垫治疗颞下颌关节盘移位的疗效评估及磁共振成像表现

Evaluation and MRI findings of occlusal splint in treatment of anterior disc displacement of temporomandibular joint

目的观察稳定性垫对颞下颌关节盘移位的治疗效果,探讨磁共振成像(MRI)在疗效评估中的作用。方法以经MRI检查诊断为颞下颌关节盘移位并接受稳定性垫治疗的33例患者作为研究对象。根据患者症状缓解情况,垫从最初的全天佩戴(除进食外)逐步过渡到夜间佩戴,整个疗程为6个月。治疗结束后,测量张口度评估下颌运动功能;视觉模拟评分法(VAS)评估疼痛程度(VAS评分);复查MRI并与治疗前进行比较。结果治疗结束后,患者VAS评分平均为2.38±1.58,显著小于治疗前的7.49±2.09(P<0.001);张口度平均为(40.14±5.03)mm,明显大于治疗前的(26.5±5.12)mm(P<0.001)。与治疗前比较,治疗结束后大部分患者MRI表现无明显变化;仅有2例患者MRI复查表现为关节腔积液减少,其中1例关节盘移位回复至正常位置,另1例由关节绞锁恢复为可复性关节盘移位。结论稳定性垫治疗颞下颌关节盘移位能明显减轻疼痛,改善下颌运动功能;MRI表现不能作为评估垫疗效的单一标准。

Objective To investigate the outcomes of stabilization occlusal splint in treatment of anterior disc displacement of temporomandibular joint,and explore the role of MRI in evaluation of the therapeutic effect.Methods Thirty-three patients with anterior disc displacement of temporomandibular joint diagnosed by MRI and treated by stabilization occlusal splint were selected.According to the conditions of symptomatic relief,occlusal splints were worn for 6 months,from 24 h per day in the early stage to night hours only later.After treatment,mandibular movement function was assessed by oral opening distance,visual analogue scale （VAS） score was obtained,and a second MRI was performed for comparison with MRI findings before treatment.Results After treatment,the mean VAS score was 2.38±1.58,and was significantly lower than that before treatment （7.49±2.09）（P0.001）.The mean oral opening distance was （40.14±5.03） mm,and was significantly larger than that before treatment （26.5±5.12） mm （P0.001）.There was no significant change in MRI findings after treatment in most of the patients.Only two patients were observed to have reduced arthroedema by a second MRI,the articular discs recaptured to normal position in one of them,and the articular interlocking recovered to reducible articular disc displacement in the other.Conclusion Stabilization occlusion splint can significantly relieve the pain and improve the mandibular movement function in the treatment of anterior disc displacement of temporomandibular joint,and MRI findings can not be used as the single criterion for evaluation of therapeutic effect.