对颞下颌关节紊乱病关节盘移位的认识及治疗策略

Understanding and treatment strategy for disc displacement of temporomandibular disorders

本文讨论了对颞下颌关节紊乱病关节盘移位的认识及治疗策略.笔者认为对颞下颌关节紊乱病关节盘移位亚类的治疗应采取以可逆性的、非手术治疗为主的治疗策略.治疗的最重要目的是恢复患者关节的正常活动度和功能,提高生活质量.建议坚持在治疗中全面评估患者的躯体疾病和精神心理状况的原则,特别是对于病程迁延、存在慢性疼痛的患者尤为重要.外科手术治疗在关节盘移位总体治疗策略中的作用很有限;但对极少数关节病变诊断明确、经正确的可逆性非手术治疗无效、且明显影响生活质量的患者,仍有重要意义.建议慎重使用可能对患者造成损害的外科手术以及为治疗颞下颌关节紊乱病而施行的改变患者天然牙列的全口咬合重建、大范围调等不可逆性的治疗方法.

Understanding and treatment strategy for disc displacement of temporomandibular disorders （TMD） were discussed in the present review. It has been strongly recommended by the author that the treatment strategy for disc displacement, one subtype of TMD, should be mainly the reversible conservative treatment methods. The most important goal of treatment for disc displacement is to recover the mobility and function of the joint in order to improve the quality of the patient＇＇s life. Comprehensive assessments both from somatic and psychological aspects for each TMD patient are necessary, especially for the patients with chronic pain. Although the role of surgical operative treatments is very limited in the general treatment strategy for TMD, it is still important for a few patients who had definite diagnosis of intra-articular disorders, severe symptoms affecting the quality of patient＇＇s life and failed to response to the correct conservative treatments. It should be very careful to treat the TMD patients by surgical operation or irreversible occlusion treatments changing the natural denture of the patient, such as full mouth occlusional reconstruction and extensive adjustment of occlusion.