2种方法治疗颞下颌关节WilkesⅢ~Ⅴ期结构紊乱的疗效比较

目的：评价并比较颞下颌关节上腔灌洗术及颞下颌关节锚固术治疗WilkesⅢ~Ⅴ期结构紊乱的总体疗效。方法选择2011年1月—2014年1月接受颞下颌关节锚固术及关节灌洗术的患者286例,根据治疗方法不同分为A、B 2组,A组164例接受颞下颌关节上腔灌洗术,B组122例接受关节盘复位锚固术,分别于术前、术后6个月对患者的颞下颌关节MRI表现、关节杂音、开口度、关节疼痛视觉模拟评分（VAS）值及头痛进行评价,通过手术前、后对比,评价2种治疗方法的临床效果,并进行长期随访（6~42个月）。采用SPSS13.0软件包对数据进行χ²检验及t检验。结果B组杂音和头痛的治愈率显著大于A组（χ₁²=14.33,χ₂²=57.24,P<0.05）。VAS及开口度的改善效果B组也显著优于A组（t₁=30.30, t₂=21.37, P<0.05）。2组患者治疗前与治疗后随访期内MRI检查结果进行比较,A组患者无关节盘解剖复位病例,9例（5.5%）出现关节盘双板区类盘样改变,B组患者全部达到关节盘解剖复位。结论颞下颌关节灌洗术后伴随临床症状的消失,关节内可以出现双板区类盘样改变,但发生率仅为5.5%。综合临床疗效及影像学表现评价,对WilkesⅢ~Ⅴ期关节结构紊乱的治疗,关节盘锚固术优于关节灌洗术。

Comparative clinical and MRI study on two methods for treatment of patients with temporomandibular joint internal derangement of Wilkes Ⅲ—Ⅴ stages

PURPOSE: To evaluate the effectiveness of arthrocentesis vs disc anchorage for treatment of temporomandibular joint internal derangement of Wilkes Ⅲ-Ⅴ stages. METHODS: From January 2011 to January 2014,286 patients who accepted arthrocentesis and disc anchorage were included in this study and were divided into 2 groups according to the treatment modality: 164 patients in group A ( arthrocentesis),122 patients in group B(disc anchorage). MRI and clinical examination including crepitus, opening degree between incisors, VAS and headache were taken pretreatment and 6 months postoperatively and the follow-up time was 6 to 42 months. SPSS 13.0 software package was used for statistical analysis. RESULTS: There were significant differences in crepitus, opening degree, headache and VAS between group A and group B(χ²₁=14.33and χ²₂=57.24,P<0.05; t₁=30.30, t₂=21.37, P<0.05). The follow-up MRI showed no disc reduction in group A, except 5.5% of the patients experienced adaptive remodeling (disc-like changes) in bilaminar zone of the disc, while normal disc-condyle relationship was found in all patients of group B. CONCLUSIONS: As the symptoms disappeared, adaptive remodeling(disc-like changes) in bilaminar zone of the disc could occur but only in 5.5% of the patients after arthrocentesis. Combined clinical effect and MRI findings we conclude that disc anchorage is superior to arthrocentesis for treatment of TMJID of Wilkes Ⅲ-Ⅴ stages .