳定型牙合垫组患者治疗后及治疗后3个月、6个月、12个月时的VAS低于再定位牙合垫组,差异有统计学意义(P<0.05)。结论:2种牙合垫均可有效地治疗颞下颌关节紊乱病,再定位牙合垫主要用于治疗可复性关节盘前移位,稳定型牙合垫治疗关节疼痛的疗效优于再定位牙合垫。     

不可复性盘前移位颞下颌关节镜术后(牙合)垫治疗评价

目的对比评价关节镜手术加或不加(牙合)垫治疗颞下颌关节盘不可复性前移位的效果.方法一组(40例)应用关节镜手术(灌洗加松解术)治疗关节盘不可复性前移位,另一组(40例)则在关节镜手术后配合(牙合)垫治疗.结果随访2年,术后3个月时两组患者(VAS法)疼痛缓解程度均值分别为1.8、 2.5, 6个月时分别为3.2、 4.8, 1年时分别为5.6、 5.8, 2年时分别为6.0、 6.2;张口度增加均值分别为3个月时5.6 mm、 7.8 mm, 6个月时为8.2 mm、 9.7 mm, 1年时为9.4 mm、 9.8 mm, 2年时为9.7 mm、 10.2 mm,其中术后3、6个月时疼痛及张口度改变均具有统计学意义(P＜0.01),而1年、2年时疼痛、张口度改变对比均不具显著性差异.结论关节镜下行灌洗加松解术,并行(牙合)垫治疗关节盘不可复性前移位短期疗效(3～6个月)较单纯采用关节镜下行灌洗加松解术效果好,而术后1～2年疗效差异不大.     

调(牙合)治疗颞下颌关节疼痛的临床分析

目的了解颞下颌关节疼痛患者的(牙合)状况,解除(牙合)干扰.方法通过面弓转移,记录正中关系,上(牙合)架,对18例颞下颌关节疼痛的患者进行了(牙合)干扰分析.结果调(牙合)对颞下颌关节疼痛与(牙合)干扰改善明显,(牙合)干扰的解除可以明显地减轻疼痛.结论调(牙合)是改善颞下颌关节疼痛的一个可行方法.     

颞下颌关节紊乱病与错(牙合)畸形特征的关系

颞下颌关节紊乱病（temporomandibular disorders,TMD）是累及颞下颌关节区和（或）咀嚼肌及相关结构的一组疾病,临床表现为关节区和（或）咀嚼肌的疼痛、开闭口运动时关节弹响及张口受限。干扰被认为是TMD主要致病因素之一,错(牙合)畸形的许多特征也被认为与TMD相关。文章回顾以往国内外相关领域研究,对TMD与错(牙合)畸形特征的关系做一阐述。     

不同(牙合)型患者正畸术前颞下颌关节X线表现

目的：调查不同[牙合]型患者正畸术前颞下颌关节（TMJ）的X线特征.方法：随机抽样观察110例口腔正畸患者行TMJ许氏位平片观察,了解不同咬合关系时TMJ的X线特征及其差异性.结果：正畸治疗前关节影像出现异常改变的发生率较高（63.6%）,关节影像异常改变在不同[牙合]型有明显差异性.结论：错[牙合]畸形可能导致关节影像的异常改变.     

颞颌关节功能紊乱的牙合垫式义齿治疗

目的 观察(牙合)垫式义齿在老年牙列缺损伴(牙合)磨耗引起TMD的修复效果。方法 87例TMD病例,男54例,女33例,年龄58～75岁。面下1/3变短,深覆(牙合)且伴有TMD症状,经升高咬合后采用(牙合)垫式义齿修复,并对治疗前后关节间隙变化进行统计学分析。结果 用(牙合)垫式义齿修复能使TMJ,(牙合),肌肉协调一致,治疗TMD效果好。结论 部分牙列缺损伴有重度(牙合)磨耗的TMD患者,(牙合)垫式义齿修复是一种有效的治疗方法。     

