颞下颌关节灌洗术与扩张术治疗不可复性关节盘前移位的对比研究

目的采用颞下颌关节上腔灌洗术与扩张术治疗不可复性关节盘前移位,通过对比评价两种方法的临床疗效。方法收集62例不可复性关节盘前移位引起张口受限的患者,分成两组,其中一组31例行关节上腔灌洗治疗;另一组31例行关节上腔扩张术,分析两组治疗前与治疗后1月患者张口度与疼痛值的变化情况并对其结果进行处理。结果两组患者治疗后的张口度与疼痛均较治疗前有显著改善,治疗后1个月,灌洗组患者的平均张口度增加11～34mm,达正常水平;扩张组的平均张口度增加6～29mm,仍处在张口受限的水平。两组患者张口度的改善有显著差异(P<0.01)。疼痛的改善在两组患者之间无显著差异。结论颞下颌关节灌洗术与扩张术均能改善不可复关节盘前移位患者的张口度,缓解疼痛。灌洗术的疗效较扩张术的疗效显著,不可复性关节盘前移位患者的治疗可遵循由简单到复杂,由创伤小到创伤大的顺序治疗方法。     

应用颞颌关节镜治疗颞颌关节盘前移位的临床研究

目的：探讨颞颌关节镜治疗颞颌关节不可复性盘前移位的临床应用效果。方法：对98例颞颌关节不可复性盘前移位患者分别采用颞颌关节镜进行关节盘前松解复位灌洗、关节上腔粘连松解灌洗、单纯关节上腔灌洗等治疗方法,通过观察疼痛程度、张口度及侧向运动度的改变,评价其临床疗效。结果：灌洗治疗后患者张口度、侧向运动度和疼痛程度较治疗前均明显改善。关节盘前松解复位灌洗组和粘连松解灌洗组治疗后疼痛减少值、张口度及侧向运动度增加值明显高于单纯灌洗组。关节盘前松解复位灌洗组在张口度增加值及疼痛减少值的改变优于粘连松解灌洗组。结论：关节上腔灌洗可以作为颞颌关节内紊乱疾病的有效治疗方法,而针对不可复性盘前移位的患者,颞颌关节镜下关节盘前松解复位灌洗治疗则具有更好的疗效。     

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.     

手法复位结合稳定型咬合板治疗急性颞下颌关节盘不可复性前移位的疗效观察

目的 探讨对急性颞下颌关节盘不可复性前移位保守治疗的认识及治疗策略的选择.方法 总结2018年5月—2020年5月本院颞下颌关节专科门诊诊治的20例急性颞下颌关节盘不可复性前移位患者,行手法复位结合稳定型咬合板治疗,3个月后对所有患者的关节盘复位情况和最大主动张口度进行评价,采用SPSS 24.0对数据进行检验分析.结果 20例患者最大主动张口度明显改善,由治疗前的(27.15±5.91)mm增加到(41.35±4.82)mm;20例患者在治疗结束后复查MRI显示关节盘复位13例(占65％),仍然不可复性盘前移位7例(35％).治疗3个月后最大主动张口度以及关节盘复位情况的比较,差异有统计学意义.结论 手法复位结合稳定型咬合板治疗急性颞下颌关节盘不可复性前移位可以有效恢复患者张口度,改善关节功能以及对于恢复盘-髁关系有较明显的效果.     

医用几丁糖治疗颞下颌关节不可复性盘前移位的临床研究

目的　观察医用几丁糖关节腔内注射对颞下颌关节不可复性盘前移位的临床治疗效果。方法　将30例颞下颌关节不可复性盘前移位患者 ,按就诊序号半随机分为试验组和对照组。试验组患者用几丁糖 1 0ml关节上腔注射治疗 ,对照组患者用强的松龙悬液 1 2 5mg关节上腔注射。注射治疗后 1d、1 4d复诊 ,测量最大张口度。结果　注射后 1 4d ,试验组患者平均张口度恢复到 (36 73± 4 6 9)mm ,比注射前增加 1 1 73mm ;对照组患者平均张口度为 (2 8 5 3± 5 81 )mm ,比注射前增加 3 86mm。试验组张口度增加值明显大于对照组 (P <0 0 5 )。结论　医用几丁糖是一种有效的治疗颞下颌关节不可复性盘前移位的生物材料。     

