手法复位配合运动与垫治疗急性颞下颌关节盘不可复性前移位的近期疗效评价

Mandibular manipulation technique followed by exercise therapy and occlusal splint for treatment of acute anterior TMJ disk displacement without reduction

目的：探讨手法复位关节盘继以运动与垫治疗对急性不可复性盘前移位患者的短期疗效;通过MRI评价复位后短期内颞下颌关节盘-髁关系。方法：选取44例患者急性开口受限（病程在2个月以内）且经MRI证实颞下颌关节盘不可复性关节盘前移位的患者（男7侧,女37侧）,施予软组织放松技术,随后行手法复位关节盘。复位后指导患者进行为期2周的下颌运动轨迹训练、关节稳定性训练和软管盘复位训练。白天自我维持下颌休息位,夜间配戴硬质热塑再定位（牙合）垫,以保持良好的盘-髁关系。分别在治疗前、后评估患者的最大主动开口度和疼痛视觉类比评分（visual analogue score,VAS）（0～10分）,治疗结束后1～3个月内MRI复查盘-髁关系。采用SPSS17.0软件包对数据进行t检验。结果：经过2周治疗后,患者开口度明显改善,由治疗前的（22.6±6.1）mm增加到（43.9±3.3）mm;疼痛明显缓解,由治疗前的3.6±1.5下降到0.7±0.25。44例患者在治疗结束后平均4.6±4.7周经MRI复查显示,20例（占46%）为正常盘-髁关系;16例（占36%）为可复性关节盘前移位;8例（占18%）仍为不可复性关节盘前移位。结论：关节盘手法复位后继以运动治疗及配戴垫,对急性盘前移位患者能够恢复开口度,缓解疼痛,对维持正常盘-髁关系有一定疗效。

PURPOSE： This study aimed to evaluate the short-term efficiency of mandibular manipulation technique combined with exercise therapy and splint treatment of acute anterior TMJ disc displacement without reduction （ADDW）, and TMJ disc-condyle relationship by magnetic resonance imaging （MRI）. METHODS： Forty-four patients （37 females, 7 males） were diagnosed as acute ADDW and confimled by MRI. All patients underwent mandibular manipulation, combined with exercise therapy, including jaw movement exercise, stabilization exercise, disc reposition exercise, and splint treatment. Anterior repositioning splint was wore only at night during sleep, while the mandible was kept in rest position during the day. The treatment was continued for 2 weeks. The baseline and endpoint outcome assessment measures were maximum active mouth opening, visual analogue scale （VAS） score of TMJ pain. Consecutive MRI was performed 1-3 months after treatment. SPSS 17.0 software package was used for statistical analysis. RESULTS： Two weeks after treatment, the patients＂ maximum active mouth opening increased from（22.6±6.1） mm to （43.9±3.3） mm, VAS score of pain decreased from 3.6±1.5 to 0.7±0.25. After treatment of 4.6±4.7 weeks on average, 20 patients （46%） displayed normal dis-condyle relationship, 16 patients （36%） had displacement with reduction, and 8 patients （18%） had displacement without reduction on MRI. CONCLUSIONS： Mandibular manipulation technique combined with exercise therapy and splint treatment seems to be useful in the treatment of anterior TMJ disc displacement with reduction, which can help to maintain the complete anatomic disc-condyle relationship.