糖皮质激素对关节腔灌洗治疗关节盘不可复性前移位疗效的影响

目的探讨关节腔灌洗后加糖皮质激素注射对治疗关节盘不可复性前移位的短期、长期疗效以及髁突骨质影像改变的影响。方法按照随机原则将90例颞下颌关节盘不可复性前移位患者分为对照组（44例）和试验组（46例）,对照组在关节腔灌洗后只注入生理盐水,试验组在关节腔灌洗后注入生理盐水与醋酸曲安奈德的混合液。治疗后3~4周（短期）和6个月（长期）复查,采用疼痛自评视觉模拟尺和Fricton颞下颌关节指数评价临床疗效,影像学评价髁突骨质的改变。对有疼痛主诉的患者同时记录治疗后1周每天睡前疼痛分值。结果1）治疗后1周,试验组疼痛减轻更显著（P<0.05）。2）2组患者治疗前后的临床体征和疼痛均有统计学差异（P<0.001）,2种治疗方法均能有效改善症状和体征,但2组之间各项指标的比较均无统计学差异。3）治疗后大多数患者的髁突骨质没有明显的变化。结论除炎症疼痛明显者外,关节腔灌洗治疗关节盘不可复性前移位不必再加激素注射。

Influence of intra-articular corticosteroid on the efficacy of arthrocentesis in treatment of temporomandibular joint anterior disc displacement without reduction

Objective To compare the efficacy and radiographic changes after arthrocentesis followed or not followed by intra -articular corticosteroid injection in patients with temporomandibular disc displacement without reduction  Methods Ninty patients were enrolled in the randomized clinical trial. After receiving arthrocentesis, either 0.5 mL triamcinolone acetonide plus 0.5 mL saline（experimental group,n=46） or 1 mL saline solution as control（control group, n=44） was injected. Patients were assessed by visual analogue scale（VAS） pain scores and Fricton temporomandibular joint（TMJ） index at first visit before treatment, 3-4 weeks and 6 months after treatment respectively. Transpharyngeal and lateral transcranial projections for temporomandibular joints were taken for imaging evaluation. The pain score of patients with pain complaint were recorded everyday for 1 week after treatment. Results Glucocorticoid injection showed more effective pain control over the first week（P<0.05）, and both groups reported symptom and clinical sign relief significantly after treatment（P<0.001）. However, quantitative evaluation for pain reduction, maximal mouth opening improvement and Friction TMJ index showed no significant difference between two groups at 3-4 weeks and 6 months after the treatment. Also there was no significant difference for condylar bone changes radiographically between the two groups. Conclusion Arthrocentesis is an effective treatment for temporomandibular joint disc displacement without reduction, but it is not necessary to inject corticosteroid after arthrocentesis. Intra -articular corticosteroid injection after arthrocentesis is indicated for only those patients with severe pain.