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。     

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。     

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。     

透明质酸钠注射治疗不可复性关节盘前移位的CBCT影像学评价

目的:对比治疗前后CBCT影像,观察透明质酸钠治疗颞下颌关节不可复性盘前移位后髁突位置及形态变化.方法:对40例患者进行3次透明质酸钠关节上腔注射治疗.通过治疗前、治疗后3、9、12个月CBCT影像学检查及临床检查,从髁突位置形态变化、疼痛度(VAS)、最大开口度(MMO)、Fricton指数观察透明质酸钠对颞下颌关节不可复性关节盘前移位的治疗效果.结果:CBCT显示不可复性关节盘前移位伴骨关节病患者治疗前与治疗后9、12个月比较,髁突骨质有明显改建,骨面变得平整光滑,骨赘减小(P =0.026,P=0.001),部分单纯不可复性关节盘前移位患者治疗后9个月髁突可以向前移动(P=0.038);治疗后患者MMO增大,VAS减小(P＜0.05),Fricton指数降低.治疗后3～12个月Fricton指数无显著变化(P＞0.05).结论:CBCT显示透明质酸钠可促进已破坏髁突表面骨质改建,但不能使后移位的髁突回到关节窝中央.     

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目的探讨透明质酸钠关节上腔和关节下腔注射在治疗颞下颌关节骨关节病中的疗效。方法选择2006年7月至2009年2月威海市立医院口腔门诊适合注射透明质酸钠的46例颞下颌关节骨关节病患者,随机分为试验组和对照组,试验组25例采用关节下腔注射透明质酸钠,对照组21例采用关节上腔注射,比较两组疗效的差异。结果张口度对照组平均增加(0.96±0.13)cm,试验组平均增加(1.28±0.09)cm,两组间差异有统计学意义(P<0.01);关节疼痛对照组平均缓解(23.43±9.62)mm,试验组平均缓解(29.08±10.51)mm,两组间差异有统计学意义(P<0.01)。治疗后3个月至6个月的症状改善进行比较,张口度对照组变化为(0.01±0.03)cm,试验组为(0.08±0.04)cm,差异无统计学意义;关节疼痛改善对照组为(1.64±0.56)mm,试验组为(4.24±0.79)mm,差异具有统计学意义(P<0.01)。结论透明质酸钠关节上、下腔注射对颞下颌关节骨关节病确有疗效,关节下腔注射较上腔注射对缓解患者的关节疼痛和改善张口度的效果更为明显,且对疼痛缓解的作用时间更持久。     

透明质酸钠在治疗颞下颌关节紊乱综合征中的作用

透明质酸是关节液的主要成分之一.本研究采用透明质酸钠作关节上腔注射治疗了31例颞下颌关节紊乱综合征患者,取得了良好的治疗效果.以生理盐水上腔注射作为对照.两者差异有高度显著性(P<0.01),其中透明质酸对早期的不可复性关节盘移位的疗效尤为满意.作者认为,这除了因为透明质酸减少了关节内摩擦力外,还可能与它阻止软骨基质蛋白多糖分解,促进了滑膜功能恢复等作用有关.     

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。     

关节腔臭氧浴联合物理疗法治疗颞下颌关节不可复性盘前移位的效果评价

目的:探讨关节腔内臭氧浴联合物理疗法治疗颞下颌关节不可复性盘前移位(anterior disc displacement without reduction,ADDwoR)的临床疗效.方法:将54例ADDwoR患者随机分为实验组(27例)和对照组(27例),分别行关节腔臭氧浴和透明质酸钠(sodium hyaluron...     

透明质酸钠和醋酸强的松龙对兔颞下颌关节影响的扫描电镜研究

目的：通过扫描电镜观察透明质酸钠和醋酸强的松龙对兔颞下颌关节表面的作用。方法：在２０只未成年日本大耳白兔的右侧颞下颌关节下腔分别注射透明质酸钠和醋酸强的松龙。术后第１,３,７,１４ｄ分批处死各组白兔,将标本处理后用扫描 镜观察发现醋酸强的松龙使髁突表面和关节盘下腔面的表面凝胶样物质分布不均匀,出现部分区域表面凝胶样物质减少甚至消失,部分区域凝胶样物质聚集成因;而透明质酸钠不改变关节表面凝胶样物质的     

