咬合板、超短波单独及其联合治疗颞下颌关节紊乱综合征的临床比较

选取我院2010年7月~2013年8月收治的114例颞下颌关节紊乱综合征患者。随机分为A、B、C三组各38例。A组接受咬合板治疗,B组给予超短波治疗,C组行联合治疗方式,比较三组患者视觉模拟评分(VAS)、疼痛缓解时间及张口度指标差异。结果三组张口度经治疗均显著上升,同时段组间比较C组显著较高(P<0.05),VAS均呈下降趋势,C组同时段较A、B组更低,对比差异有显著统计学意义(P<0.05);A组疼痛缓解起效时间及显效时间与B组比较无显著差异(P>0.05),C组则分别显著低于A、B组。咬合板联合超短波治疗颞下颌关节紊乱综合征效果显著,优于单一咬合板或超短波单一治疗,可抑制疼痛,增加张口度,具有较高的临床应用价值。     

尖牙保护性咬合板治疗颞下颌关节紊乱病82例分析

目的研究尖牙保护性咬合板用于颞下颌关节紊乱病治疗的症状改善情况。方法对82例颞下颌关节紊乱病患者运用尖牙保护性咬合板进行治疗,在治疗后6个月后,观察患者疼痛、弹响或绞锁和开口受限症状变化情况。结果 82例患者,显效60例,好转18例,无效4例。其中对疼痛显效88.7%,对弹响或绞锁显效60.3%,对开口受限显效76.2%。结论尖牙保护性咬合板对于颞下颌关节紊乱病有较好的治疗效果,对疼痛症状的治疗疗效明显,对弹响或绞锁的治疗作用较差。     

物理疗法及手法治疗对颞下颌关节紊乱的疗效

目的观察物理疗法及手法治疗对颞下颌关节紊乱(TMD)的疗效。方法TMD患者90 例随机分为药物组(n=30)、理疗组(n=30)、理疗+手法组(n=30)。治疗前及治疗4 周后采用疼痛视觉模拟评分(VAS)、最大张口度、关节弹响程度进行评定。结果治疗后,各组疼痛均明显改善(P<0.01),理疗组还伴有最大张口度明显改善(P<0.01),理疗+手法组患者最大张口度、关节弹响程度显著改善(P<0.001)。治疗后三项评定从优到差顺序均为理疗+手法组、理疗组、药物组。结论理疗结合手法治疗可更有效改善TMD患者关节疼痛、张口受限及关节弹响。     

关节镜治疗颞下颌关节紊乱病的临床研究

目的 评价应用颞下颌关节内镜上腔灌洗术治疗颞下颌关节紊乱病患者的临床疗效.方法 对保守治疗无效的26例临床表现为张口受限合并关节疼痛的颞下颌关节紊乱病患者行颞下颌关节镜上腔灌洗术,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)、张口度的变化,并通过MRI检测治疗前后关节盘位置的变化.结果 治疗后张口度≥35 mm的患者占88.5%(23/26),不同时期的张口度均较治疗前有显著差异(P<0.01),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),所有病例均无并发症发生.MRI显示有4例患者的关节盘部分复位.结论 颞下颌关节内镜下的上腔灌洗术直视下操作准确,能有效治疗颞下颌关节紊乱病,明显改善张口度和缓解疼痛.颞下颌关节镜治疗技术安全有效,有临床推广应用价值.     