再定位■垫治疗颞下颌关节盘绞锁的临床疗效评估及磁共振成像表现

目的观察再定位■垫治疗颞下颌关节盘绞锁患者的临床疗效,探讨磁共振成像(MRI)在疗效评估中的作用。方法 40例颞下颌关节盘绞锁患者,接受再定位■垫治疗6个月前后,对其最大张口时疼痛程度、关节弹响和下颌运动功能进行测量分析,并通过MRI比较治疗前后的关节盘长度和盘-髁距离。结果 40例颞下颌关节盘绞锁患者经过再定位■垫治疗后,最大张口疼痛程度VAS分值显著下降,关节弹响显著减少,下颌运动功能明显改善,MRI扫描测量关节盘长度变化不明显,盘-髁距离显著缩小。结论颞下颌关节盘绞锁患者,戴用再定位■垫治疗,可取得满意的临床疗效,并可在MRI影像学解剖结构测量中得到验证。     

暂时性绞锁颞下颌关节的运动特征研究

目的：本研究观察分析了暂时性绞锁颞下颌关节髁状突的运动轨迹特征。方法：对9名可复性盘前移位伴暂时性绞锁患以MT－1602下颌三维运动轨迹描记仪记录髁状突的运动数据,动态观察锁结和非锁结时的髁状突运动扫描轨迹。结果：发现锁结和非锁结时髁状突循两条不同路径滑动。结论：前移位关节盘后带在不同位置对髁状突阻力不一样,神经肌肉的功能状态在前移位关节盘的发展中不可忽视。     

下颌三维定位技术指导下稳定型殆垫治疗颞颌关节紊乱病的疗效分析

目的：探讨超声三维下颌定位技术指导下修正性调磨的骀垫对TMD的临床疗效。方法：本研究从北京口腔医院颞颌关节门诊2003年3月～2008年12月就诊的患者选用40例（男12例女28例）颞颌关节病并有关节绞锁的患者,超声三维下颌定位仪中的髁突运动中心电子位置分析（electronicpositionanalysis,EPA）检测指导下进行修正性调磨骀垫治疗后,比较治疗前后下颌运动程度如张口度、关节绞锁运动、弹响和下颌运动疼痛的变化情况。结果：本研究发现超声三维下颌定位技术指导下修正性调磨的殆垫治疗后,下颌运动明显改善,张口运动及被动最大张口度治疗前后均有显著性差异;绞锁运动症状明显改善。并有统计学差异。结论：超声三维下颌定位技术指导下修正性调磨的黯垫治疗TMD,能够改善TMD症状,在治疗绞锁运动方面有显著疗效。     

Natural course of acute closed lock of the temporomandibular joint

To clarify the features of acute closed lock of the temporomandibular joint we compared the clinical condition of patients with acute and chronic closed lock, and investigated the natural history of acute closed lock. Forty patients with unilateral acute closed lock who were given no treatment and 40 patients with unilateral chronic closed lock were enrolled in the study. The duration of locking in those with acute closed lock ranged from 1 to 7 days, and that of those with chronic closed lock from 3 to 4 months. Differences between the groups in sex, age, maximum mouth opening, and joint pain were analysed. In those with acute closed lock who had had no treatment, maximum mouth opening and joint pain were measured at the initial visit and after 2, 4, 8, and 12 weeks. The number of dysfunctional joints was counted during each period and the natural course of the acute closed lock investigated. There were more women and older patients among those with chronic, than among those with acute, closed lock. We found no significant differences in the symptoms in the two groups. After 2 weeks of allowing the acute closed lock to take its natural course only 15 of the 40 had not resolved successfully, and after 12 weeks of taking its natural course only 2 had been unsuccessful. The number of joints that did not resolve successfully decreased progressively over time. Any treatment for acute closed lock should be easier and more effective than that of following its natural course.     

Arthroscopic management of temporomandibular closed lock

Sixty-three consecutive patients with painful closed lock involving 83 temporomandibular joints were treated by surgery and followed up for at lest 24 months. Prior to surgical treatment all had imaging to demonstrate that the cause of their painful jaw locking was an anterior displaced disc without reduction. All patients had received at least three months non-surgical treatment without response. The arthroscopic surgery consisted of release of adhesions, manipulation and placement of 25 mg hyaluronic acid into the joint space. No significant surgical complications occurred. Postoperative treatment involved physical therapy and stabilization splints. At 24 months after surgery 57 patients (90.5 per cent) had no pain and mouth opening had improved from preoperative 27.2±5.4 mm to 44.4±4.1 mm (p<0.001). This study shows that arthroscopic surgery with continuing non-surgical therapy is a highly effective treatment for painful closed lock.     

