关节灌洗和透明质酸钠治疗不可复性关节盘前移位的疗效比较

目的探讨关节灌洗和透明质酸钠治疗不同病程的颞下颌关节(TMJ)不可复性关节盘前移位的临床效果。方法选择2006年10月至2009年3月TMJ不可复性关节盘前移位126例(138侧关节)进行关节灌洗和透明质酸腔内注射治疗,按发病病程分为三组:6个月以内组36例;6～12个月组42例;12个月以上组48例。随访12～36个月(平均26个月),并对三种方法的疗效进行比较。结果三组总有效率为88.9%(112/126)。其中6个月以内组术后张口度平均增加(8.2±3.4)mm,健侧侧向运动增加(4.8±1.4)mm,91.7%(33/36)患者疼痛明显缓解,有效率为94.4%(34/36)。6～12个月组张口度平均增加(8.0±3.2)mm,健侧侧向运动增加(4.4±1.5)mm,90.5%(38/42)患者疼痛明显缓解,有效率为92.9%(38/42)。12个月以上组术后张口度平均增加(7.1±4.1)mm,健侧侧向运动增加(3.5±2.4)mm,81.3%(39/48)患者疼痛明显缓解,有效率为83.3%(40/48)。三组比较,张口度、侧向运动改善、疼痛缓解及有效率,6个月以内组和6～12个月组均优于12个月以上组(P<0.05),而6个月以内组和6～12个月组差异无统计学意义(P>0.05)。结论关节灌洗术和透明质酸钠治疗不可复性关节盘前移位是有效的治疗方法,发病在12个月以内治疗效果明显优于12个月以上。因此,早期治疗有助于提高疗效。     

手术治疗单侧不可复性关节盘前移位的疗效观察

目的探讨手术治疗单侧颞下颌关节不可复性关节盘前移位的临床效果。 方法选择2012年10月至2013年10月单侧不可复性关节盘前移位患者54例,均经磁共振成像（MRI）确诊,保守治疗效果不佳,进行关节盘复位手术,按发病病程分为以下三组：6个月以内组（15例）;6~12个月组（22例）;12个月以上组（17例）。治疗后1、6和12个月对患者进行复诊,并对三组的疗效进行比较。 结果术后1、6和12个月复诊时,三组病例术后张口度改善情况和疼痛缓解情况均较术前有明显改善（P < 0.05）。术后12个月时,6个月以内组和6~12个月组张口度改善情况优于12个月以上组（P < 0.05）;而这两组仅在术后1个月复查时有明显差异（P < 0.05）,在其他复查时间点该两组无明显差异。6~12个月组术后张口度改善情况均优于12个月以上组（P < 0.05）。6个月以内组和6~12个月组疼痛缓解程度均优于12个月以上组（P < 0.05）;而6个月以内组和6~12个月组未发现明显差异。 结论在保守治疗效果不佳的前提下,手术是治疗不可复性关节盘前移位的有效方法,尤其对于发病时间在12个月以内的病例的治疗效果明显优于病程较长者,早期治疗对于预后十分重要。     

透明质酸钠关节腔注射治疗颞下颌关节盘不可复性前移位

透明质酸是关节的主要成分 ,近年来的研究证明 ,它在关节病的治疗中有重要价值[1 ,2 ] 。本研究通过对比的方法 ,评价透明质酸钠关节腔注射治疗颞下颌关节盘不可复性前移位的疗效。　　作者单位 :116 0 11大连医科大学附一院口腔科 (齐东元、潘巨利 ) ;鞍钢铁西医院口腔科 (刘成海 )　　一、材料和方法1 .临床资料 :2 7例患者男 1 1例 ,女 1 6例 ,年龄 1 5至 62岁 ,平均 2 9.6岁。均具有颞下颌关节盘不可复性前移位的特殊病史和典型症状 ,即既往有较长时期的关节弹响史 ,以后关节弹响突然消失 ,而出现严重的张口受限 ,并伴有疼痛 ,张口时下…     

