颞下颌关节灌洗术对WilkesⅢ期患者临床症状及关节盘形态影响的研究

Clinical symptoms and temporomandibular joint disc deformity study of Wilkes Ⅲ stage patients treated with arthro-centesis

目的探讨颞下颌关节灌洗术对WilkesⅢ期患者治疗前及治疗后6个月临床症状及关节盘形态变化的影响。方法选取2013年1—12月就诊患者137例,经临床及磁共振成像(MRI)检查符合颞下颌关节结构紊乱WilkesⅢ期诊断,进行颞下颌关节上腔灌洗术。所有患者于术前和术后6个月分别接受临床及MRI检查,临床检查包括可视疼痛模拟标尺(VAS)测量值和张口度。MRI检查包括关节盘形态及关节上腔积液。将各指标所测得数据采用SPSS20.0软件进行统计分析。结果 137例患者关节灌洗术后VAS均值明显降低,张口度明显增大(P<0.05),治疗成功率为78.1%(107/137)。MRI结果显示,治疗后关节盘变形加重,然而关节腔渗液明显减少,治疗前后差异有统计学意义(P<0.05)。7例患者出现关节盘双板区适应性改建,发生率为5.1%(7/137)。结论颞下颌关节灌洗术能有效减轻疼痛,有效减少关节上腔渗液,对于WilkesⅢ期短期疗效肯定;伴随着张口疼痛、张口受限临床症状的消失,部分患者可出现双板区适应性改建;然而,随着时间推移关节盘变形有进一步加重的趋势。

Objective This study aims to evaluate the effectiveness of arthrocentesis on Wilkes Ⅲ stage patients. Clinical examinations and magnetic resonance imaging（MRI） findings before treatment and six months after treatment were compared and analyzed. Methods A total of 137 outpatients diagnosed with temporomandibular joint internal derangement（TMJID） associated with Wilkes Ⅲ stage through clinical examination and MRI findings from January 2013 to December 2013 were randomly included. All the patients were successfully treated with arthrocentesis. Moreover, all the patients accepted clinical and MRI examination before arthrocentesis treatment and six months after. Clinical examination included visual analogue scale and opening degree, whereas MRI examination included articular disc morphology and effusion in the upper compartments. Statistical analysis was performed using SPSS 20.0. Results Results showed that the average score of visual analogue scale six months after treatment was significantly lower than that before treatment（P〈0.05）. The success rate was 78.1%（107/137）. The rate of disc deformity after arthrocentesis treatment was higher than that before the treatment. By contrast, the positive rate of effusion after arthrocentesis was significantly lower than that before the treatment（P〈0.05）. Bilaminar zone adaptive changes（disk-like） were found in seven cases（5.1%, 7/137） after treatment. Conclusion Arthrocentesis could effectively relieve pain of the TMJID patients. Furthermore, MRI results indicated that arthrocentesis could significantly decrease articular effusion. Arthrocentesis was effective for the treatment of Wilkes Ⅲ stage in the short term. Adaptive changes in bilaminar zone occurred in a few patients. However, serious disc deformity with the passage of time is a trend that has been observed.