摘要
目的:评价并比较颞下颌关节上腔灌洗术及颞下颌关节锚固术治疗WilkesⅢ~Ⅴ期结构紊乱的总体疗效。方法:选择2011年1月—2014年1月接受颞下颌关节锚固术及关节灌洗术的患者286例,根据治疗方法不同分为A、B 2组,A组164例接受颞下颌关节上腔灌洗术,B组122例接受关节盘复位锚固术,分别于术前、术后6个月对患者的颞下颌关节MRI表现、关节杂音、开口度、关节疼痛视觉模拟评分(VAS)值及头痛进行评价,通过手术前、后对比,评价2种治疗方法的临床效果,并进行长期随访(6~42个月)。采用SPSS13.0软件包对数据进行χ2检验及t检验。结果:B组杂音和头痛的治愈率显著大于A组(χ12=14.33,χ22=57.24,P〈0.05)。VAS及开口度的改善效果B组也显著优于A组(t1=30.30,t2=21.37,P〈0.05)。2组患者治疗前与治疗后随访期内MRI检查结果进行比较,A组患者无关节盘解剖复位病例,9例(5.5%)出现关节盘双板区类盘样改变,B组患者全部达到关节盘解剖复位。结论:颞下颌关节灌洗术后伴随临床症状的消失,关节内可以出现双板区类盘样改变,但发生率仅为5.5%。综合临床疗效及影像学表现评价,对WilkesⅢ~Ⅴ期关节结构紊乱的治疗,关节盘锚固术优于关节灌洗术。
PURPOSE: To evaluate the effectiveness of arthrocentesis vs disc anchorage for treatment of temporomandibular joint internal derangement of Wilkes Ⅲ- Ⅴ stages. METHODS: From January 2011 to January2014,286 patients who accepted arthrocentesis and disc anchorage were included in this study and were divided into 2groups according to the treatment modality: 164 patients in group A( arthrocentesis),122 patients in group B(disc anchorage). MRI and clinical examination including crepitus, opening degree between incisors, VAS and headache were taken pretreatment and 6 months postoperatively and the follow-up time was 6 to 42 months. SPSS 13.0 software package was used for statistical analysis. RESULTS: There were significant differences in crepitus, opening degree, headache and VAS between group A and group B(χ21=14.33 and χ22=57.24,P 0.05; t1=30.30, t2=21.37, P 0.05). The follow-up MRI showed no disc reduction in group A, except 5.5% of the patients experienced adaptive remodeling(disc-like changes) in bilaminar zone of the disc, while normal disc-condyle relationship was found in all patients of group B. CONCLUSIONS:As the symptoms disappeared, adaptive remodeling(disc-like changes) in bilaminar zone of the disc could occur but only in 5.5% of the patients after arthrocentesis. Combined clinical effect and MRI findings we conclude that disc anchorage is superior to arthrocentesis for treatment of TMJID of Wilkes Ⅲ-Ⅴ stages.
出处
《中国口腔颌面外科杂志》
CAS
2015年第5期441-445,共5页
China Journal of Oral and Maxillofacial Surgery
关键词
颞下颌关节
灌洗术
锚固术
Temporomandibular joint
Arthrocentesis
Disc anchorage