关节上下腔留注透明质酸钠治疗TMD疗效观察

目的　探讨关节上下腔注射透明质酸钠 (HA)治疗TMD的方法及疗效。方法　对 37例TMD患者行HA上下腔注射为试验组 ,另 33例TMD患者行HA上腔注射为对照组 ,并从开口度、开口型、疼痛指标作定性、定量分析。结果　对照组治疗TMD疗效较好 ,试验组治疗TMD效果显著 ,两者有显著差异 (P <0 .0 5 )。结论　关节上下腔注射HA治疗TMD是一种更有效的非手术治疗方法     

关节冲洗术治疗颞下颌关节紊乱病的实验研究

目的 研究关节冲洗对兔颞下颌关节滑膜炎和骨关节病的治疗作用。方法 用基质金属蛋白酶-1腔内注射制备兔的颞下颌关节骨关节病的动物模型,分为滑膜炎组和骨关节病组,分别行左侧关节上腔冲洗治疗,在不同时期观察关节各成分的组织病理学变化。结果 滑膜炎组左侧关节各时期病变均明显轻于右侧。骨关节病组左侧关节各时期病变均与右侧同步,仅程度稍轻。结论 冲洗治疗对兔颞下颌关节的急性滑膜炎有良好的疗效,对早期骨关节病可抑制其病变发展,促进其自身修复。     

Total Alloplastic Temporomandibular Joint Reconstruction for Management of TMJ Ankylosis

Introduction

Temporomandibular joint (TMJ) ankylosis involves the fusion of the mandibular condyle to the glenoid fossa, the skull base. The dilemma with regards to treatment planning whether distraction is done before gap arthroplasty or as a simultaneous procedure or after gap arthroplasty is still a controversy. In an attempt to carry out both the procedures simultaneously there is loss of vector control of the distal segment and the risk of pseudoarthrosis at the osteotomy site. This combined problem could be overcome by the use of total alloplastic joint prosthesis which offers a firm posterior stop for the proximal segment and negates aggressive physiotherapy.

Material and methods

The reference literatures were retrieved from Pub Med and Science Direct database. Three case reports of bilateral recurrent TMJ ankylosis successfully treated with custom made total TMJ by the authors are illustrated.

Conclusion

The purpose of this article is to review the world literature on various alloplastic joints available for TMJ reconstruction and to introduce our indigenous total joint prosthesis in the management of recurrent ankylosis.     

Impact of prolotherapy in temporomandibular joint disorder: a quality of life assessment

Chronic pain and functional impairment associated with temporomandibular joint (TMJ) disorders (TMD) considerably reduce oral health-related quality of life (OHRQoL). In the present study we have assessed the influence of prolotherapy in patients with TMD by the subjective measurement of QoL using the Oral Health Impact Profile-14 (OHIP-14). Twenty-five patients diagnosed with TMD (mean (range) age 38 (18 – 70) years) were included. They had all undergone dextrose prolotherapy to the TMJ at regular time intervals (four times at intervals of two weeks) using the method suggested by Hemwall-Hackett. They were asked to answer the OHIP-14 questionnaire before and two years after prolotherapy. Seven domains of OHRQoL were rated on a 5-point Likert scale from 0 (never) to 4 (very often). Domain scores and total OHIP-14 scores were compared using inferential statistics (chi squared and Wilcoxon signed rank tests). Prolotherapy was effective over time, as all the domains’ mean scores decreased considerably after treatment. The total mean score before prolotherapy was 21.20, which was extensively reduced to 13.08 after prolotherapy (p=0.001). There was statistically significant improvement in all domains, including functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap (p≤0.005 in all cases). We concluded that prolotherapy has a promising role in the improvement of OHRQoL of patients with TMD, and its beneficial effects persist at least two years after treatment.     

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.