用铸造金属支架以增加位的方法恢复老年人正常咬合关系

老年人牙列缺失，没有及时镶牙修复，余留牙倾斜移位对颌牙伸长，不良咀嚼习惯，造成正常生理[牙合]曲线发生改变，以使咬合关系严重紊乱造成牙冠切端和牙颌面过度磨损，导致咬合垂直距离降低，引起颞下颌关节紊乱，出现关节区弹响、压痛、张口受限等症状 。     

关节镜治疗颞下颌关节紊乱病的远期疗效观察(英文)

目的评价应用颞下颌关节镜治疗颞下颌关节紊乱病的远期疗效。方法对保守治疗无效的22例临床表现为张口受限合并关节疼痛的颞下颌关节紊乱病患者行颞下颌关节镜手术治疗,分析术前、术后6月、术后2年不同时期患者的疼痛值、张口度的变化。结果治疗后张口度≥35mm的患者占90.9%(20/22),不同时期的张口度均较治疗前有显著差异(P0.05),治疗后不同时期的疼痛直观模拟标尺(VAS)均较治疗前明显降低,有显著差异(P0.001),所有病例均无并发症发生。结论颞下颌关节内镜手术能有效治疗颞下颌关节紊乱病,明显改善张口度和缓解疼痛。     

关于举办“重型颅脑创伤诊疗新技术临床系列化研究”省级继续医学教育学习班的通知

颞下颌关节弹响是颞下颌关节紊乱病（TMD）常见症候之一，表现为耳前区张、闭口时可闻及弹响或杂音。临床治疗多以局部理疗、药物封闭和咬合垫等，但疗效欠佳。作者采用方丝弓矫治器治疗颞下颌关节弹响41例，疗效显著，现报道如下。     

个体化综合物理疗法治疗颞下颌关节紊乱病的疗效观察

目的观察个体化综合物理治疗改善颞下颌关节紊乱病（TMD）患者症状的临床疗效观察。 方法选取2011年4月至2012年3月我院康复医学科收治的TMD患者307例,根据TMD研究用诊断标准（RDC/TMD）对307例患者进行分类,并根据患者的RDC/TMD分类选择包括健康教育、超短波治疗、超声治疗、软组织按摩技术、关节松动技术、关节稳定性训练等的个体化综合物理治疗。所有患者均于治疗前和治疗3周后采用最大主动张口度、目测类比法（VAS）、关节弹响程度进行疗效评价。 结果治疗后,TMD患者307例的张口度、VAS评分和关节弹响程度分别为（36.95±6.59）mm、（1.21±0.62）分、(29±17)%,与治疗前比较,差异均有统计学意义（P<0.05）。 结论个体化综合物理治疗可显著改善颞下颌关节紊乱病患者的关节弹响、疼痛、张口受限等症状。     

肌功能训练和TDP照射用于颞下颌关节紊乱病的治疗

目的 :评价肌功能训练和特定电磁波 (TDP)照射治疗颞下颌关节紊乱病的疗效。方法 :对 160例颞下颌关节紊乱病患者采用临床随机对照研究的方法 ,分为治疗组 (肌功能训练、TDP照射和咬合板治疗 )和对照组 (局部封闭和咬合板治疗 ) ,对两组的疗效进行评价。结果 :治疗组总有效率为 81 3% ,对照组总有效率为 85 0 % ,两组的差异无显著意义 (P >0 0 5 )。结论 :肌功能训练和TDP照射在颞下颌关节紊乱病治疗中有可靠的辅助疗效     

延续性护理对颞下颌关节紊乱病患者健康管理依从性及知识知晓程度的效果

目的 观察延续性护理对颞下颌关节紊乱病患者健康管理依从性及知识知晓程度的效果。方法 选择2021年1月至2022年12月就治于南京医科大学附属口腔医院的颞下颌关节紊乱病患者100例为观察样本,2021年1月至12月的50例患者设为对照组,2022年1月至12月的50例患者设为观察组。遵循颞下颌关节紊乱病咬合板治疗,给予对照组患者常规护理;于此基础之上给予观察组患者延续性护理。对干预后的两组患者各项观察指标进行比较。结果 观察组患者疾病不确定感评分低于对照组,健康管理知识知晓度评分、健康管理依从性评分高于对照组,疼痛评分低于对照组,张口度高于对照组（P＜0.05）。结论 对于颞下颌关节紊乱病患者给予延续性护理,有利于其疾病不确定感的减低、健康管理知识知晓度与依从性的提升、疼痛度的减低与张口度的增大。     

