关节镜上腔灌洗术治疗中老年颞下颌关节紊乱病的临床研究

目的：评价应用颞下颌关节镜上腔灌洗术治疗临床表现为张口受限合并关节区疼痛的中老年颞颌关节紊乱病患者的临床疗效。方法：对保守治疗无效的16例颞下颌关节紊乱病引起张口受限合并关节疼痛的中老年患者，行颞下颌关节镜上腔灌洗术，分析治疗前后不同时期患者的疼痛值（疼痛直观模拟标尺VAS）、张口度和健侧侧向运动度变化，并通过MRI检测治疗前后关节盘位置的变化。结果：治疗后张口度35mm、健侧侧向运动≥6mm的患者占87．5％（14／16），不同时期的张口度均较治疗前有显著差异（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〈0．001），无并发症的发生。MRI显示，有1例患者的关节盘部分复位。结论：颞下颌关节内窥镜下的上腔灌洗术直视下操作准确，能有效治疗颞下颌关节紊乱病的患者，明显改善张口度和缓解疼痛。颞下颌关节镜治疗技术安全有效，有临床应用价值。

Arthroscopy and lavage of TMJ for the treatment of temporomandibular disorders in senile patient

Objective: To evaluate the clinical efficacy of the TMJ arthroscopy and lavage as a treatment for temporomandibular disorders (TMDs) in senile patient. Methods: 16 patients with limited mouth opening caused by TMDs were treated with TMJ arthroscopy and lavage. Clinical data including pain and mandibular motion were collected and then analyzed. MRI was used to evaluate disc position in patients. Results: The mandibular motion of 87.5%(14/16)patients had increased significantly (P <0.001) at different period of time, especially within 1 month. Jaw pain had also been improved significantly(P <0.001). MRI revealed that only 1 patients demonstrated a partially relocated disc. Conclusions: Arthroscopy and lavage is effective in reducing pain and increasing mandibular motion in senile patients with TMDs, especially in patients with symptoms duration less then 6 months. It is recommended as a simple alternative to more invasive TMJ procedures in senile patients.