关节松动术配合理疗治疗颞下颌关节紊乱综合征的疗效评估

Effects of joint mobilization combined with physiotherapy on temporomandibular disorders

目的:观察关节松动术手法配合理疗治疗颞下颌关节紊乱综合征(TMD)的疗效。方法:筛选TMDⅡb类患者40例,随机分为关节松动术配合理疗组(A组,n=20)、针灸配合理疗组(B组,n=20)。治疗前及治疗4周后采用疼痛视觉模拟评分(Visual Analogue Scale,VAS)、最大张口度、下颌功能障碍问卷(Mandibular Function Impairment Questionnaire,MFIQ)、MRI评定患者的疼痛程度、最大张口度、下颌功能及盘髁活动度。结果:治疗后,两组疼痛(A组1.10±1.59,B组1.25±1.37)较治疗前差异均具有显著性意义(P<0.001),两组组间比较差异无显著性意义(P>0.05);A、B组最大张口度(A组36.50±4.68mm,B组26.15±4.49mm)、下颌功能障碍(A组0.50±0.76,B组0.75±0.55)、盘髁活动度(A组6.54±1.22mm,B组4.43±1.36mm)较治疗前差异均具有显著性意义(P<0.001),两组组间比较差异有显著性意义(P<0.05)。结论:关节松动术配合理疗的治疗方法可有效改善TMDⅡb类患者的关节疼痛。与针灸配合理疗治疗相比较,关节松动术配合理疗对张口受限、下颌功能障碍、盘髁活动度等症状的改善更加明显。

Objective： To observe effects of joint mobilization combined with physiotherapy on temporomandibular disorders （TMD）. Method： Forty subjects with I1 b classes TMD were randomly divided into the joint mobilization combined with physiotherapy group （group A, n=20） and the acupuncture combined with physiotherapy group （group B, n=20）. The pain, maximum active mouth opening, mandibular function and degree of joint activities were as- sessed using Visual Analogue Scale（VAS）of pain, maximum active mouth opening and Mandibular Function Im- pairment Questionnaire （MFIQ） and MILl before and 4 weeks after treatment. Result： All the patients got significant improvement in the pain （group A 1.10±1.59,group B 1.25±1.37）after treatment（P〈0.001）, while no significant difference between two groups（P〉0.05）. Group A and group B both got obviously improved maximum active mouth opening（group A 36.50±4.68mm,group B26.15±4.49mm）, Mandibular Function Impairment Questionnaire（MFIQ）（group A 0.50±0.76,group B 0.75±0.55）and degree of joint activities（group A 6.54±1.22mm, group B 4.43±1.36mm）（P〈0.001）, and at the same time group A had more significant improvement than group B （P〈0.05）. Conclusion： The joint mobilization combined with physiotherapy can improve the pain of I/b TMD, and improve limited mouth opening, mandibular function impairment more obviously than the acupuncture combined with physiotherapy.