颞下颌关节上腔封闭-扩张联合灌洗及粘弹补充治疗不可复性关节盘前移位

目的评价颞下颌关节上腔封闭-扩张术联合灌洗及粘弹补充疗法治疗不可复性关节盘前移位的临床效果.方法对29例不可复性关节盘前移位患者行关节上腔封闭-扩张治疗,3～5d后行灌洗术,结束时注入1%透明质酸钠1ml.在治疗的同时配合被动张口训练.以配对t检验对数据进行处理.结果封闭-扩张术后张口度及健侧侧向运动度较治疗前、灌洗及粘弹补充治疗术后张口度及健侧侧向运动度较灌洗术前均有显著增加(P＜0.01),疼痛基本消失.治疗过程中有5例患者出现健侧关节疼痛,经用封闭-扩张治疗后疼痛消失,张口度相应增加3～5mm.结论(1)颞下颌关节上腔封闭-扩张联合灌洗及粘弹补充疗法能有效改善不可复性关节盘前移位患者的张口度及侧向运动度,缓解关节疼痛.(2)封闭-扩张术与灌洗及粘弹补充疗法两者有互补及累加作用.(3)及时发现对侧关节的隐匿病变并进行治疗,能提高整体疗效.     

颞颌关节上腔灌洗术治疗不可复性关节盘前移位的临床研究

目的：评价颞下颌关节穿刺灌洗术治疗不可复性关节盘前移位的临床疗效。方法：关节上腔灌洗术治疗30例因不可复性关节盘前移位而引起张口受限的患者。结果：张口受限病程在6个月之内，关节冲洗疗效显著。结论：关节上腔灌洗术所需器械价廉易得，操作简单，疗效显著，在我国目前关节镜的普及率较低的情况下，具有较好的临床应用价值。     

透明质酸钠关节腔注射联合牙合垫治疗不可复性关节盘前移位的疗效评价

目的:评价关节腔注射透明质酸钠联合稳定性牙合垫治疗颞下颌关节不可复性盘前移位的临床疗效。方法:将在郑州市口腔医院就诊的40例不可复性盘前移位的患者随机分为实验组和对照组,实验组采用关节上腔注射透明质酸钠联合稳定性牙合垫治疗,对照组采用单纯的关节上腔注射透明质酸钠治疗,对比分析两组患者在治疗前、治疗后、治疗后3个月、6个月时的Friction颞下颌关节紊乱指数、疼痛视觉模拟评分(VAS)和最大开口度。结果:两组患者治疗后开口度、疼痛程度及颞下颌关节紊乱症状及体征与术前比较均明显改善,差异均有统计学意义(P<0.05)。实验组与对照组患者治疗后同时点比较,张口度差异不明显(P>0.05)。实验组患者治疗后及治疗后3、6个月时VAS、颞下颌关节紊乱指数(craniomandibular index ,CMI)和颞下颌关节功能障碍指数(dysfunction index , DI)低于对照组,差异均有统计学意义(P<0.05)。结论:关节上腔注射透明质酸钠联合牙合垫治疗颞下颌关节不可复性盘前移位疗效优于单纯的关节上腔注射治疗透明质酸钠。     

颞下颌关节灌洗术治疗不可复性关节盘前移位的临床研究

目的 评价颞下颌关节上腔灌洗术治疗不可复性关节盘前移位的临床疗效。方法 ３８例因不可复性关节盘多位引起张口受限的患者行关节上腔灌洗治疗,分析治疗不同时期患者的疼痛值、下颌运动度变化,通过关节造影判定治疗前后关节盘位置的变化。结果 治疗后不同时期的下颌运动均较治疗前的显著增加（Ｐ〈０．００１）,特别在治疗后１个月内增加明显,疼痛亦有显著缓解（Ｐ〈０．０１）。关节造影显示仅有２患者的关节盘部分复位。结     

