稳定型咬合板联合关节灌洗术治疗颞下颌关节紊乱病的疗效评价

doi:10.19438/j.cjoms.2022.06.008

中国口腔颌面外科杂志 ›› 2022, Vol. 20 ›› Issue (6): 565-570.doi: 10.19438/j.cjoms.2022.06.008

稳定型咬合板联合关节灌洗术治疗颞下颌关节紊乱病的疗效评价

陈静, 朱敏

台州市第一人民医院口腔科,浙江台州 318020

收稿日期:2022-05-10 修回日期:2022-07-14 出版日期:2022-11-20 发布日期:2022-11-20
通讯作者: 陈静,E-mail: fdsss3t4@sina.com
作者简介:陈静（1986-）,女,硕士,主治医师
基金资助:
浙江省医药卫生科技项目(2019332849)

Clinical efficacy of stable occlusal plate combined with joint lavage in the treatment of temporomandibular joint disorders

CHEN Jing, ZHU Min

Department of Stomatology, Taizhou First People's Hospital. Taizhou 318020, Zhejiang Province, China

Received:2022-05-10 Revised:2022-07-14 Online:2022-11-20 Published:2022-11-20

摘要/Abstract

摘要： 目的评价稳定型咬合板联合关节灌洗术治疗颞下颌关节紊乱病的临床效果。方法选取2020年1月—2021年1月在台州市第一人民医院因颞下颌关节紊乱病就诊的患者104例,随机分为对照组和试验组（每组各52例）,对照组给予单纯关节灌洗术,试验组配戴稳定型咬合板联合关节灌洗术,均治疗6个月。比较2组患者最大开口度、疼痛、颞下颌关节紊乱指数、生活质量量表（SF-36）和心理健康评分及关节液内肿瘤坏死因子α(TNF-α)、基质金属蛋白酶2(MMP-2)水平。采用SPSS 19.0软件包对数据进行统计学分析。结果治疗后,2组最大开口度、SF-36评分升高;疼痛、颞下颌关节紊乱指数、心理健康评分降低。试验组最大开口度、SF-36评分显著高于对照组（P<0.01）;疼痛、颞下颌关节紊乱指数、心理健康评分显著低于对照组（P<0.01）。治疗后,2组关节液内TNF-α、MMP-2水平显著降低,且试验组显著低于对照组（P<0.01）。试验组治疗总有效率为96.15%,显著高于对照组的82.69%（P<0.01）。结论稳定型咬合板联合关节灌洗术可有效提升疗颞下颌关节紊乱病临床疗效,抑制炎性反应,有效缓解颌面部疼痛,改善生活质量及心理状况。

关键词: 稳定型咬合板, 关节灌洗术, 颞下颌关节紊乱病, 颌面部疼痛

Abstract: PURPOSE: To analyze the clinical effect of stable occlusal plate combined with joint lavage in the treatment of temporomandibular joint disorder(TMD). METHODS: A total of 104 patients with TMD in Taizhou First People's Hospital from January 2020 to January 2021 were selected and randomly divided into the control group and the experimental group, with 52 cases in each group. The control group was given gangliolar lavage, while the experimental group wore stable occlusal plate combined with gangliolar lavage, both treated for 6 months. Clinical efficacy was analyzed by comparing the maximum mouth opening, pain, craniomandibular index(CMI), SF-36 and mental health score, tumor necrosis factor (TNF-α) and matrix metallo proteinase 2 (MMP-2) levels in 2 groups of patients. SPSS 19.0 software package was used for data analysis. RESULTS: After treatment, the maximum mouth opening and SF-36 score increased, and the scores of pain, CMI, mental health decreased in the two groups. The maximum mouth opening, TOI index and SF-36 score of the experimental group were significantly higher than those of the control group(P<0.01). The scores of pain, CMI, mental health in the experimental were significantly lower than those of the control group(P<0.01). After treatment, the levels of TNF-α and MMP-2 in the joint fluid of the two groups were significantly decreased, and the experimental group was significantly lower than the control group(P<0.01). The total effective rate of the experimental group(96.15%) was significantly higher than that of the control group(82.69%, P<0.01). CONCLUSIONS: Stable occlusal plate combined with ganglionic lavage can effectively improve the clinical efficacy of TMD, inhibit inflammatory response, effectively relieve maxillofacial pain, improve the quality of life and psychological clearance.