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。     

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。     

殆垫及关节灌洗术治疗颞下颌关节盘不可复性前移位的临床分析

目的：对不可复性关节盘前移位的不同治疗方法进行临床分析和总结,进一步探索合理的治疗不可复性关节盘前移位的方法。方法：将48例不可复性关节盘前移位的关节病患者分成3组,即[牙合]垫治疗组、关节灌洗组、关节灌洗术联合[牙合]垫治疗组。将3种治疗方法对不可复性关节盘前移位治疗前后的疼痛指数、最大开口度进行统计分析,比较3种治疗方法的临床疗效。结果：疼痛指数：3组患者治疗前后疼痛指数的改变值,[牙合]垫治疗组〈关节灌洗组〈关节灌洗术联合[牙合]垫治疗组（P〈0.05）,关节灌洗组与关节灌洗术联合[牙合]垫治疗组治疗前后开口度的改善度,差异无显著性,但均优于[牙合]垫治疗组（P〈0.05）。结论：对不可复性关节盘前移位的治疗,关节灌洗术联合[牙合]垫治疗的临床疗效优于[牙合]垫治疗或关节灌洗术,同时,关节灌洗术的临床疗效显效方面优于[牙合]垫。     

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     

不可复性关节盘前移位的颞下颌关节系统生物力学研究

目的：研究构建病理状态下的颞下颌关节系统三维有限元模型并进行力学分析,探讨不可复关节盘前移位后颞下颌关节系统的应力分布情况。方法：利用CT和MRI扫描,通过Mimics和Geomagic软件平台,构建病理状态下的颞下颌关节系统三维模型,并在其基础上进行力学分析。结果：建立了包括上、下颌骨,关节窝、全牙列及关节盘的颞下颌关节系统个体化三维数字模型。力学分析显示．正常关节盘的应力集中在中带外侧部,应力分布较均匀,而当关节盘前移位时,关节盘的中带出现应力集中现象．容易引起该部位关节盘变薄或穿孔：髁突表面应力主要分布在前斜面．而当关节盘前移位时,髁突受力增大．提示该部位易发生退行性变。结论：利用cT和MRI,能够实现对病理状态下的颞下颌关节系统的三维重建．且关节盘移位侧的关节盘、髁突应力峰值均大于正常侧关节。     

改良切口关节盘锚固术治疗颞下颌关节盘不可复性前移位的临床评价

目的: 评价应用改良切口关节盘锚固术治疗颞下颌关节盘不可复性前移位的临床疗效。方法: 选取2014年9月—2016年9月我院颞下颌关节专科就诊的24例（30侧）颞下颌关节紊乱病患者,采用改良切口颞下颌关节盘锚固术进行治疗, 分析术前、术后6个月不同时期患者的疼痛值、开口度的变化及MRI影像学表现,采用SPSS17.0软件包中的t检验评价手术效果。结果: 治疗前平均开口度为（23.63±3.31）mm(17~29 mm),治疗后平均开口度为（38.00±2.30）mm(32~42 mm),治疗后开口度≥35 mm 的患者占 87.5%（21/24）;疼痛直观模拟标尺（visual analogue scale,VAS）值术前为29.76±23.35（0~80）,术后6个月为3.71±7.91（0~50）,术后6个月的开口度及VAS值均与治疗前有显著差异（P<0.05）。MRI影像学评价有效率达96.67%（29/30侧）,所有病例均无并发症发生。结论: 颞下颌关节盘锚固术能有效治疗颞下颌关节盘不可复性前移位,在复位关节盘的前提下,显著改善开口度和缓解疼痛。     

