三种方法治疗颞下颌关节紊乱病的疗效比较

目的　比较关节灌洗、关节镜和关节开放手术 3种方法治疗颞下颌关节紊乱病的临床效果。方法　应用 3种方法治疗颞下颌关节紊乱病 :关节灌洗术治疗 35例 (42侧关节 ) ,关节镜术治疗 4 2例 (5 0侧关节 ) ,关节开放手术治疗 2 8例 (2 9侧关节 ) ,并对 3种方法的疗效进行比较。结果　关节灌洗组随访 2 4～ 5 2个月 ,术后张口度平均增加 (8.1± 3.9)mm ,健侧侧向运动增加 (3.8± 1.4 )mm ,85 .7%患者疼痛缓解 ,72 .2 %杂音消失 ,总有效率为 82 .9%。关节镜组随访 2 4～ 5 6个月 ,张口度平均增加 (7.5± 3.8)mm ,健侧侧向运动增加 (4.1± 1.8)mm ,88.1%患者疼痛缓解 ,79.2 %杂音消失 ,总有效率为 85 .7%。关节开放手术组 ,随访 2 4～ 5 5个月 ,术后张口度平均增加 (8.0± 5 .1)mm ,健侧侧向运动增加 (3.7± 2 .3)mm ,92 .9%患者疼痛缓解 ,总有效率为 89 3%。 3组比较 ,张口度、侧向运动改善及疼痛缓解率均无显著差异。结论　关节灌洗术、关节镜术和关节开放手术治疗颞下颌关节紊乱病均有效 ,但关节灌洗术方法简单、损伤小 ,易于推广应用。首先应选择手术创伤小的治疗方法 ,最后才选择开放手术。

A COMPARATIVE STUDY OF THREE METHODS IN TREATMENT OF TEMPOROMANDIBULAR DISORDERS

Objective To compare clinical effects of arthrocentesis, arthroscopy and artrotomy in treatment of temporomandibular disorders (TMD). Methods 35 cases (42 joints) with TMD underwent arthrocentesis, 42 cases (50 joints) underwent arthroscopic surgery and 28 cases (29 joints) were performed with arthrotomy. The clinical effects of three treatment groups were compared. Results In arthrocentesis group, the follow up period was 24 to 52 months. Postoperative MIO (Maximum interincisal opening) increased 8.1±3.9mm and lateral excursions increased 3.8±1.4mm in average. 85.7% of all with painful symptom patients had released of pain and dismiss of noises in 72.2% of patients. The total success rate was 82.9%. In arthroscopic surgery group, the follow up period was 24 to 56 months. Postoperative MIO increased 7.5±3.8mm and lateral excursions increased 4.1±1.8mm in average. 88.1% of pain patients and 79.2% of patients with noises reduced the symptoms. The total success rate was 85.7%. In arthrotomy group, the follow up period was 24 to 55 months. Postoperative MIO increased 8.0±5.1mm and lateral excursions increased 3.7±2.3mm in average. 92.8% of pain patients had released of pain. The total success rate was 89.3%. Comparing with MIO, lateral excursions and pain release, no significant differences were found among arthrocentesis group, arthroscopy group and arthrotomy group. Conclusion Arthrocentesis, arthroscopy and arthrotomy are all effective procedures in treatment of TMD. However, arthrocentesis is a simple and minimally invasive treatment modality for TMD, and easy to use widely. A simple and minimally invasive treatment modality should be chosen first, and then open surgery.