颞下颌关节紊乱病磁共振诊断的研究

目的:研究MRI对颞下颌紊乱病诊断的准确性和可信性.方法:利用MRI对19例单侧关节疼痛颞下颌关节紊乱病(TMD)患者38侧关节完成开闭口斜矢状位T1和T2加权成像,观察盘突关系、盘形态改变及关节腔内积液情况.利用关节镜诊断为金标准判定MRI诊断的准确率.同期行灌洗术治疗,分析治疗前后不同时期患者的疼痛值(疼痛直观模拟标尺VAS)变化.结果:MRI检查结果显示在患侧89.47%(17/19)显示不可复性关节盘移位,10.53%(2/19)显示可复性关节盘移位,47.37%(9/19)关节上腔前隐窝出现积液.在健侧15.79%(3/19)显示可复性关节盘移位,无不可复性关节盘移位和腔内积液出现.通过关节镜手术对患侧进行检查,关节盘移位在MRI片上均得到证实,MRI检查的准确率为100%,灌洗术后疼痛100%有显著缓解(P<0.001).结论:颞下颌关节紊乱病与关节盘移位和腔内积液密切相关,通过MRI检查可以准确有效的对颞下颌紊乱病进行诊断,灌洗术对关节疼痛治疗效果显著.     

Natural course of disc displacement with reduction of the temporomandibular joint: changes in clinical signs and symptoms.

PURPOSE: The goal of this study was to examine the natural course of disc displacement with reduction in the temporomandibular joint (TMJ). PATIENTS AND METHODS: This retrospective study involved 24 patients who had been diagnosed with disc displacement with reduction of the TMJ, but who had not undergone any treatment. The extent of maximal mouth opening, protrusion, lateral excursions, noise of the TMJ, pain of the TMJ, and tenderness of masticatory muscles were recorded monthly for a mean of 25.8 months. RESULTS: Maximal mouth opening, protrusion, and lateral excursions remained unchanged during follow-up. TMJ pain decreased by 15.7% (P >.05). Clicking decreased by 20.8% (P <.05), and tenderness of masticatory muscles decreased by 33.3% (P <.05). Reciprocal clicking remained unchanged in 19 patients (79.2%) and disappeared in 5 patients (23.8%). Four patients (16.7%) in whom clicking disappeared had a normal mouth opening, but locking developed in 1 patient (4.2%). CONCLUSIONS: In patients with disc displacement with reduction who do not undergo treatment, range of movement remains unchanged over time. Tenderness of masticatory muscles tended lessen, but reciprocal clicking and TMJ pain tended to remain. Clicking did not progress to locking in most patients.     

Sound analysis of temporomandibular joint internal derangements with phonographic recordings

STATEMENT OF PROBLEM: Temporomandibular joint (TMJ) sound recordings could be analyzed to assess the state of TMJ internal derangements. PURPOSE: The aim of the study was to assess the value of sound analysis in the diagnosis of the type of the TMJ internal derangements. MATERIAL AND METHODS: After clinical and radiologic examinations, phonographic sound recordings on mandibular excursions were obtained in 52 patients with TMJ internal derangements and 12 control individuals. Sound correlations were made on the basis of opening-closing, protrusive-retrusive, and lateral excursions of the mandible. RESULTS: Clicking was a consistent finding of anterior disc displacement with reduction, whereas crepitation was found in varying degrees in anterior disc displacement and osteodegenerative arthritis. Silent TMJs were the feature of normal TMJs, except for the situations of acute lock. Although in 29 TMJs opening click was followed by a closing click (reciprocal clicking), 46 TMJs with opening click also had clicking on protrusion. On the other hand, 19 TMJs with opening click also had clicking on ipsilateral motion, and 40 TMJs with opening click had clicking on contralateral motion of the mandible. The sound patterns were found to be similar in opening-protrusive clicks and opening-contralateral clicks. The lack of protrusive clicking in the presence of opening click was considered an indication of late disc reduction on opening. Crepitation was observed in advanced cases of TMJ internal derangements. CONCLUSION: Within the limitations of this study, the results suggest that TMJ sound analysis on mandibular excursions was indicative for diagnosis and establishment of severity of TMJ internal derangements. Clicking and crepitation may be looked on as signs of abnormal joint disorder, clicking indicating anterior disc displacement with reduction, and crepitation, indicating progression from anterior disc displacement without reduction to osteodegenerative arthritis.     

