颞下颌关节紊乱病典型疼痛病人感觉功能改变的初步定量比较研究

Preliminary quantitative comparative study on somatosensory function changes in pain patients with temporomandibular disorders

目的:初步定量研究颞下颌关节紊乱病(temporomandibular disorders,TMD)中两种典型疼痛的感觉功能改变。方法:采用定量感觉测试(quantitative sensory testing,QST)技术测试颞下颌关节痛病人与咀嚼肌痛病人(各30名)的疼痛点、对侧点与手部,基于健康对照组(60名)数据进行Z值转换,采用多因素方差分析和上调/下调评估系统分析两组病人感觉功能差异。结果:疼痛点与对照点比较,机械触觉较迟钝,机械痛觉和温度觉较敏感(P<0.01);两组病人比较,颞下颌关节痛组疼痛点多种感觉更敏感,咀嚼肌痛组对侧与手部多种感觉更敏感(P<0.05);98.3%病人存在感觉功能异常,两组病人异常类型存在差异,咀嚼肌痛组手部异常比率较高(P<0.01)。结论:颞下颌关节痛和咀嚼肌痛的感觉功能改变存在差异,咀嚼肌痛可能涉及中枢敏化,需个性化诊疗。

Objective:The somatosensory function changes of two typical types of pain in temporomandibular disorders(TMD)were studied quantitatively.Methods:Quantitative sensory testing(QST)was performed on the pain sites,contralateral sites and right hands of 30 TMD arthralgia patients and 30 myalgia patients.Z-transformation was performed based on the data of healthy controls.Differences of somatosensory changes between two groups were assessed through multi-way ANOVA and loss/gain coding system.Results:The sensitivity to mechanical tactile stimuli of pain sites was decreased in two groups,while the sensitivity to mechanical pain stimuli and thermal stimuli was increased compared with other sites(P<0.01).When compared between two groups,pain sites of arthralgia patients showed significantly more sensitive than myalgia patients in multiple parameters,while contralateral sites and hands of myalgia patients presented increased sensitivity to multiple stimuli significantly(P<0.05).98.3%of patients represented somatosensory abnormalities on the pain sites.There were differences in types of abnormalities between TMD arthralgia and myalgia patients.Significantly higher distribution frequency of abnormalities in hand could be detected in myalgia patients(P<0.01).Conclusion:There are significant differences in somatosensory function changes between TMD arthralgia and myalgia,involving modulation of central nervous system.It indicates a possible need for individualized TMD diagnosis and treatment.