针刺激痛点结合运动疗法治疗颞下颌关节紊乱病的临床观察

目的:观察针刺激痛点结合运动疗法对颞下颌关节紊乱病的疗效.方法:选取颞下颌关节紊乱病患者63例随机分为对照组31例和观察组32例,因治疗期间脱落3人,对照组和观察组各30例.2组均给予运动疗法包括筋膜手法、颞颌关节松动术配合宣传教育训练.观察组在对照组的基础上结合针刺激痛点的方法.在治疗前和治疗4周后,用疼痛视觉模拟评...     

Intra-articular morphine as analgesic in temporomandibular joint arthralgia/osteoarthritis.

The aim of this study was to determine the analgesic efficacy of a single dose intra-articular injection (i.a.) of morphine in 53 patients with unilateral arthralgia/osteoarthritis of the temporomandibular joint (TMJ). This randomized, double-blind, parallel group, multicenter study included a screening visit, a treatment visit, and a follow-up visit 1 week after treatment. Recordings of visual analog scales (VAS) pain intensity scores at maximum mouth opening (main efficacy variable) and at jaw rest were made directly before a 1-ml i.a. injection into one TMJ of either 1.0mg morphine-HCl, 0.1mg morphine-HCl, or saline (placebo). The pain intensity was also recorded at the follow-up and in a diary 3 days before and 5 days after the injection. The VAS pain score at maximum mouth opening was considerably reduced 1-10h after injection but without significant differences between groups. At the follow-up, the median VAS pain score at maximal mouth opening was significantly lower in the 0.1-mg morphine group than in the 1.0-mg morphine group (P<0.043) or the saline group (P<0.021). A significant increase in pain pressure threshold over the affected joint was seen in the 0.1-mg morphine group compared with the saline group at the follow-up but not 1 and 2h post-injection. The incidence of adverse events was small and did not differ between the treatment groups. In conclusion, one i.a. injection of 0.1mg morphine significantly increased the pain pressure threshold and mouth opening ability, but evidence for the analgesic property of the locally applied opioid was inconclusive. No dose-effect relation and no significant short-term analgesic property were seen. Although statistically significant, the magnitude of the reduced VAS pain intensity score was not clinically relevant at the 1-week follow-up.     

应用上颌全牙弓牙合垫治疗颞下颌关节紊乱病的效果分析

目的观察应用上颌全牙弓牙合垫治疗颞下颌关节紊乱病的临床效果。方法选取2011年1月至2012年1月颞下颌关节紊乱病患者94例,随机分成两组,治疗组和对照组各47例。治疗组利用上颌全牙弓牙合垫进行治疗,对照组只给予药物治疗,定期检查两组治疗前后的咀嚼肌疼痛、关节弹响以及张口度的变化情况。结果经过5~10个月的治疗,治疗组29例痊愈,16例症状减轻,总有效率95.74%,与对照组80.85%比较,具有显著性差异(P0.05)。结论应用上颌全牙弓牙合垫治疗颞下颌关节紊乱病疗效显著。     

体外冲击波联合肌肉能量技术对颞下颌关节紊乱疗效的临床研究

目的:探究体外冲击波联合肌肉能量技术对颞下颌关节紊乱的临床效果。方法:选取符合纳入标准的颞下颌关节紊乱(TMD)患者共120例,采用计算机随机分成常规治疗组、体外冲击波(ESWT)组、肌肉能量技术(MET)组和体外冲击波联合肌肉能量技术(ESWT+MET)组4组,每组30例。常规治疗和MET每日1次,每周5次,连续4周;ESWT每周1次,治疗4周。治疗前后记录患者最大张口度(MMO)、压力疼痛阈值(PPT)、疼痛情况(VAS)和下颌功能损害问卷(MFIQ)评分。结果:治疗前4组患者的MMO、PPT、VAS及MFIQ评分差异无统计学意义。治疗4周后,4组患者的MMO及PPT均较治疗前明显增加(P<0.05),且ESWT组、MET组及ESWT+MET组高于常规组(P<0.05),ESWT+MET组高于ESWT组和MET组(P<0.05);MET组的MMO较ESWT组增加(P<0.05),ESWT组的PPT较MET组增加(P<0.05)。4组VAS及MFIQ评分均较治疗前明显下降(P<0.05),ESWT组、MET组及ESWT+MET组低于常规组(P<...     

