慢性咀嚼肌痛患者面部感觉功能改变的初步定量评价与分析

Evaluation and analysis of facial somatosensory changes of chronic masticatory muscle pain patients with quantitative sensory testing

目的 初步定量评价与分析慢性咀嚼肌痛（masticatory muscle pain,MMP）患者面部感觉功能的改变情况,以期为临床提供参考.方法 采用标准定量感觉测试,测试20例慢性MMP患者疼痛侧和对侧咀嚼肌及20名健康对照者右侧相同咀嚼肌的冷感知阈变化值、温感知阈变化值、冷痛阈值、热痛阈值、机械触觉感知阈值、机械痛觉阈值、压痛阈值,使用配对t检验比较慢性MMP组疼痛侧与对侧差异,使用成组t检验比较慢性MMP患者疼痛侧或对侧与健康对照组的差异.结果 与健康对照组相比,慢性MMP组疼痛侧和对侧咀嚼肌区冷感知阈变化值[（-1.2±0.5）和（-1.7±0.9）℃]和冷痛阈值[（27.6±2.3）和（27.0±2.0）℃]显著升高,温感知阈变化值[（2.0±1.1）和（2.1±1.2）℃]、热痛阈值[（37.9±3.2）和（39.7±3.9）℃]和机械痛觉阈值[（49.3±34.1）和（111.8±86.3） mN]显著降低（P＜0.05）;疼痛侧咀嚼肌区机械触觉感知阈值[（1.8±1.4） mN]显著升高（P=0.01）.结论 慢性MMP患者双侧咀嚼肌区存在温度感觉、温度痛觉和机械痛觉过敏,疼痛侧咀嚼肌区存在机械感觉迟钝等三叉神经系统感觉功能改变.慢性MMP可能影响了三叉神经系统的中枢调节功能.

Objective To evaluate and analysis facial somatosensory changes of patients with chronic masticatory muscle pain（MMP） quantitatively.Methods The seven parameters of standardized quantitative sensory testing（QST） protocol were used to test the pain sites,contralateral sites of masticatory muscles of 20 chronic MMP patients and the same sites of right masticatory muscles of 20 matched healthy controls.QST thresholds were compared within groups using paired t test and between groups using unpaired t test.Results Compared to the controls,all seven parameters of bilateral sides of patients had changed.Mainly cold detection thresholds[（-1.2±0.5） and （-1.7±0.9） ℃] and cold pain thresholds[（27.6±2.3） and （27.0±2.0） ℃] of pain and contralateral sides increased significantly,while warm detection thresholds[（2.0± 1.1） and （2.1± 1.2） ℃],heat pain thresholds[（37.9±3.2） and （39.7±3.9） ℃],and mechanical pain thresholds [（49.3 ± 34.1） and （111.8 ± 86.3） mN] of pain and contralateral sides decreased significantly（P〈0.05）.Mechanical detection thresholds of pain sites[（1.8± 1.4） mN] significantly increased（P=0.01）.Conclusions Chronic MMP patients were detected thermal hyperesthesia,thermal hyperalgesia,and mechanical hyperalgesia.Mechanical hypoesthesia was found at the pain sites of masticatory muscles.Chronic MMP might influence the central modulation of trigeminal nerve system.