急性颞下颌关节盘不可复性前移患者手法复位结合综合物理疗法的近期疗效观察

doi:10.19438/j.cjoms.2018.06.007

摘要/Abstract

摘要： 目的: 观察手法复位结合综合物理疗法治疗急性颞下颌关节盘不可复性前移患者的近期临床疗效。方法: 总结我院康复医学科门诊自2017年1月—2017年12月收治的急性开口受限（病程在2个月以内）且经MRI证实颞下颌关节盘不可复性关节盘前移40例患者（男4例,女36例）的临床资料。治疗首先施予健康教育、物理因子治疗（超短波治疗、超声治疗、激光治疗）,随后予手法复位,即刻配戴硬质热塑再定位垫,同时进行运动疗法（软管盘复位训练、关节稳定性训练和颈椎姿势训练）。每周5次,连续治疗2周。所有患者均于治疗前和治疗后采用最大主动开口度（mm）、视觉类比评分（visual analogue pain score,VAS）（0~10分）、下颌功能损害问卷评分（mandibular function impairment questionnaire,MFIQ）进行疗效评估。治疗结束后MRI复查盘-髁关系。采用SPSS22.0软件包对数据进行配对t检验和Wilcoxon符号秩检验。结果: 治疗结束后即刻,最大主动开口度从（24.5±6.4）mm 增加到（40.1±4.4）mm,开口末VAS从2（0,3）分下降到0（0,0）分,咀嚼VAS从1（0,3）分下降到0（0,0）分,下颌功能损害问卷评分从（25.0±6.5）分下降到（12.3±6.4）分,均具有统计学意义（P<0.05）。静息VAS 从0（0,0）分下降到0（0,0）分,无统计学差异（P>0.05）。40例患者在治疗结束后平均（3.6±3.1）周MRI 显示正常盘-髁关系23例（占 57%）,可复性关节盘前移位9例（占23%）,不可复性盘前移位 8例（20%）。结论: 手法复位结合综合物理疗法治疗急性颞下颌关节盘不可复性前移可以即刻增加开口度,缓解疼痛,改善TMJ功能,并对维持正常盘-髁关系有一定作用。

关键词: 颞下颌关节紊乱病, 急性不可复性盘前移, 综合物理疗法, 手法复位

Abstract: PURPOSE: To evaluate the clinical effect of mandibular manipulation combined with comprehensive physical therapy for treatment of acute anterior disc displacement without reduction of temporomandibular joint(TMJ). METHODS: Forty patients (36 females, 4 males) of acute TMJ disc displacement without reduction with limited opening from Jan. 2017 to Dec. 2017 in the Department of Rehabilitation Medicine, Shanghai Ninth People'S Hospital, Shanghai Jiao Tong University School of Medicine, were included in the study. All patients received education, electrotherapy (ultra-short wave diathermy, ultrasound and laser), mandibular manipulation followed by anterior repositioning splint and exercise therapy (disc reposition exercise stabilization exercise and cervical posture exercise). The treatment was continued for 2 weeks, 5 times a week. The baseline and endpoint outcome assessment measures were active maximum mouth opening(MMO), visual analogue scale(VAS) score and mandibular function impairment questionnaire(MFIQ). Consecutive MRI were performed after treatment. SPSS 22.0 software package was used for statistical analysis. RESULTS: After 2 weeks of treatment, MMO increased from (24.5±6.4) mm to (40.1±4.4) mm (P<0.05), VAS at rest dropped from 0(0,0) to 0(0,0)( P>0.05),VAS with opening dropped from 2(0,3) to 0(0,0) (P<0.05), VAS with chewing dropped from 1(0,3) to 0(0,0) (P<0.05) and MFIQ dropped from(25.0±6.5) to (12.3±6.4) (P<0.05). (3.6±3.1) weeks after treatment, 23 patients (57%) were normal, 9 patients (23% ) displayed displacement with reduction and 8 patients(20%) had displacement without reduction. CONCLUSIONS: Mandibular manipulation combined with comprehensive physical therapy can immediately increase mouth opening, relieve pain, improve mandibular function and maintain disc-condyle relationship after successful reposition in the treatment of acute anterior disc displacement without reduction .

Key words: Temporomandibular disorders, Acute anterior disc displacement without reduction, Comprehensive physical therapy, Mandibular manipulation

中图分类号:

R782.6

方仲毅, 刘丽琨, 蔡斌, 范帅, 姜鑫. 急性颞下颌关节盘不可复性前移患者手法复位结合综合物理疗法的近期疗效观察[J]. 中国口腔颌面外科杂志, 2018, 16(6): 518-522.

FANG Zhong-yi, LIU Li-kun, CAI Bin, FAN Shuai, JIANG Xin. Clinical effect of mandibular manipulation combined with comprehensive physical therapy for treatment of acute anterior disc displacement without reduction[J]. China J Oral Maxillofac Surg, 2018, 16(6): 518-522.

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