Diagnostic Criteria for Screening Headache Patients for Temporomandibular Disorders

Patients with temporomandibular disorders frequently suffer from headache. The purpose of this study was to develop a simple screening exam which would allow the physician to identify headache patients with coexisting temporomandibular disorders. Twenty-eight migraine and 27 tension headache patients were identified by board certified neurologist and then were examined by a dentist for signs of temporomandibular disorders. These patients were then compared to 63 patients with temporomandibular internal derangements and 62 patients with myofascial pain dysfunction. Comparisons of the clinical signs showed that the temporomandibular internal derangement and myofascial pain dysfunction patients differed significantly from the headache patients in regards to specific signs of jaw dysfunction. The presence of reciprocal clicking of the temporomandibular joint or pain with maximum jaw opening and pain upon palpation of the temporomandibular joint distinguished temporomandibular internal derangement patients from headache patients. These criteria have a sensitivity of 92% and specificity of 91%. Pain on palpation over the temporomandibular joint, or pain with maximum jaw opening using passive stretch, and pain with lateral movement of the jaw, distinguished myofascial pain dysfunction patients from headache patients. These criteria have a sensitivity of 77% end specificity of 85%. By using these screening tests, the physician can identify the concurrent existence of temporomandibuler disorders in headache patients and triage the patient to a clinician knowledgeable in the diagnosis and treatment of temporomandibular disorders for further evaluation.     

运用毫火针与针推治疗TKA术后疼痛及关节运动障碍等疗效的对比观察

目的 对比运用毫火针与针推治疗TKA术后疼痛及关节障碍等并发症的临床疗效差异。方法 分为观察组（常规康复训练+毫火针，30例）和对照组（常规康复训练+普通针刺及推拿，30例），在治疗前和治疗后，分别给予关节活动范围（ROM）、视觉模拟评分（VAS）、骨关节指数（WOMAC）及WOMAC 量表评分。并比较两组间疗效差异。 结果 与治疗前比较，两组患者在治疗后 1周、2周的VAS 、 HSS、ROM、WOMAC均较治疗前有明显改善（均P ＜ 0.05）；组间比较 治疗1周后，VAS、HSS评分观察组优于对照组，差异有统计学意义（均P ＜ 0.05）；治疗2周后，VAS、ROM、HSS评分观察组优于对照组，差异有统计学意义（P ＜ 0.05、P ＜ 0.01、P ＜ 0.05）； 从WOMAC 量表里得出的各项评分可以看出，治疗后的评分均较治疗前明显下降(P＜0.05),两组患者的疼痛、僵硬、肿胀均得到了改善；组间比较：治疗第1周完成及第2周治疗完成后WOMAC 量表得出各项评分，观察组均优于对照组，差异具有明显的统计学意义（P＜0.01）。 火针组总有效率为96.7%,针推组为 90.0%,差异有统计学意义(P＞0.05)。 结论 毫火针与针推治疗TKA术后疼痛及关节运动障碍等并发症的疗效相当, 毫火针在改善TKA术后患者的疼痛，肿胀及僵硬感的临床疗效优于针推，在临床上值得推广应用。     

Effect of health education in treatment of cervical spondylopathy by blocking of nerve ganglion

