关节灌洗术对WilkesⅢ期患者临床症状及盘位影响的研究

Clinical and disc position on Wilkes Ⅲ stage patients treated with arthrocentesis

目的:从临床症状和MRI表现两方面评价关节灌洗术对于WilkesⅢ期患者的治疗效果。方法:选取2013年1月至2014年12月就诊患者137例,所有患者于术前和术后6个月分别接受临床及MRI检查,将各指标所测得数据采用SPSS20.0软件进行统计分析,方法采用配对t检验,检验水准P<0.05。结果:137例患者接受灌洗治疗后,张口度均有不同程度的增加(t_1=27.42,P=0.000),VAS较术前减小(t_2=32.12,P=0.000)。关节盘位置均未发生解剖复位,且出现进一步前移(AD′、C′D′:t_3=17.15,P=0.003,t_4=18.17,P=0.014)。9.4%(13/137)由不可复性前移位变为可复性前移位。结论:关节灌洗可部分逆转不可复性盘前移位,由不可复性前移位变为可复性前移位(9.4%),但不能达到解剖复位。灌洗术对于WilkesⅢ期短期临床疗效肯定,能有效改善张口度、减轻疼痛。关节灌洗术对于治疗WilkesⅢ期患者存在局限性,术后应定期复查,调整治疗方案。

Objective： To evaluate the effectiveness of arthrocentesis on Wilkes Ⅲ stage patients by clinical examination and MRI findings before and after six months treatments. Methods： 137 outpatients from January 2013 to December 2014 were recruited. Clinical and MRI examination on all the patients were taken before and after six months treatment. Paired t test（SPSS20.0 software） was used for statistical analysis（α = 0.05）. Results： Among all of the patients, the opening degree were improved after treatment,（t_1= 27.42, P = 0.000）. The VAS decreased（t_2= 32.12, P = 0.000）. Anatomical reduction was not found in any patients. There were only 13 cases（9.4%） of ADDWR turned into ADDR. Conclusion： Temporomandibular joint arthrocentesis could partly invert disc displacement from ADDWR to ADDR. Anatomical reduction was not found in any patients. Arthrocentesis was effective for the treatment of Wilkes Ⅲ stage in short-term evaluation, it can successfully improve mouth opening and relieve pain.