2种方法治疗急性不可复性关节盘前移位的临床疗效观察

目的 比较关节腔注射透明质酸联合再定位牙合垫与手法复位联合再定位牙合垫这2种方法治疗急性颞下颌关节不可复性盘前移位(ADDWOR)的临床疗效。方法 选取108例急性ADDWOR患者,分为关节腔注射透明质酸联合再定位牙合垫组和手法复位联合再定位牙合垫组,各54例。分别在治疗前和治疗即刻、1周后、1个月后、 3个月后对两组患者的视觉模拟疼痛指数评估(VAS)、下颌运动范围(包括最大主动张口度、最大前伸及侧方运动范围)进行评估,并采用重复测量方差分析对数据进行统计分析。结果 两组治疗方法在治疗即刻、1周后、1个月后、3个月后VAS评分及下颌运动范围各项指标较治疗前均有明显改善(P<0.05),注射联合牙合垫组最大主动开口度、最大前伸及侧方运动范围大于手法联合牙合垫组(P<0.05)。两组VAS评分差异无统计学意义(P>0.05)。结论 2种治疗方法都可以改善急性ADDWOR患者的下颌运动功能,缓解疼痛,关节腔注射联合再定位牙合垫在改善下颌运动度方面治疗效果更好。     

关节下腔治疗颞下颌关节不可复性盘前移位

目的研究经关节下腔治疗颞下颌关节（TMJ）不可复性盘前移位（ADDw/oR）的临床疗效。方法将临床和影像学检查确诊的单侧TMJADDw/oR患者56例,随机分为关节上腔组和下腔组,以治疗前作对照,经关节内灌洗、注射玻璃酸钠后行手法复位并佩戴密歇根（Michigan）稳定性咬合板2个月,复诊记录摩擦指数并评价其疗效。结果关节上腔和下腔治疗组开口度均较治疗前明显增大（P〈0.01）,摩擦指数值较治疗前均明显下降（P〈0.01） 下腔治疗组开口改善度较上腔治疗组增加明显（P〈0.05）,而摩擦指数值又明显小于上腔治疗组（P〈0.05）。结论TMJADDw/oR的关节下腔治疗效果明显优于上腔。     

关节盘锚固定术治疗颞下颌关节盘前移位的临床应用

目的 通过对不可复性盘前移位的患者行关节盘复位锚固定术,探讨关节盘锚固定术治疗不可复性盘前移位的疗效。方法 对根据临床症状及磁共振成像诊断为不可复性盘前移位的患者15例（20侧关节）行关节盘锚固定术。结果 15例20侧关节接受关节盘复位固定术,手术后MRI显示12例16侧达到优,2例3侧达到良,有效率为95%,仅有1侧为“差”,占5%。所有不可复性盘前移位患者术后3、6、12个月较术前的疼痛改善依次为90%、95%、90%,下颌最大侧向运动改善依次为0.4、3.2、5.9 mm,最大张口度改善依次为8.6、16.2、22 mm。结论 关节盘锚固定术治疗不可复性盘前移位具有显著疗效。     

关节腔注射透明质酸与物理疗法治疗颞下颌关节不可复性盘前移位的临床疗效对比

目的 比较关节腔注射透明质酸和物理疗法治疗颞下颌关节不可复性盘前移(anterior disc displacement without re-duction,ADDwoR)的临床疗效.方法 回顾性纳入2018年2月—2020年8月于我院康复科门诊就诊的ADDwoR患者72例,注射组和物理治疗组各36例.比较治疗前、治...     

Incidence of anterior disc displacement without reduction of the temporomandibular joint in patients with dentofacial deformity

The aim of this study was to investigate the incidence of anterior disc displacement without reduction (ADDwoR) of the temporomandibular joint (TMJ) in patients with dentofacial deformity. Eighty-eight female patients (176 joints) with skeletal class III malocclusion and 33 female patients (66 joints) with skeletal class II malocclusion, with or without anterior open bite and asymmetry, were evaluated. Magnetic resonance imaging (MRI) of the TMJ was used to diagnose ADDwoR. A statistical analysis was performed to examine the relationship between ADDwoR and skeletal structure. ADDwoR was present in 37 of the 66 joints (56.1%) in class II compared to 34 of the 176 joints (19.3%) in class III (P < 0.05). In class III, ADDwoR was significantly more common in joints with mandibular asymmetry (24/74; 32.4%) than in joints with open bite (9/62; 14.5%) and joints with open bite and without mandibular asymmetry (1/38; 2.6%). In class II, ADDwoR was significantly less common in joints with mandibular asymmetry and without open bite (1/8; 12.5%). ADDwoR was only observed on the deviated side in both class III and class II with mandibular asymmetry. The prevalence of ADDwoR differed according to the dentofacial morphology.     

