2种方法治疗颞下颌关节WilkesⅢ~Ⅴ期结构紊乱的疗效比较

Comparative clinical and MRI study on two methods for treatment of patients with temporomandibular joint internal derangement of Wilkes Ⅲ—Ⅴ stages

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.