防粘连冲洗液灌洗治疗闭口绞锁的短期疗效

Short-term effect of arthrocente sis and lava ge with adhesion-preventing solution on the treatment of temporomandibular joint closed lock

目的:探讨羧甲基壳聚糖防粘连冲洗液在治疗颞下颌关节闭口绞锁中的临床疗效。方法:将临床检查与(magnatic resonance imaging)MRI检查符合闭口绞锁诊断的患者168例随机分为两组,采用Nitzan报告的关节灌洗治疗方法,分别对患者进行氯化钠灌洗及羧甲基壳聚糖防粘连冲洗液灌洗治疗,对患者术前、术后6个月的疼痛及张口度变化进行统计学分析。结果:在年龄分布,绞锁时间,关节疼痛的VAS值及张口度方面,治疗前两组患者差异无统计学意义。氯化钠冲洗组成功率61.9%(52/84),羧甲基壳聚糖防粘连冲洗液冲洗组成功率72.6%(61/84),氯化钠冲洗组失败的32例患者中,30例患者平均年龄38.6岁,平均绞锁时间大于7个月,羧甲基壳聚糖防粘连冲洗液冲洗组失败的23例患者中,平均年龄39.1岁,平均绞锁时间大于8个月。虽上述两组失败患者的平均年龄与治疗成功患者的平均年龄(26.8岁及27.1岁)差异无统计学意义,但年龄大及绞锁时间长的患者疗效较差,无论是VAS值还是张口度,两组在治疗前后比较差异均有统计学意义;组间比较发现,两组VAS值术后均有明显减小且两组间差异无统计学意义(P>0.05)。但在张口度改善方面。羧甲基壳聚糖防粘连冲洗液冲洗组术后张口度增大明显大于氯化钠冲洗组(P<0.05)。结论:在关节灌洗中,选用羧甲基壳聚糖防粘连冲洗液进行冲洗,可有效消除疼痛、增加张口度,从而恢复下颌功能。对于羧甲基壳聚糖防粘连冲洗液的长期疗效有待进一步研究。

Objective： To investigate the clinical effect of carboxymethyl chitosan （CMCS） adhesion-preventing solution on temporomandibular joint arthrocentesis and lavage for the treatment of closed lock. Methods： 168 patients, who were di- agnosed as closed lock by clinical and MRI examination, were randomly assigned into two groups. The physiological saline group consisted of 84 patients with unilateral symptomatic joint, including 64 women and 20 men whose mean age was 31.9 years. Locking duration was 5.0 months on average. The CMCS group consisted of 84 patients with 84 joints, includ- ing 62 women and 22 men whose mean age was 32.2 years and locking duration was 4.9 months on average. The two-nee- dle technique refers to the approach first described by Nitzan et al, and the arthrocentesis procedure was performed in exact- ly the same manner in two groups. The visual analogue scale （VAS） of temporomandibular pain and maximal opening de- gree without pain were recorded at baseline and 6 months follow-up. Criteria for success were as follow： the arthralgia dis- appeared or was mild, opening degree was more than 35 mm and the patient was eating a normal diet. Within-group and be- tween-group differences before and after treatment 6 months were statistically analyzed by paired test （value〈0.05）. Results： There was no between-group statistical difference in the items of age, locking duration, VAS, and opening degree. Accord- ing to our criteria the success rate was 61.9% in physiological saline group, 72.6% in the CMCS group. With respect to the results, failure of 32 patients in physiological saline group included 30 patients with long-standing closed lock over a periodof 7 months, and the mean age of those cases was 38.6 years, which was higher than that of effective cases （mean age, 26.8 years）, failure of 23 patients in CIVICS group had a period of 8 months closed lock and the mean age of those patients was 39.1 years, which was higher than that of the effective cases （mean age 27.1 years）. Statistically significant differences were found on both VAS score and opening degree in either physiological saline group or CMCS group before and at six months follow-up. There was no statistical between-group difference on VAS score before and at six months follow-up, but significant between-group differences existed on re-establishing opening degree, with better results in CMCS group patients. Conclusion： CMCS should be recommended as the first-line solution in arthrocentesis and lavage of closed lock for its more effective in eliminating pain, re-establishing opening degree and mandibular function. The long-term clinical outcomes of CMCS need further study.