Efficacy of stabilisation splint therapy combined with non‐splint multimodal therapy for treating RDC/TMD axis I patients: a randomised controlled trial

Stabilisation splint therapy has long been thought to be effective for the management of temporomandibular disorders (TMD). However, the superiority of stabilisation splint therapy compared to other TMD treatments remains controversial. The aim of this study was to determine the efficacy of stabilisation splint therapy combined with non‐splint multimodal therapy for TMD. A total of 181 TMD participants were randomly allocated to a non‐splint multimodal therapy (NS) group (n = 85) or a non‐splint multimodal therapy plus stabilisation splint (NS+S) group (n = 96). Non‐splint multimodal therapy included self‐exercise of the jaw, cognitive–behavioural therapy, self‐management education and additional jaw manipulation. Three outcome measurements were used to assess treatment efficacy: mouth‐opening limitation, oro‐facial pain and temporomandibular joint sounds. A two‐factor repeated‐measures analysis of variance (anova ) was used to evaluate the efficacy of the two treatment modalities (NS vs. NS+S), and Scheffe's multiple comparison test was used to compare the treatment periods. Subgroup analyses were performed to disclose the splint effects for each TMD diagnostic group. All three parameters significantly decreased over time in both groups. However, there were no significant differences between the two treatment groups in the total comparison or subgroup analyses; an exception was the group with degenerative joint disease. No significant difference between the NS and NS+S treatment approaches was revealed in this study. Therefore, we conclude that the additional effects of stabilisation splint are not supported for patients with TMD during the application of multimodal therapy.     

阻塞性睡眠呼吸暂停低通气综合征患者颞下颌关节间隙测量

目的:通过对阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者的颞下颌关节(temporomandibular joint,TMJ)行磁共振扫描分析,探讨OSAHS患者与正常人群颞下颌关节形态的差异.方法:选取2014年1月-2016年5月收治的18例OSAHS患者和18例健康成人,分别记为研究组和对照组;按照呼吸暂停及低通气指数(apnea and hypopnea index,AHI),将OSAHS患者分为轻、中、重3个亚组(n=6).对所有纳入人群行TMJ的MRI扫描并测量关节间隙,采用SPSS 17.0软件包对测量数据进行统计学处理.结果:2组患者在年龄、性别构成、关节上间隙及髁突有无移位方面差异均无显著性(P＞0.05).OSAHS患者TMJ左侧前间隙[(2.61±0.19)mm:(2.47±0.18)mm,P＜0.05]、右侧前间隙[(2.63±0.18)mm:(2.48±0.17)mm,P＜0.0S]大于正常人群.OSAHS患者TMJ左侧后间隙[(2.43±0.20)mm:(2.51±0.19)mm,P＜0.05]、右侧后间隙[(2.44±0.20)mm:(2.60±0.13)mm,P＜0.05]小于正常人群.轻度OSAHS组TMJ左侧前间隙[(2.53±0.26)mm:(2.73±0.07) mm,P＜0.05]、右侧前间隙[(2.54±0.11)mm:(2.74±0.14)mm,P＜0.05]均小于重度组;轻度OSAHS组TMJ左侧后间隙[(2.56±0.29)mm:(2.29±0.09)mm,P＜0.05]、右侧后间隙[(2.55±0.23) mm:(2.31±0.09)mm,P＜0.05]均大于重度组.结论:OSAHS患者的髁突相比正常人群处于关节窝偏后位置.髁突位于关节窝偏后位置的趋势与OSAHS的严重程度相关.     

(iii) Bearing surfaces

Alternative bearings surfaces to polyethylene have reduced wear and have led to improved patient outcomes, allowing younger and more active patients to be considered for joint replacements. These bearing surfaces have been developed largely as a response to osteolysis and loosening associated with polyethylene particulate debris. This has led to the evolution of various forms of cross-linked polyethylene and to the greater use of hard-on-hard bearings. The use of metal-on-metal led to resurfacing hip replacements and to the use of large head metal-on-metal hip replacements. Although metal-on-metal bearings have a number of theoretical advantages, the release of metal debris and ions from some designs has been catastrophic. In the future new bearing surfaces must be more thoroughly tested pre-clinically and in well-designed clinical series.     