Flexure deformation in temporomandibular joint disk displacement without reduction may predict treatment outcome

To identify whether the direction of disk flexure deformation predicts the prognosis in cases of anterior disk displacement without reduction of painful temporomandibular joint (TMJ), the relationship between the direction of flexure, observed on pseudodynamic magnetic resonance (MR) images, and the outcome of conservative treatment using a flat occlusal splint was analysed in 40 female patients who perceived occasional or constant pain at unilateral TMJ with disk displacement without reduction. From the MR findings, 20 patients were classified as having upward flexure deformation of the disk and 20 as having downward flexure deformation. Patients' TMJ pain, masticatory muscle pain, amount of maximal mouth opening, and MR findings were evaluated before treatment. All patients were treated with a flat occlusal splint for 6 months. The patients' signs and symptoms were analysed statistically within each group before treatment and 3 and 6 months afterwards, and were also compared between the upward and downward flexure groups. There was no statistical difference between the groups before treatment, except in the amount of maximal mouth opening and the extent of disk displacement. The upward flexure group had persistent TMJ pain and tendency of delayed alleviation of masticatory muscle pain compared with the downward flexure group, although maximal opening gradually increased in both groups. Thus, the direction of the flexure in deformation of the disk, which can be observed only with pseudodynamic MR imaging, may predict the prognosis of painful disk displacement without reduction following treatment with a flat occlusal splint.     

改良后牙咬合板治疗颞下颌关节盘不可复性前移位的效果评价

目的:探讨改良后牙咬合板治疗颞下颌关节盘不可复性前移位的临床效果.方法:随机选取2016年10月-2017年10月在广州医科大学附属口腔医院就诊的颞下颌关节盘不可复性前移位患者89例作为研究对象,其中,男18例,女71例,年龄16～59岁.患者分为2组,第1组47例,治疗方案为配戴改良后牙咬合板;第2组42例,治疗方案...     

关节盘前移位患者的关节音分析

目的比较关节盘前移位（ADD）患者和正常人开闭口运动中颞下颌关节（TMJ关节音的振动参数,探讨关节音频谱图的临床诊断价值。方法运用关节音分析仪记录43例ADD患者和15例正常人的TMJ表面振动参数,收集关节振动信号并进行提取处理和统计学分析。结果（1）病例组两侧TMJ的振动总能量、小于300Hz的振动能量、大于300Hz的振动能量、峰振幅均明显大于对照组（P〈0.01）;（2）不可复性盘前移位者关节振动能量及峰振幅明显低于可复性盘前移位者（P〈0.05）;（3）关节音频谱图对ADD的诊断灵敏度、特异性较高（分别为87.5%和86.7%）。结论ADD患者关节音振动的各个参数明显高于正常人,不同病变阶段的关节音亦不同,通过分析TMJ音频谱图,可能有助于鉴定异常关节音所属的病变阶段,有望成为ADD的无创辅助诊断和早期筛查方法。     

小针刀联合运动疗法治疗颞下颌关节盘不可复性前移位的效果评价

目的 评价小针刀联合运动疗法治疗颞下颌关节盘不可复性前移位的临床疗效。方法 选取32 例颞下颌关节盘不可复性前移位患者,随机分为实验组（16例）和对照组（16例）,2组患者均接受健康指导、手法复位、运动训练,实验组同时给予小针刀治疗。治疗前和治疗后3、6个月,比较分析2组患者疼痛视觉模拟评分（VAS）、最大开口度（maximum mouth opening, MMO）、Fricton颞下颌关节紊乱指数;MRI检查治疗后3、6个月时2组患者的颞下颌关节盘-髁关系。采用SPSS 19.0软件包对数据进行统计学分析。结果 对照组治疗前平均MMO为 25.95 mm,治疗结束后增大到 38.71 mm,3 个月和 6 个月复诊时平均MMO分别为38.94和38.94 mm;实验组治疗前平均MMO为 26.3 mm,联合治疗结束后增大到41.06 mm,3 个月和 6 个月复诊时分别为41.04和41.19 mm。对照组16例患者治疗前VAS为 3.93,治疗后降为1.60,3个月、6个月复诊时分别降为1.18、0.62;实验组联合治疗前VAS为4.063,治疗后降为0.80,3个月、6个月复诊时分别降为0.375、0.25。治疗后3个月和6个月比较,2组患者Fricton颞下颌关节紊乱指数明显改善,治疗前、后及2组间治疗效果有显著差异（P<0.05）。MRI检查提示,2组患者治疗前均诊断为不可复性关节盘前移位。3个月时,对照组16例患者中,6例为可复性关节盘前移位;6个月时,3例患者复发为不可复性关节盘前移位。实验组患者复位后3个月复查时有5例为可复性关节盘前移位,6个月时不可复性关节盘前移位患者为2例。经统计学分析,2组患者颞下颌关节盘-髁关系比治疗前均显著改善（P<0.05）,治疗后2组间治疗效果无显著差异（P>0.05）。结论 小针刀联合运动疗法较单纯运动疗法治疗颞下颌关节盘不可复性前移位效果更理想。     

