稳定性牙合垫、手法及物理治疗对颞下颌关节盘不可复性移位的短期疗效评价

Evaluation of short term efficacy of the stabilized splint and the combination of manipulative and physical therapies for temporomandibular joint disc displacement without reduction

目的探讨稳定性牙合垫、手法及物理治疗对颞下颌关节盘不可复性移位的短期治疗效果。方法选择2013年2月—2015年3月在上海交通大学医学院附属第九人民医院口腔修复科就诊的关节盘不可复性移位患者共168名,按治疗方法不同随机分为牙合垫治疗组(组1)、手法及物理治疗组(组2)、牙合垫+手法及物理治疗组(组3)和对照组(组4)。分别在治疗前和治疗期(共3个月)每3周对所有患者的疼痛程度和无痛最大主动张口度进行评价。结果组1、组2、组3在治疗后3周起自发咀嚼肌疼痛VAS值与治疗前差异有统计学意义(P<0.05),组4治疗后仅12周与治疗前差异有统计学意义;组2、组3在治疗后6周起扪诊疼痛VAS值与治疗前差异有统计学意义(P<0.05),组1在治疗后9周起与治疗前差异有统计学意义(P<0.05),组4在12周与治疗前差异有统计学意义(P<0.05);组1、组2在治疗后6周起咀嚼运动疼痛VAS值与治疗前差异有统计学意义(P<0.05),组3在治疗后3周起与治疗前差异有统计学意义(P<0.05),组4治疗后与治疗前差异无统计学意义(P≥0.05)。组1的无痛最大张口度在治疗后9周起与治疗前差异有统计学意义(P<0.05),组2、组3在治疗后3周起与治疗前差异有统计学意义(P<0.05),组4治疗后与治疗前差异无统计学意义(P≥0.05)。结论牙合垫、手法及物理治疗均能在短期内即缓解大多数肌肉和关节来源的疼痛,健康宣教能缓解部分疼痛。牙合垫+手法及物理治疗能较迅速改善患者的张口度,从而满足其基本生理功能需要。

Objective To explore short term efficacy of the stabilized splint and the combination of manipulative and physical therapies for temporomandibular joint （TMJ） disc displacement without reduction. Methods One hundred and sixty-eight patients with TMJ disc displacement without reduction who visited the Department of Prosthodontics of Shanghai Ninth People＇s Hospital affiliated to Shanghai Jiao Tong University School of Medicine from Feb, 2013 to Mar. 2015 were enrolled and randomly assigned to stabilized splint group （group 1）, combination of manipulative and physical therapies group （group 2）, stabilized splint and combination of manipulative and physical therapies group （ group 3）, and control group （ group 4）. The degree of pain and pain-free maximum active mouth opening among all patients were evaluated before treatment and every three weeks during three months of treatment. Results For VAS values of spontaneous masseter pain, the differences in group 1, group 2, and group 3 before treatment and 3 weeks after treatment were statistically significant （P〈0.05） and the difference in group 4 before treatment and 12 weeks after treatment was statistically significant. For VAS values of palpation pain, the differences in group 2 and group 3 before treatment and 6 weeks after treatment were statistically significant （P 〈0.05）, the difference in group 1 before treatment and 9 weeks after treatment was statistically significant （P〈0.05）, and the difference in group 4 before treatment and 12 weeks after treatment was statistically significant （P〈0.05）. For VAS values of chewing pain, the differences in group 1 and group 2 before treatment and 6 weeks after treatment were statistically significant （P〈0.05）, the difference in group 3 before treatment and 3 weeks after treatment was statistically significant （P〈0.05）, and the difference in group 4 before and after treatment was not statistically significant （PI〉 0. 05）. For pain-free maximum mouth opening, the difference in group 1 before treatment and 9 weeks after treatment was statistically significant （P〈0.05）, the differences in group 2 and group 3 before treatment and 3 weeks after treatment were statistically significant （P〈0.05）, the differences in group 2 and group 3 before treatment and 3 weeks after treatment were statistically significant （P 〈0.05）, and the difference in group 4 before and after treatment was not statistically significant （P≥0.05）. Conclusion Both splints and the combination of manipulative and physical therapies can alleviate most muscle and joint pain in short term. Health education may partly alleviate pain. Splints and the combination of manipulative and physical therapies can rapidly improve the mouth opening of patients and satisfy the basic physiological function.