     

山羊颞下颌关节盘细胞肌动蛋白骨架的研究

目的:通过激光扫描共聚焦显微镜(Laser Scanning Confocal Microscope,LSCM)研究原代及传代山羊颞下颌关节盘细胞骨架(Cytoskeleton,CSK)蛋白-肌动蛋白的形态及蛋白量的改变,以说明关节盘细胞随着传代的发生,细胞骨架蛋白-肌动蛋白的差异。方法:原代(P0)山羊颞下颌关节盘细胞及传代1、2、3、4(P1、P2、P3、P4)代的关节盘细胞,分别接种在有方形盖玻片的6孔板中制作细胞爬片。对各代关节盘细胞肌动蛋白骨架进行免疫荧光染色,利用激光共聚焦显微镜获取各代关节盘细胞肌动蛋白的形态,同时利用荧光强度测定软件对各代关节盘细胞肌动蛋白荧光量进行测定。结果:丝状的肌动蛋白主要沿着细胞膜外围均匀排列,随着传代丝状结构逐渐清晰,且逐渐增粗,P4代时形成较粗的纤维束。荧光强度整体趋势是随着传代荧光量表达是递增的,P3代以内没有统计学差异,而在P4代时统计学差异明显。结论:肌动蛋白骨架随着传代过程形态学上发生了改变,在P4代时可见骨架蛋白形成较粗的纤维束,荧光量表达同其他代细胞差异明显,这为以后工程化颞下颌关节盘种子细胞的选择提供了依据。     

颞下颌关节紊乱患者心理因素与唾液中SIgA含量的关系

目的观察人格、应激、情绪与应对方式等心理因素在颞下颌关节紊乱病(TMD)中的作用及其与口腔局部免疫功能的关系。方法采用明尼苏达多相人格调查表(MMPI)、生活事件调查表、特质应对问卷、自我评定焦虑量表(SAS)、抑郁自评表(SDS)对确诊TMD患者31例和匹配对照组30例进行个别心理测试,以放射免疫法对两组被试唾液中的SIgA含量进行测定。结果TMD患者MMPI诸指标得分均高于对照组,差异有显著性(P<0.05,P<0.01),其中有10例患者的临床量表得分高于全国常模正常值;病人组的负性生活事件和负性工作得分均高于正常对照组,差异有显著性(P<0.05,P<0.01);病人组正性应对的得分低于正常对照组,而负性应对的得分高于正常对照组,差异有显著性(P≤0.05,P<0.01);病人组的焦虑、抑郁得分均高于正常对照组,差异有显著性(P<0.01);病人组唾液中SIgA含量低于正常对照组,差异有显著性(P<0.01);抑郁得分与SIgA含量呈轻度负相关(r=-0.320,P<0.05)。结论TMD患者具有明显的人格偏离、不良生活事件、不良情绪和负性应对方式,这些所导致的更强、更持久的应激以及口腔局部免疫功能的低下,是疾病的重要原因之一。     

颞下颌关节的3T磁共振高分辨扫描方法研究

目的：探索3T磁共振对颞下颌关节（TMJ）的成像方法与序列特点,并优化扫描参数。方法：采用Siemens3.0TTrio磁共振扫描机,8通道相控阵头线圈,对25例双侧TMJ分别行张口位、闭口位扫描。其中正常志愿者15例,TMD10例。结果：所有被检查者均一次扫描成功,分别取T1WI,T2WI,PWI以及T2WI,T1WI 3D容积成像,扫描方位以髁突为中心,分别做平行于髁突长轴的斜冠状位,垂直于髁突长轴的斜矢状位扫描,正常志愿者的双侧TMJ在优化后的扫描序列中充分而完整显示关节盘、关节间隙、关节窝、关节盘随张闭口改变而位置变化情况,关节周围软组织与骨组织亦充分清楚显示。10例TMD均完全显示出关节盘移位情况,与临床症状一致。结论：3T磁共振扫描机成像速度快,视野内成像矩阵高,解剖细节显示充分,组织分辨力高,对于TMJ等小关节的结构异常与细微病变的显示充分,是其它医学检查设备无法比拟的。