Arthroscopic management of temporomandibular closed lock

Sixty-three consecutive patients with painful closed lock involving 83 temporomandibular joints were treated by surgery and followed up for at lest 24 months. Prior to surgical treatment all had imaging to demonstrate that the cause of their painful jaw locking was an anterior displaced disc without reduction. All patients had received at least three months non-surgical treatment without response. The arthroscopic surgery consisted of release of adhesions, manipulation and placement of 25 mg hyaluronic acid into the joint space. No significant surgical complications occurred. Postoperative treatment involved physical therapy and stabilization splints. At 24 months after surgery 57 patients (90.5 per cent) had no pain and mouth opening had improved from preoperative 27.2±5.4 mm to 44.4±4.1 mm (p<0.001). This study shows that arthroscopic surgery with continuing non-surgical therapy is a highly effective treatment for painful closed lock.     

Effects of four treatment strategies for temporomandibular joint closed lock

A previous randomized controlled trial (RCT) by Schiffman et al. (2007)¹⁵ compared four treatments strategies for temporomandibular joint (TMJ) disc displacement without reduction with limited mouth opening (closed lock). In this parallel group RCT, 106 patients with magnetic resonance imaging (MRI)-confirmed TMJ closed lock were randomized between medical management, non-surgical rehabilitation, arthroscopic surgery, and arthroplasty. Surgical groups also received rehabilitation post-surgically. The current paper reassesses the effectiveness of these four treatment strategies using outcome measures recommended by the International Association of Oral and Maxillofacial Surgeons (IAOMS). Clinical assessments at baseline and at follow-up (3, 6, 12, 18, 24, and 60 months) included intensity and frequency of TMJ pain, mandibular range of motion, TMJ sounds, and impairment of chewing. TMJ MRIs were performed at baseline and 24 months, and TMJ tomograms at baseline, 24 and 60 months. Most IAOMS recommended outcome measures improved significantly over time (P ≤ 0.0003). There was no difference between treatment strategies relative to any treatment outcome at any follow-up (P ≥ 0.16). Patient self-assessment of treatment success correlated with their ability to eat, with pain-free opening ≥35 mm, and with reduced pain intensity. Given no difference between treatment strategies, non-surgical treatment should be employed for TMJ closed lock before considering surgery.     

颞下颌关节盘绞锁的自然病程探讨

目的 定期追踪随访颞下颌关节盘绞锁患者,初步了解关节盘绞锁的自然病程和转归.方法 初诊为关节盘绞锁的68例患者中,54例进行24个月的电话追踪随访.根据绞锁的病程发展分为:症状进展组(即发生不可复性盘前移位)、症状消失组、症状持续组,并用统计学方法分析组间年龄、性别、病程、有无疼痛和绞锁发生频率间有无差异.结果 54例随访患者中,症状进展组16例(30%),症状持续组32例(59%),症状消失组6例(11%);3组患者的性别、年龄、初诊时有无疼痛和绞锁发生的频率比较,差异均无统计学意义(P>0.05).结论 关节盘绞锁患者发生不可复性盘前移位的风险增大;关节盘绞锁发展为不可复性盘前移位与患者的性别、年龄、病程、有无疼痛和绞锁频率似无关,有待扩大样本量后进一步研究.

Abstract：

Objective To investigate the clinical natural course of temporomandibular joint(TMJ) intermittent closed lock(ICL) through 24 months follow-up. Methods Sixty-eight patients with ICL were included, and 54 patients finished 24 months follow-up. The disease duration, frequency of joint lock and joint pain were recorded at the patient′s first visit. Telephone interviews were taken for every month, and the frequency of joint lock and joint pain were recorded. According to the development of ICL, the patients were divided into 3 groups: symptom-worsened group, symptom-disappeared group, symptom-persisted group. Results There were 16 patients(30%) whose symptoms worsened into closed lock (disk displacement without reduction), 32 patients(59%) whose symptoms persisted during the 24 months follow-up, and 6 patients′(11%) symptoms disappeared. In symptom-persisted group,the frequency of joint lock decreased in 11/32(34%), increased in 4/32(13%), did not change in 17/32(53%).There was no significant difference in gender, age, frequency of joint lock and joint pain recorded at the first visit among these 3 groups(P>0.05).The disease duration in the symptom-disappeared group was much shorter than the other 2 groups (P<0.05). Conclusions ICL of TMJ was more likely to get worse into closed lock. There seemed no significant relation between the sequelaes of ICL and patients′ gender, age, disease duration, frequency of joint lock and joint pain, and larger sample studies were necessary.     