Key words: Stable occlusal plate, Joint lavage, Temporomandibular joint disorder, Maxillofacial pain

中图分类号:

R782.6

陈静, 朱敏. 稳定型咬合板联合关节灌洗术治疗颞下颌关节紊乱病的疗效评价[J]. 中国口腔颌面外科杂志, 2022, 20(6): 565-570.

CHEN Jing, ZHU Min. Clinical efficacy of stable occlusal plate combined with joint lavage in the treatment of temporomandibular joint disorders[J]. China J Oral Maxillofac Surg, 2022, 20(6): 565-570.

参考文献

[1] Kmeid E, Nacouzi M, Hallit S, et al.Prevalence of temporomandibular joint disorder in the Lebanese population, and its association with depression, anxiety, and stress[J]. Head Face Med, 2020, 16(1): 19-30.
[2] Valesan LF, Da-Cas CD, Réus JC, et al.Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis[J]. Clin Oral Investig, 2021, 25(2): 441-453
[3] Sotelo EDP, Vendruscolo CP, Fülber J, et al.Effects of joint lavage with dimethylsulfoxide on LPS-induced synovitis in horses-clinical and laboratorial aspects[J]. Vet Sci, 2020, 7(2): 57-68.
[4] Sahoo RK, Galluccio F, Chang KV, et.al. Indications and future perspectives of a minimally invasive ultrasound-guided double-needle joint lavage[J]. J Med Ultrasound, 2021, 29(4): 291-293.
[5] Alajbeg I, Živkovic K, Gikic M.The role of stabilization splint in the treatment of temporomandibular disorders[J]. Acta Med Croatica, 2015, 69(1): 33-43.
[6] Bitiniene D, Zamaliauskiene R, Kubilius R, et al.Quality of life in patients with temporomandibular disorders. A systematic review[J]. Stomatologija, 2018, 20(1): 3-9.
[7] Racich MJ.Occlusion, temporomandibular disorders, and orofacial pain: an evidence-based overview and update with recommendations[J]. J Prosthet Dent, 2018, 120(5): 678-685.
[8] 张邀光, 房维. 颞下颌关节紊乱病诊断标准的研究进展[J]. 口腔医学研究, 2021, 37(12): 1069-1072.
Zhang YG, Fang W.Progress of diagnostic criteria for temporomandibular disorders[J]. Journal of Oral Science Research, 2021, 37(12): 1069-1072.
[9] 林雪峰, 陈伟生. RDC/TMD在中国颞下颌关节紊乱病患者分类中的临床应用[C]. 第九次全国颞下颌关节病学及学研讨会论文集, 2012: 54-55.
Lin XF, Chen WS.Clinical application of RDC/TMD in the classification of temporomandibular joint disorders in China[J]. Proceedings of the 9th National Symposium on Temporomandibular Joint Epidemiology and Pathology, 2012: 54-55.
[10] Ungor C, Atasoy KT, Taskesen F, et al.Long-term outcome of arthrocentesis plus hyaluronic acid injection in patients with Wilkes stage II and III temporomandibular joint internal derangement[J]. J Craniofac Surg, 2015, 26(7): 2104-2108.
[11] Lee K, Chon S.Assessments of muscle thickness and tonicity of the masseter and sternocleidomastoid muscles and maximum mouth opening in patients with temporomandibular disorder[J]. Healthcare (Basel), 2021, 9(12): 1640-1651.
[12] Alonso-Royo R, Sánchez-Torrelo CM, Ibáñez-Vera AJ, et al.Validity and reliability of the helkimo clinical dysfunction index for the diagnosis of temporomandibular disorders[J]. Diagnostics (Basel), 2021,11(3): 472-482.
[13] Manfredini D, Rancitelli D, Ferronato G, et al.Arthrocentesis with or without additional drugs in temporomandibular joint inflammatory-degenerative disease: comparison of six treatment protocols[J]. J Oral Rehabil, 2012, 39(4): 245-251.
[14] Liu F, Steinkeler A.Epidemiology, diagnosis, and treatment of temporomandibular disorders[J]. Dent Clin North Am, 2013, 57(3): 465-479.
[15] Dimitroulis G.Management of temporomandibular joint disorders: a surgeon's perspective[J]. Aust Dent J, 2018, 63(Suppl 1): S79-S90.
[16] 王宸, 杨璞, 张东芳, 等. 膝关节镜术中不同生理盐水继续灌洗量对早期膝关节疼痛和肿胀程度的影响[J]. 中国修复重建外科杂志, 2021, 35(2): 178-182.
Wang C, Yang P, Zhang DF, et al.The effect of different continuous saline irrigation volume under arthroscopy on early postoperative pain and swelling of the knee[J]. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(2): 178-182.
[17] Gudova R, Voog-Oras Ü, Ivask O.Arthrocentesis techniques used in the treatment of temporomandibular disorders: literature review[J]. Stomatologija, 2021, 23(4): 95-100.
[18] Bergstrand S, Ingstad HK, Møystad A, et al.Long-term effectiveness of arthrocentesis with and without hyaluronic acid injection for treatment of temporomandibular joint osteoarthritis[J]. J Oral Sci, 2019, 61(1): 82-88.
[19] Al-Moraissi EA, Farea R, Qasem KA, et al.Effectiveness of occlusal splint therapy in the management of temporomandibular disorders: network meta-analysis of randomized controlled trials[J]. Int J Oral Maxillofac Surg, 2020, 49(8): 1042-1056.
[20] Saha FJ, Pulla A, Ostermann T, et al.Effects of occlusal splint therapy in patients with migraine or tension-type headache and comorbid temporomandibular disorder: a randomized controlled trial[J]. Medicine (Baltimore), 2019, 98(33): e16805.
[21] van Grootel RJ, Buchner R, Wismeijer D, et al. Towards an optimal therapy strategy for myogenous TMD, physiotherapy compared with occlusal splint therapy in an RCT with therapy-and-patient-specific treatment durations[J]. BMC Musculoskelet Disord, 2017, 18(1): 76-93.
[22] Ibi M.Inflammation and temporomandibular joint derangement[J]. Biol Pharm Bull, 2019, 42(4): 538-542.
[23] Wang Y, Bao M, Hou C, et al.The Role of TNF-α in the pathogenesis of temporomandibular disorders[J]. Biol Pharm Bull, 2021, 44(12): 1801-1809.
[24] Fonseca MT, Moretti EH, Marques LMM, et al. A leukotriene-dependent spleen-liver axis drives TNF production in systemic inflammation[J]. Sci Signal, 2021,14(679): eabb0969.
[25] Nascimento GC, De Paula BB, Gerlach RF, et al.Temporomandibular inflammation regulates the matrix metalloproteinases MMP-2 and MMP-9 in limbic structures[J]. J Cell Physiol, 2021, 236(9): 6571-6580.
[26] Ulmner M, Sugars R, Naimi-Akbar A, et al.Cytokines in temporomandibular joint synovial fluid and tissue in relation to inflammation[J]. J Oral Rehabil, 2022, 49(6): 599-607.