鼠颞下颌关节创伤后感觉神经肽阳性纤维的变化

目的:观察间接创伤后鼠颞下颌关节中感觉神经肽阳性纤维分布及密度的动态变化,探讨感觉神经肽在颞下颌关节疾病中的作用。方法:将42只SD大鼠随机均分为6组,分别在创伤前、创伤后1、3、7、14和28d时处死,灌注同定后取双侧颞下颌关节,脱钙后恒冷切片,ABC法漂染,并对结果进行半定量分析。结果:创伤前鼠颞下颌关节中有广泛而丰富的降钙素基因相关肽和P物质阳性纤维的分布。创伤后两种神经肽阳性纤维的密度均显著降低,分别在创伤后3、1d达到最低值。然后逐渐增加,至28d时达到或超过正常值。结论:创伤后颞下颌关节中感觉神经肽的逆行释放显著增加。它们不仅参与痛觉传导,而且是颞下颌关节病理改变的神经源因素。     

Reduced or painful jaw movement after collision-related injuries: a population-based study

BACKGROUND: The authors report the incidence of and factors associated with reduced and/or painful jaw movement after motor vehicle collisions that resulted in whiplash-associated disorders (WADs). METHODS: All adults filing collision-related personal injury claims during an 18-month period in Saskatchewan, Canada, were evaluated via questionnaire to determine demographic characteristics, precollision health (including jaw pain), collision parameters and collision-related symptoms, including reduced and/or painful jaw movement and injury-related neck pain. The authors excluded patients who were hospitalized for more than two days and those who sustained injuries as a pedestrian, bicyclist or motorcyclist. In determining incidence rates, the authors also excluded those who had had jaw pain before the collision. RESULTS: The incidence of reduced and/or painful jaw movement was 14.9 percent (n = 1,158), and it was higher in subjects with WADs (15.8 percent) than in those without WADs (4.7 percent; relative risk = 3.36, 95 percent confidence interval, 2.36 to 4.78). Within the WAD injuries, multivariable logistic regression revealed that the onset of reduced and/or painful jaw movement was associated with female sex; age < 50 years; having hit one's head in the collision; and postinjury symptoms of difficulty swallowing, ringing in the ears, dizziness or unsteadiness, and more intense neck pain. Collision parameters, such as head position at the time of the crash and headrest use and type, were not associated with onset of jaw symptoms. CONCLUSIONS: Reduced or painful jaw movement was more common in people with WADs than in those with other collision-related injuries. Among those with WADs, reduced or painful jaw movement was more common in women and younger people. CLINICAL IMPLICATIONS: Reduced or painful jaw movement is an important aspect of WADs, and more studies are needed to determine how to best assess and treat this problem.     

Radiographic parameters as prognostic indicators for healing of class II furcation defects

OBJECTIVE: To evaluate radiographic measurements for use as prognostic indicators for healing of class II furcation defects following regenerative therapy. MATERIAL AND METHODS: In 17 patients (eight females), 33 class II furcation defects (mandibular buccal (n=10) and lingual (n=12), and maxillary buccal (n=11)) were treated using the barrier membrane technique. Twenty-six furcations were treated using a bioabsorbable membrane, while a nonresorbable membrane was used to treat the remaining seven furcation defects. Clinical parameters and standardized radiographs were obtained before as well as 6 and 24 months after therapy. All radiographs were digitized and evaluated by an examiner blinded to the clinical data. The following distances were measured: cemento-enamel junction line (CEJ-line) to alveolar crest (AC) at the furcation site (AC-CEJ line), CEJ-line to the furcation fornix (Fx-CEJ line), width of the furcation at the level of the AC (FW) as well as the distance from Fx to a straight line between the AC mesial and distal of the tooth (Fx-AC line). RESULTS: Statistically significant (p<0.001) horizontal attachment gains could be observed 6 and 24 months after therapy (6 months: 1.49+/-0.85 mm; 24 months: 1.14+/-0.91 mm). However, a small but statistically significant (p=0.031) attachment loss of 0.35 mm was observed between the 6 and 24 months examination. Multilevel regression analyses identified baseline probing depth (p=0.0017) and 3 of the radiographic distances as prognostic factors: Fx-CEJ line (p=0.014), FW (p=0.0535), Fx-AC line (p=0.0827). CONCLUSION: The analysis of presurgical radiographs may yield information on the success of the regenerative therapy of buccal and lingual class II furcation defects. A long root trunk, a wide furcation entrance and an Fx coronal to the AC have negative influences on the success of therapy. Further, a deep probing depth at the furcation site at baseline increases the likelihood for more favourable horizontal attachment gain in furcations.     

