稳定型咬合板治疗颞下颌关节紊乱病疼痛症状的研究

Pain control in the treatment of temporomandibular disorders by stabilization splint

目的:探讨稳定型咬合板治疗颞下颌关节紊乱病(TMD)疼痛的疗效。方法:TMD疼痛患者61例,急性组28例(男11例,女17例);慢性组33例(男18例,女15例)。记录治疗前后疼痛指数,双侧颞肌前束(temporal anterior,TA)和咬肌(m assetermusc le,MM)牙尖交错位最大紧咬时电位及最大紧咬时咬合接触情况。结果:(1)2组治疗后1月疼痛指数均明显低于治疗前(P<0.05),治疗前后疼痛强度差值及显效率2组之间无显著差异(P>0.05)。(2)治疗后无论是急性组还是慢性组TA及MM最大紧咬电位症状侧均较治疗前明显升高(P<0.05),而非症状侧治疗前后无明显差异(P>0.05)。(3)治疗后急性组TA和MM肌电不对称指数与治疗前相比均明显降低(P<0.05)。治疗后肌电不对称指数TA慢性组明显高于急性组(P<0.05),而MM无明显差异(P>0.05)。(4)2组治疗前后左、右两侧咬合接触点数、以及咬合接触不对称指数无明显差异(P>0.05)。结论:稳定型咬合板治疗可以明显缓解TMD疼痛,但对急、慢性疼痛的缓解程度无明显差异。其机制可能与肌功能活动情况易于得到明显改善等生理学基础有关。

Objective：To investigate the effect of stabilization splint on the treatment of temporomandibular disorders （TMD） with oral-facial pain. Methods ：Sixty-one patients were divided into two groups, acute pain group and chronic pain group. Graded Scale （ GS ） value, EMG activities of bilateral anterior temporolis （ TA ） and masseter muscle （MM） and occlusal contact points during biting in intereuspal position were recorded before and 1 month after treatment. Results： （ 1 ） In both groups, the GS values decreased remarkably（ P 〈 0.01 ） 1 month after treatment. （ 2 ） After treatment EMG activity of TA and MM on the symptomatized side in both acute and chronic groups increased （ P 〈 0. 005 ）, that of those on normal side did not（ P 〉 0.05 ）. （ 3 ） In acute group the asymmetry of bilateral activity of TA and MM was improved significantly 1 month after splint treatment （ P 〈 0. 05 ） but in chronic group was not （ P 〉 0.05）. （4） In both groups the occlusal contact number was not increased and the symmetry was not improved 1 month after splint treatment（P 〉0.05）. Conclusions：Occlusal splint is effective in the control of TMD pain, the treatment mechanism is related to the quick improvement of masticatory muscles.