颞下颌关节紊乱病(附278例临床分析)

目的　总结我科自 1996～ 2 0 0 0年诊断的颞下颌关节紊乱病 2 78例 ,选用保守治疗为主的序列综合疗法 ,取得一定的治疗效果。方法　本组 2 78例病人 ,男 135例 ,女 143例。年龄 15～ 55岁 ,平均年龄 2 9 5岁。病史 1～ 10年临床表现为关节弹响 ,关节周围肌群疼痛 ,头痛及下颌运动异常 ,完全符合 1997年全国第二届颞下颌关节紊乱综合征会议制订的诊断标准。根据以保守治疗为主的序列疗法的要求 ,我们选用 4种综合治疗法 ,即激光 +超短波 +超声波 +肌肉封闭 ;上颌咬合板 +理疗 +肌肉封闭 ;关节腔及关节周围药物注射 ;手术治疗。并根据病人主、客观反应分成有效、明显有效、无效 3个疗效判定标准 ,在同一条件下进行客观评价。结果　根据疗效判定标准 ,对 2 78例患者逐人进行评定 ,治疗有效者 112例占 4 0 % ,明显有效者 145例占 52 % ;无效者 2 1例占 8%。以上结果经 4年随访。结论　①咀嚼肌紊乱病是由于关节周围肌群功能不协调造成 ,主要表现是肌肉疼痛 ,治疗就是止痛并消除产生肌肉疼痛的原因。②结构紊乱病是由于髁状突、关节盘、关节窝出现结构关系的异常改变 ,主要是上下颌之间垂直距离过低造成关节盘前移 ,关节盘附着松弛或撕脱。治疗就是要恢复上下颌间的垂直高度 ,增加关节腔间隙 ,减轻髁状突对?

Clinical Analysis of Temporomandibular Joint Disorder of 278 cases

Objective To study the curative effect of consequence complex treatment for temporomandibular joint disorder patient mainly in conservative treatment. Methods There were 278 cases of temporomandibular joint disorder patient. male 135 and female 143 aging from 15~55 years old (29.5 in average) among them. The clinical manifestation of patient and diagnosis were accorded with national standard made at the second meeting in 1997. Four complex methods were used according to requirement of consequence procedure: laser, ultra short wave, ultrasonic wave and muscle blockage; occlusion board, physiotherapy and muscle blockage; Joint and peri-joint drug injection; operation. The assessment of curative standard was made to compare with.Results The curative rate was 40% (112/278), remarked effective rate was 52%(145/278) and invalid rate was 8%(21/278). All cases were followed up for 4 years.Conclusion Masticatory muscles disorder was caused by peri-joint muscle incoordination characterized with myalgia. Analgesia and remove the causing factors were the treatment. Configuration disorder was caused by abnormal changes of condyloid, joint disc, cavity characterized joint disc dislocated forward, torsion or relax by much shorter of vertical distant upper and lower jaw. The treatment was to correct the abnormal relationship of the configuration of joint. The joint cavity distension, relax attachment of joint disc and synovitis could be treated with cavity and peri-joint drug injection. The organic disorder of joint should be performed operation after invalid conservative treatment.