防粘连冲洗液灌洗治疗闭口绞锁的短期疗效

目的：探讨羧甲基壳聚糖防粘连冲洗液在治疗颞下颌关节闭口绞锁中的临床疗效.方法：将临床检查与（magnatic resonance imaging）MRI检查符合闭口绞锁诊断的患者168例随机分为两组,采用Nitzan报告的关节灌洗治疗方法,分别对患者进行氯化钠灌洗及羧甲基壳聚糖防粘连冲洗液灌洗治疗,对患者术前、术后6个月的疼痛及张口度变化进行统计学分析.结果：在年龄分布,绞锁时间,关节疼痛的VAS值及张口度方面,治疗前两组患者差异无统计学意义.氯化钠冲洗组成功率61.9％（52/84）,羧甲基壳聚糖防粘连冲洗液冲洗组成功率72.6％ （61/84）,氯化钠冲洗组失败的32例患者中,30例患者平均年龄38.6岁,平均绞锁时间大于7个月,羧甲基壳聚糖防粘连冲洗液冲洗组失败的23例患者中,平均年龄39.1岁,平均绞锁时间大于8个月.虽上述两组失败患者的平均年龄与治疗成功患者的平均年龄（26.8岁及27.1岁）差异无统计学意义,但年龄大及绞锁时间长的患者疗效较差,无论是VAS值还是张口度,两组在治疗前后比较差异均有统计学意义;组间比较发现,两组VAS值术后均有明显减小且两组间差异无统计学意义（P＞0.05）.但在张口度改善方面.羧甲基壳聚糖防粘连冲洗液冲洗组术后张口度增大明显大于氯化钠冲洗组（P＜0.05）.结论：在关节灌洗中,选用羧甲基壳聚糖防粘连冲洗液进行冲洗,可有效消除疼痛、增加张口度,从而恢复下颌功能.对于羧甲基壳聚糖防粘连冲洗液的长期疗效有待进一步研究.     

Timing interventions in relation to temporomandibular joint closed lock duration: a systematic review of ‘locking duration’

Temporomandibular joint (TMJ) ‘closed lock’ (CL) is a clinical condition causing TMJ pain and limited mouth opening (painful locking) that is mostly attributed to disc displacement without reduction (DDwoR), or less commonly to anchored disc phenomenon (ADP). Both conditions are described clinically as CL that can be ‘acute’ or ‘chronic’ depending on the duration of locking. There is, however, no consensus about the duration of locking that defines the acute state and its effect on the success of interventions. This review paper, therefore, aims to provide: (i) a narrative review of the pathophysiological need for early intervention in DDwoR and the clinical implications of acute/chronic CL stages on the management pathway; (ii) a systematic review investigating the effects of locking duration on the success of interventions for CL management. Electronic and manual searches until mid‐August 2013 were conducted for English‐language studies of any design investigating the effects of non‐surgical and surgical interventions for acute or chronic CL (DDwoR or ADP). A total of 626 records were identified, and 113 studies were included. Data extraction and quality assessment were completed for all included studies. Included studies were, however, heterogeneous and mostly of poor‐quality leading to contradictory and inconsistent evidence on the effect of the duration of locking on treatment outcomes. Future high‐quality trials investigating the effect of CL duration on treatment outcome are needed. At present, early intervention by ‘unlock’ mandibular manipulation seems to be the most practical and realistic approach that can be attempted first in every CL patient as an initial diagnostic/therapeutic approach.     

稳定咬合板和再定位咬合板治疗青少年颞下颌关节盘间断性锁结的临床疗效评价

目的:比较稳定咬合板和再定位咬合板进行治疗对于青少年颞下颌关节盘间断性锁结患者的临床应用疗效.方法:将40例青少年颞下颌关节盘间断性锁结患者,随机分为两组,分别戴用稳定咬合板和再定位咬合板进行治疗3-6个月,记录治疗前后关节疼痛指数、关节弹响及主动开口度;并比较MRI影像检查中关节盘-髁突距离在治疗前、后的变化.结果:...