Follow-up Examination of the Temporomandibular Joint Disk After Splint Therapy by Magnetic Resonance Imaging—A Case Report

A 38-year-old female patient presented with temporomandibular joint (TMJ) pain, bilateral clicking and intermittent locking. The patient was treated with a splint in order to decrease the symptoms and to obtain a proper disk-condyle relationship. The effect of the splint therapy was investigated after one month and after one year and five months using magnetic resonance imaging (MRI) with splints in place. After treatment for one year and six months, the clicking sound of the right TMJ disappeared, and she became free from locking. With the aid of MRI, it was found that the disk of the right TMJ had changed from an anterior position with reduction to a superior position. In the left TMJ, the disk changed from an anterior position without reduction to an anterior position with reduction. MRI gave important information on the disk position and the efficacy of the splint therapy.     

Pre- and posttreatment analysis of clinical symptoms of patients with temporomandibular disorders.

OBJECTIVE: This study treated patients with temporomandibular disc displacement with reduction (with pain, limited mandibular movement, and clicking sound symptoms) using a combination of analgesics, injection, mandibular exercise, and occlusal splints. METHOD AND MATERIALS: Twenty-five patients with temporomandibular joint (TMJ) disorders were evaluated for pretreatment complaints and clinical findings, such as TMJ sounds, mandibular deviation, limited mouth opening, and bilateral magnetic resonance imaging results. Diagnostic treatment was then planned; all patients received occlusal splints, and 10 patients received injections. RESULTS: Evaluations were conducted 1 year after the initial diagnosis and treatment. Complaints (especially of pain) by the patients who received injections had reduced significantly. After 6 months of occlusal splinting, clinical findings of patients with TMJ disc displacement had greatly improved. To manage parafunctional habits of the patients, night plate usage was continued. Therefore, clinical symptom reduction was maintained. CONCLUSION: The use of mandibular manipulation technique can decrease the anterior disc displacement of the TMJ.     

手法复位辅助

目的 探讨关节腔扩张后手法复位辅助再定位垫治疗颞下颌关节紊乱病急性不可复性盘前移位.方法 2%局麻药2～3 ml 注入关节上腔,手法复位解除不可复性前移位的关节盘,复位后即刻戴用再定位垫保持良好的盘-突关系.结果近期临床观察表明①开口度恢复,最大开口度从治疗前的25.8 mm增大到46.6 mm;②疼痛症状消失,疼痛分值视觉模拟尺从治疗前的2.62下降到0.43; ③颞下颌关节功能改善,Fricton关节功能障碍指数和颞下颌关节紊乱指数分别从治疗前的0.337和0.185下降到0.021和0.011.结论颞下颌关节紊乱病急性不可复性盘前移位药物治疗和理疗无效的情况下,关节盘复位辅助定位垫是一有效的治疗方法.远期效果如何尚需进一步观察.     

Evaluation of TMJ Surgery in Cases not Responding to Conservative Treatment

The aim of the study was to evaluate the treatment outcome after temporomandibular joint (TMJ) surgery, which was performed in 33 patients (27 women and six men) between 1970 and 1986. Before surgery, the patients received different types of conservative treatment for an average time of 29 months. The most common diagnosis was anterior disk displacement (ADD) with or without reduction (n = 10), followed by unspecified arthralgia (n = 8), osteoarthrosis (n = 7) and ankylosis (n = 4). Standardized clinical records served as the basis for comparison of symptomatology at comparable time points. Furthermore, 31 of the 33 patients were subjected to a clinical follow-up, including anamnestic, clinical, radiological and cast analysis, 2–17 years after operation. Pain, sleeping problems and consumption of analgesics were significantly reduced after surgery. The anamnestic, as well as the clinical dysfunction indices, according to Helkimo,¹ were also significantly reduced. TMJ clicking was reduced, but crepitations increased in number. The best improvements were seen in patients with ADD without reduction and in patients with ankylosis.