温针灸结合中药熏蒸对风寒瘀阻型颞下颌关节紊乱患者Fricton指数、最大张口度、生活质量的影响

Effect of Warm Acupuncture and Moxibustion Combined with Fumigation of Traditional Chinese Medicine on Fricton Index,Maximal Opening Degree and Quality of Life of Cold-Wind Stagnation Temporomandibular Joint Disorder Patients

目的：探讨温针灸结合中药熏蒸对风寒瘀阻型颞下颌关节紊乱患者颞下颌关节功能评价（Fricton指数）、最大张口度、生活质量的影响。方法：选取2016年9月—2017年11月在本院治疗的风寒瘀阻型颞下颌关节紊乱患者76例作为研究对象,根据随机数字表分为对照组和联合治疗组,每组38例。对照组采用双氯芬酸二乙氨乳胶剂和中药熏蒸治疗,联合治疗组在对照组基础上加用温针灸治疗。观察两组治疗前后Fricton指数评分[下颌运动分（MM）、关节杂音分（JN）、关节压诊分（JP）、功能障碍指数（DI）、肌肉压诊分（MP）、肌肉压痛指数（PI）、颞下颌关节指数（CMI）]、生活质量评分（SF-36量表评分）,观察两组治疗前、治疗后、随访3个月最大张口度。结果：两组治疗前MM、JN、JP、DI、MP、PI、CMI评分比较,差异无统计学意义（P〉 0. 05）。两组治疗后MM、JN、JP、DI、MP、PI、CMI评分均低于治疗前,且联合治疗组低于对照组,差异均有统计学意义（P 〈0. 05）。两组治疗后、随访3个月最大张口度均大于治疗前,差异有统计学意义（P 〈0. 05）,治疗后与随访3个月比较,差异无统计学意义（P〉 0. 05）。两组治疗前最大张口度比较,差异无统计学意义（P〉 0. 05）,联合治疗组治疗后、随访3个月最大张口度大于对照组,差异有统计学意义（P 〈0. 05）。两组治疗前生理功能、生理职能、躯体疼痛、总体健康、活力、社会功能、情感职能和精神健康评分比较,差异无统计学意义（P〉 0. 05）。联合治疗组治疗后躯体疼痛、社会功能评分均高于对照组,差异有统计学意义（P 〈0. 05）。对照组治疗前后SF-36量表各项目评分比较,差异无统计学意义（P〉 0. 05）。联合治疗组治疗后生理功能、躯体疼痛、社会功能、精神健康评分均高于治疗前,差异有统计学意义（P 〈0. 05）。结论：温针灸结合中药熏蒸治疗风寒瘀阻型颞下颌关节紊乱可以明显改善患者临床疼痛、功能障碍、最大张口度等临床症状,增强患者社会活动度,提高患者生活质量。

Objective： To investigate the effect of warm acupuncture combined with traditional Chinese medicine fumigation on the temporomandibular joint function（Fricton index）,maximal opening degree and quality of life in patients with temporomandibular joint disorder. Methods： Seventy-six patients with temporomandibular joint disorder who were hospitalized in our hospital from September 2016 to November 2017 were selected as study subjects. According to the random number table,they were divided into control group and combination treatment group,38 cases in each group. The control group was treated with diclofenac diethylamine emulsion and fumigation with Chinese medicine. The combined treatment group was treated with warm acupuncture moxibustion on the basis of the control group. The Fricton index scores before and after treatment in the two groups were observed. The mandibular movement score（MM）,joint murmur score（JN）,joint pressure diagnosis score（JP）,dysfunction index（DI）,muscle pressure diagnosis score（MP）,muscle tenderness index（PI）,temporomandibular joint index（CMI）,and quality of life score（SF-36 scale scores） were used to observe the maximum degree of mouth opening before and after treatment and 3 months follow-up in the two groups. Results： There was no significant difference in the scores of MM,JN,JP,DI,MP,PI or CMI before treatment between the two groups（P〈0.05）. The scores of MM,JN,JP,DI,MP,PI and CMI after treatment in the two groups were lower than those before treatment,and the combined treatment group＇s were lower than those of the control group,and the differences were statistically significant（P〈0.05）. The maximum oral opening after treatment and 3 months follow-up in both groups were greater than those before treatment（P〈0.05）. There was no significant difference between the two groups after treatment and 3 months follow-up（P〈0.05）. There was no statistically significant difference between the two groups before treatment（P〈0.05）. The maximum opening degree in the combined treatment group and 3 months follow-up after treatment was greater than that in the control group（P〈0.05）. There was no significant difference between the two groups in terms of physiological function,physiological function,physical pain,general health,vitality,social function,emotional function or mental health score before treatment（P〈0.05）. The somatic pain and social function scores in the combined treatment group were higher than those in the control group,and the difference was statistically significant（P〈0.05）. There was no significant difference in the scores of the items of the SF-36 scale before and after treatment in the control group（P〈0.05）. The physiological function,somatic pain,social function,and mental health scores of the combined treatment group were higher than those before treatment,and the difference was statistically significant（P〈0.05）. Conclusion： Warm acupuncture and moxibustion combined with fumigation of traditional Chinese medicine for the treatment of cold-wind stagnation temporomandibular joint disorder can significantly improve clinical symptoms such as clinical pain,dysfunction,maximal mouth opening,etc.,increase the degree of social activity of patients,and improve the quality of life of patients.