个体化开放楔形胫骨高位截骨治疗内侧间室膝骨关节炎的优势

文题释义：开放楔形胫骨高位截骨：是一种治疗内侧间室膝骨关节炎合并膝内翻的保膝术式。通过胫骨近端内侧切口,在水平面、冠状面双截骨后,进行楔形撑开、钢板固定。其治疗意义在于将内翻的下肢力线转移至相对正常的膝外侧,以缓解内侧症状,延长关节寿命,延缓骨关节炎进展,甚至避免关节假体置换。 个体化力线矫形：根据膝骨关节炎的多阶段性,针对不同退变程度的膝内侧间室,施行不同的力线矫形方案。通过术前规划截骨后的楔形撑开角度或距离,可以将内翻的下肢力线矫正至中线或偏外侧,以达到临床治疗效果。 背景：开放楔形胫骨高位截骨对于内侧间室膝骨关节炎合并膝内翻患者疗效明确,但目前关于力线矫正点的选择仍以Fujisawa点作为参考,个体化力线矫形是否能获得更优越的临床疗效？ 目的：探讨开放楔形胫骨高位截骨术中个体化下肢力线矫形治疗内侧间室膝骨关节炎的短期疗效。 方法：选择2016年6月至2018年5月无锡市人民医院骨科因内侧间室膝骨关节炎行开放楔形胫骨高位截骨治疗的46例患者。根据X射线片、MRI综合评估患膝并划分退变等级(Ⅰ-Ⅲ级),其中Ⅰ,Ⅱ级患者随机分为个体化组及对照组,每组16例;14例Ⅲ级患者作为Fujisawa组。个体化组轻度退变Ⅰ级矫正下肢力线至胫骨平台50%点,中度退变Ⅱ级矫正至胫骨平台外侧55%点;对照组、Fujisawa组均矫正力线至62.5%点。测量评估术后下肢力线,比较术前、术后膝关节活动度、股胫角、胫骨近端内侧角;随访术前及术后3,6,12个月患膝的美国特种外科医院评分、西安大略和麦克马斯特大学骨关节炎指数,比较患者术后综合满意度的自评分。结果与结论：①所有患者均获得12个月随访;②3组下肢力线矫形结果满意,术后膝关节活动度、胫骨近端内侧角较术前明显增加,股胫角明显减少(P < 0.05);③随着随访时间延长,3组患者的美国特种外科医院评分显著增加,西安大略和麦克马斯特大学骨关节炎指数显著减少,组内不同时点差异有显著性意义(P < 0.05);个体化组术后3,6个月美国特种外科医院评分高于对照组,西安大略和麦克马斯特大学骨关节炎指数低于对照组,差异有显著性意义(P < 0.05);个体化组及对照组术后12个月美国特种外科医院评分、西安大略和麦克马斯特大学骨关节炎指数差异无显著性意义(P > 0.05);④所有患者对手术矫形效果满意,个体化组术后综合满意评分高于对照组,差异有显著性意义(P < 0.05);⑤结果表明,个体化开放楔形胫骨高位截骨通过准确地力线矫形,有利于膝关节早期功能恢复,提升患者满意度。 ORCID: 0000-0003-0566-2858(俞颖豪) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程