颞下颌关节盘前移位病因研究进展

颞下颌关节盘前移位(temporomandibular joint anterior disc displacement, TMJ ADD)是临床上常见的一种颞下颌关节紊乱病(temporomandibular disorder, TMD),主要表现为疼痛、关节弹响和下颌运动受限,严重者影响日常生活。但其病因复杂,至今尚无统一结论,对其发病机制也缺乏明确而全面的认识。本文将对ADD的病因以及发病机制作一综述。     

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.     

Physiological effects of anterior repositioning splint on temporomandibular joint disc displacement: a quantitative analysis

Anterior repositioning splints (ARS) are used primarily for the management of temporomandibular joint (TMJ) anterior disc displacement with reduction (ADDwR). However, the exact physiological effects of ARS are still unclear. This study investigated the short and long‐term effects of ARS on disc and condyle angles/positions by metric analysis. Twenty‐two subjects diagnosed with ADDwR were recruited. Maxillary full‐coverage ARS were fabricated, and MRI of TMJs was obtained before splint treatment, immediate post‐insertion and 6 months after splint treatment. Disc–condyle relationship was determined by disc–condyle angle measurement. Disc and condyle positions were described as X‐Y coordinates with the summit of glenoid fossa as the origin of the coordinates. Thirty‐two TMJs were classified as ADDwR and 12 were normal. Upon ARS insertion, all TMJs with ADDwR got normal disc–condyle relationships. The condyles moved significantly forward and downward, while the discs moved significantly backward and upward. MRI at 6 months after treatment (without ARS insertion) indicated that only 40·6% (13/32) of the joints were maintained in the normal disc–condyle relationship. The majority of condyles returned to their pre‐treatment positions, while the discs generally moved anteriorly again. The use of ARS resulted in forward and downward condyle movement, and a concurrent backward movement of the disc resulting in ideal spatial disc–condyle relationship. The stability of this relationship, however, could not be maintained in the majority of TMJs upon ARS removal. Findings explain the good short‐term clinical outcomes with ARS and their relatively lower efficacy in the long term.     

Serum cortisol level and disc displacement disorders of the temporomandibular joint

Temporomandibular disorders (TMD) are a significant public health problem, affecting approximately 5–12% of the population. Objectives: This retrospective cross‐sectional study investigated the relationship between 8 AM serum cortisol levels (8ASC) and disc displacement disorders (DDD) of TMD. One hundred and forty patients with DDD were recruited. Among them, 60 patients comprised the case group of disc displacement without reduction with limited opening (DDWORWLO, age 37·7 ± 17·22), and 80 were ‘other DDD’ for the control group (age 36·4 ± 13·08). The independent variables included domains of demography, history, malocclusion, comorbid symptoms, comorbid TMD and 8ASC. Data were analysed with the chi‐square test, logistic regression and receiver operating characteristic (ROC) curve. Results of multiple logistic regression showed that 8ASC was the only factor significantly related to DDWORWLO (P = 0·006). Receiver operating characteristic analysis of DDWORWLO and 8ASC indicated an area under the curve of 0·669, standard error of 0·049 and P value of 0·001. The adequate cut‐off point of 8ASC was 12·45 (μg dL^?1), with sensitivity of 0·636, and specificity of 0·729. 8 AM serum cortisol level can be used as a clinical clue to differentiate DDWORWLO from other DDD.