一例初诊颈椎半脱位引起颞下颌关节紊乱病患者的循证治疗

Evidence-based Treatment to One Case of Temporomandibular Disorder Patient Induced by Diagnosed Subluxation of Cervical Vertebra

目的:借助循证医学的方法为颈椎半脱位病患者引起颞下颌关节紊乱病确定治疗目标和治疗方案。方法:充分评估患者情况后,提出临床问题,计算机检索MEDLINE数据库(1950～2007年)、SUMSEARCH数据库(2007年1月)、Cochrane图书馆等数据库(2007年第1期)、TRIPDA-TABASE数据库(1997～2007年)、中文生物医学期刊数据库(1994～2007年),并手工检索《中国口腔颌面外科杂志》等相关的4种中国科技论文统计源期刊(创刊～2006年),无语种限制。检索主题词为:temporomandibular;traction;subluxation cervical vertebra;tem-poromandibular disorders;meta-analysis;systmatic reviews;RCT;randomized controlled trials。结果:共检索出与不同问题相关的随机对照试验63篇,系统评价或Meta分析14篇。根据患者病情和通过对检索结果进行分析,为患者制定颈托外固定,局部给予按摩、热敷,并对症治疗方案。经90d的随访证实,该方案适合患者。结论:采用循证治疗方法,为初诊颈椎半脱位引起颞下颌关节紊乱病确定合理的治疗目标和治疗方案,可有效提高治疗效果。

Objective： To make an individualized treatment plan concerning diagnosed subluxation of cervical verte bra in patient through evidence--based medicine. Methods： After clinical problem were put forward, we searched The Cochrane Library （Issue 1,2007） , MEDLINE （1950 -- 2007） SUMSEARCH （Jan. 2007）, TRIPDATABASE （ 1997 -- 2007）, CMCC （ 1994-- 2007） and hand-- searched four Chinease journals （ starting publication-- 2007）, ac cording to the search strategy. Subject words were： temporomandibular; traction; subluxation cervical vertebra; temporomandibular disorders; meta-- analysis; systematic reviews; RCT; randomized controlled trials. Results： A total of 63 RCTs, and 14 systematic reviews were identified. A rational treatment plan was cervical gear exopexy and massage, fomentation including with symptomatic treatment. The plan was made upon a serious evaluation of the data. After 90 days follow--up, the plan was proved optimal. Conclusion： The treatment efficacy in diagnosed subluxation of cervical vertebra lead to temporomandibular disorders in patient has been improved by determining an individualized treatment plan according to evidence--based methods.