保守序列方法治疗颞下颌关节不可复性盘前移位的临床研究

目的:观察保守序列方法治疗颞下颌关节不可复性盘前移位的临床效果.方法:纳入颞下颌关节不可复性盘前移位患者300例,其中,男性110例,女性190例,年龄16 ～ 85岁.第1组200名,采用保守序列治疗方法,即关节上腔单针灌洗+透明质酸钠凝胶注射+理疗+手法复位+口腔操,第2组100名,采用单纯透明质酸钠凝胶关节上腔注射法.利用MMO(最大张口度,mm)及VAS(视觉类比量表)评价治疗前后患者张口度及颞下颌关节疼痛值的变化.结果:第1组总有效率95.5％(191/200),治疗前MMO为(22.90±3.18)、VAS为(5.81±0.32);治疗后3个月MMO为(37.05±4.43)、VAS为(1.29±0.19);治疗后6个月MMO为(36.29±4.08)、VAS为(1.37±0.22);治疗后12个月MMO为(35.76±3.87)、VAS为(1.52±0.28).第2组总有效率78％(78/100),治疗前MMO为(23.12±4.02)、VAS为(6.11±0.67);治疗后3个月MMO为(36.11±4.02)、VAS为(1.89±0.21);治疗后6个月MMO为(35.49±3.78)、VAS为(2.21±0.32);治疗后12个月MMO为(31.53±4.87)、VAS为(3.88±0.51).2组逐项比较差异均有统计学意义(P＜0.05).结论:保守序列治疗方法对治疗颞下颌关节不可复性盘前移位无论近期还是远期都有良好的治疗效果.     

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。     

Short-term therapeutic outcome of intra-articular high molecular weight hyaluronic acid injection for nonreducing disc displacement of the temporomandibular joint

In a patient with temporomandibular disorder who does not respond to conservative treatment, treatment with intra-articular injection of high molecular weight sodium hyaluronate can be suggested. In our study, 27 patients with nonreduced disc displacement were diagnosed clinically and confirmed by magnetic resonance imaging. The age range was from 21 to 63 years old, with a mean of 39.3 years. Two cycles of injection of high molecular weight sodium hyaluronate was performed on alternative weeks. Pain intensity was measured by the visual analog scale. Maximal mouth opening, clicking joint noise, and lateral movement were measured before and after injection for more than 6 months. Reduction of pain intensity and improvement in the maximum mouth opening parameter was statistically significant. In conclusion, this intra-articular injection using high molecular weight sodium hyaluronate looks very positive for patients affected by nonreduced disc displacement and is encouraged to be used as a primary treatment of temporomandibular joint dysfunction.     

Pumping injection of sodium hyaluronate for patients with non-reducing disc displacement of the temporomandibular joint: two year follow-up.

OBJECTIVES: The purpose of the present study was to examine the long-term effect of pumping injection of sodium hyaluronate into the TMJ in patients with non-reducing disc displacement. PATIENTS: Sixty patients with non-reducing disc displacement underwent pumping injection of sodium hyaluronate (pumping group). Seventy-six patients with non-reducing disc displacements were observed without any active treatment (observation group). STUDY DESIGN: In both patient groups clinical signs and symptoms were observed periodically for 2 years. Variables such as age, range of maximum mouth opening, angle of posterior slope of the articular eminence and degenerative bony changes of the condyle at the initial visit were also examined. Cox hazards analysis was applied to examine the clinical outcome for such variables in addition to the results of pumping injection of sodium hyaluronate. RESULTS: Pumping injection of sodium hyaluronate seemed to have a favourable effect when compared with the control group (untreated) (p = 0.0002). However, the four background variables mentioned could not be explained as predictors of outcome. CONCLUSION: Pumping injection of sodium hyaluronate seems to be effective for non-reducing disc displacement of the temporomandibular joint.     

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.     

Pumping injection of sodium hyaluronate for patients with non-reducing disc displacement of the temporomandibular joint: two year follow-up

Objectives: The purpose of the present study was to examine the long-term effect of pumping injection of sodium hyaluronate into the TMJ in patients with non-reducing disc displacement. Patients: Sixty patients with non-reducing disc displacement underwent pumping injection of sodium hyaluronate (pumping group). Seventy-six patients with non-reducing disc displacements were observed without any active treatment (observation group). Study design: In both patient groups clinical signs and symptoms were observed periodically for 2 years. Variables such as age, range of maximum mouth opening, angle of posterior slope of the articular eminence and degenerative bony changes of the condyle at the initial visit were also examined. Cox hazards analysis was applied to examine the clinical outcome for such variables in addition to the results of pumping injection of sodium hyaluronate. Results: Pumping injection of sodium hyaluronate seemed to have a favourable effect when compared with the control group (untreated) (p=0.0002). However, the four background variables mentioned could not be explained as predictors of outcome. Conclusion: Pumping injection of sodium hyaluronate seems to be effective for non-reducing disc displacement of the temporomandibular joint. Copyright 2001 European Association for Cranio-Maxillofacial Surgery.     

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.