颞下颌关节骨关节病术后不同辅助治疗效果评价

Clinical effect evaluation of different postoperative adjuvant therapies for temporomandibular joint osteoarthrosis

目的评价颞下颌关节骨关节病(temporomandibular joint osteoarthrosis,TMJOA)术后不同辅助治疗方法的临床效果,为术后康复治疗提供参考。方法选取2015年6月至2021年11月于中国医科大学附属口腔医院口腔颌面外科行颞下颌关节盘松解复位固定手术的191例TMJOA患者进行回顾性分析。术后行[牙合]垫治疗+常规功能训练的63例患者记为[牙合]垫组,行几丁糖关节腔内注射治疗+常规功能训练的57例患者记为注射组,仅行常规功能训练的71例患者记为对照组。对3组患者治疗前后的疼痛视觉模拟评分法(VAS)评分、最大张口度、下颌运动分、肌肉压诊分进行比较分析。结果治疗前,3组各项评价指标比较,差异均无统计学意义(均P>0.05)。治疗后3个月,3组各项评价指标总的比较,差异均有统计学意义(均P<0.05);关于VAS评分、下颌运动分、肌肉压诊分方面,分值由低至高依次为注射组、[牙合]垫组、对照组,而最大张口度由大至小依次为注射组、[牙合]垫组、对照组,差异均有统计学意义(P<0.05);且3组各项评价指标结果均明显优于治疗前(均P<0.05)。结论TMJOA患者行颞下颌关节盘松解复位固定手术后采取适当辅助治疗和功能训练均能显著改善颞下颌关节功能,其中几丁糖关节腔内注射治疗结合常规功能训练的效果较佳。

Objective To evaluate the clinical effect of different adjuvant treatments for temporomandibular joint osteoarthrosis(TMJOA)after surgery,and to provide reference for postoperative rehabilitation treatments.Methods A total of 191 TMJOA patients who accepted temporomandibular joint disc repositioning and fixation in the Department of Oral and Maxillofacial Surgery,China Medical University Hospital of Stomatology from June 2015 to November 2021 were selected for a retrospective analysis.The 63 patients treated with splint and routine functional training were classified as splint group;57 cases treated with intraarticular injection of chitosan and routine functional training were classified as injection group;71 cases only receiving routine functional training were classified as control group.The scores of visual analogue scale(VAS),maximum incisal opening,mandibular movement score and muscle palpation score were compared and analyzed in the three groups before and after treatment.Results Before treatment,there was no significant difference in each index among the three groups(P>0.05).There were statistically significant differences among the three groups in terms of various evaluation indexes three months after treatment(P<0.05).In terms of VAS score,mandibular movement score and muscle palpation score,the groups with scores from low to high were injection group,splint group and control group,while the groups with maximum incisal opening degree from large to small were injection group,splint group and control group,all being with significant difference(P<0.05).The results of each evaluation index in the three groups were significantly better after treatment than before treatment(P<0.05).Conclusion Patients who accept appropriate adjuvant treatments and functional training after TMJOA temporomandibular joint disc repositioning and fixation can significantly improve the function of TMJOA,in which the curative effect of intraarticular injection of chitosan combined with routine functional training is relatively better.