稳定型咬合板联合关节灌洗术治疗颞下颌关节紊乱病的疗效评价

Clinical efficacy of stable occlusal plate combined with joint lavage in the treatment of temporomandibular joint disorders

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 5

编辑推荐

Metrics

本文评价

[1]	孙明媛, 俞蕾蕾, 顾雅洁, 夏滴. 品管圈在提高颞下颌关节紊乱患者术后功能锻炼依从性的效果评价[J]. 中国口腔颌面外科杂志, 2021, 19(4): 340-344.
[2]	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.
[3]	姜鑫, 刘丽琨, 蔡斌, 方仲毅, 徐丽丽, 范帅. 应用运动训练维持颞下颌关节盘手法复位后的盘-髁关系[J]. 中国口腔颌面外科杂志, 2016, 14(5): 435-439.
[4]	王留兰, 孙琦, 董敏俊, 陶晓峰. 螺旋CT、锥形束CT与MRI在颞下颌关节紊乱病成像中的应用比较[J]. 中国口腔颌面外科杂志, 2015, 13(1): 73-77.
[5]	董小宇,朱祖凤,张新丽,何帅. 应用HSROC统计模型对高分辨率超声诊断颞下颌关节盘前移位准确性的meta分析[J]. 中国口腔颌面外科杂志, 2014, 12(3): 266-272.