Background:The clinical symptoms of disorders of temporomandibular joint,clicking of joint and dyscinesia of mandibular,which treatment ways are virious and its curative effect is different.Objective:To explore the effect of the ulotrasonic wave treatment of 116 patients with disorders of temporomandibular joint.Unit:Affiliated Second Hospital of Qiqihaer Medical College.Subject:116 patients with temporomandibular joint,47 males and 69 females,aged 14-70 years old,average 36 years old.Disease history recorded from 2 days to several months.Pathosenic parts:18 cases were bilateral,42 cases were dextral and 56 cases were left.Pathogenic factors included mental,traumatic and others factors.clinical stages:75 cases in dysfunction period of masseter (65 per cent),36 cases in disturbance period of structure of joint (31 per cent) and 5 cases in period of organic changes.Intervention:With CSL-I type ultrasonic wave treatment machine produced by Shanghai,frequency 800 kHz,diameter 3.5cm,we used the method of contact and movement,which adopted liquid paraffin as coupled agent.We told patients open mouth slightly and placed sound-head on the part of temporomandibular joint,0.75-1.0W/cm,once 10 minutes,once each day and 10 days as a treatment course.We can observe the effect after two courses of treatment,meantime adopt comprehensive treatment like rehabilitative therapy to eliminate causes of diseases.Main result measurements index:recovery:joint pain disappears,extent of opening mouth normal,snap disappears and figure of opening mouth abnormity disappears;improved:joint pain obviously alleviates,extent of opening mouth obviously improves and snap and figure of opening mouth alleviate;ineffective:no changes before and after treatment.Results:75 cases disorders of masseter function,75 cured (58 in one treatment course,17 in two treatment course),recovery rate 100 per cent;36 cases of disorders of joint structure,28 cured (18 in one treatment course,10 in two treatment course),recovery rate 77.78 per cent.8 cases improved (two treatment courses),total effective rater 100 per cent;5 cases of organic changes,4 cases improved (two treatment courses),1 case ineffective,total effective rate 80 per cent.Conclusion:The treatment of ultra wave of temporomandibular joint can alleviate pain and improve blood circulation,ralax contracted muscle,and improve injury recovery.     

Effectiveness of a Home Exercise Program in Combination with Ultrasound Therapy for Temporomandibular Joint Disorders

[Purpose] This study compared the effectiveness of home exercise alone versus home exercise combined with ultrasound for patients with temporomandibular joint disorders. [Subjects and Methods] This study enrolled 23 female and 15 male patients who were divided randomly into two groups. The home exercise group performed a home exercise program consisting of an exercise program and patient education, and the home exercise combined with ultrasound group received ultrasound therapy in addition to the home exercise program. Pain intensity was evaluated using a visual analogue scale. Pain free maximum mouth opening was evaluated at baseline and 2 weeks after the treatment. [Results] There was no difference between the two groups in baseline values. After the treatment, the visual analogue scale decreased and pain free maximum mouth opening scores improved significantly in each group. Additionally, both values were higher in the home exercise combined with ultrasound group than in the home exercise group. [Conclusion] The combination of home exercise combined with ultrasound appears to be more effective at providing pain relief and increasing mouth opening than does home exercise alone for patients with temporomandibular joint disorders.Key words: Temporomandibular joint disorders, Ultrasound therapy, Home exercise     

咬（牙合）板与义齿对老年人颞下凳关节功能恢复的作用

Temporomandibulardisorders（TMD）amongeldersisdifferentinclinicalmanifestationcomparedwiththatamongyoungman．DeclineoftemporomandibularjointandtoothlossarecommonamongelderswhichbothcontributedtocharacteristicsofTMD．WeanalyzedcharacteristicsofTMDamongeldersclinicallyandsearchappropriatedtreatmentmethodforTMDbyarticulatingbiteplateandartificialtooth．１Subjectandmethod１．１Subjects３６caseswithclinicallyandX－rayprovedTMDwereincludedinthecurrentstudy．Patientsconsistedof２０malesand１６…