咀嚼肌紊乱飞行员低强度激光治疗:随机对照临床试验

Administration of low-level laser on masticatory dysfunction of pilot:protocol for a randomized controlled clinical trial

目的观察应用钕激光(neodymium:yttrium-aluminum-garnet,Nd:YAG)低能量激光疗法(1ow level laser therapy,LLLT)治疗暴露在高正加速度(+GZ)环境下患咀嚼肌功能紊乱飞行员的临床疗效。方法随机入组80例咀嚼肌功能紊乱+GZ飞行员对象,依照激光频率不同分为4组(波长:1 064 nm,脉宽:100 ms,功率:1.5 W,能量密度:50 mJ/cm2,试验1组频率:5Hz,试验2组频率:10Hz,试验3组频率:20Hz;安慰剂组频率:0Hz;n=20),应用Nd:YAG激光LLLT定量、定向治疗颞下颌关节(temporomandibular joint,TMJ)区和颞肌、咬肌、二腹肌前腹和胸锁乳突肌等咀嚼肌群,治疗时间:60 s/位点,6次/w,术后随访,采用Fricton颞下颌关节紊乱综合征(temporomandibular joint dysfunction syndrome,TMJDS)紊乱指数,观察入组对象咀嚼肌功能紊乱症状、体征改善状况。结果试验1组Nd:YAG激光LLLT治疗前、后CMI评定,DI值减少明显,差异有统计学意义(P<0.05),PI和CMI总分较治疗前无明显下降(P>0.05);试验2组PI值减少明显(P<0.05),DI和CMI总分有显著下降(P<0.01);试验3组仅有CMI总分较治疗前有明显下降(P<0.05);安慰剂组DI、PI和CMI总减少无统计学差异(P>0.05);组间比较:和安慰剂组治疗后比较,试验1组治疗后DI值显著减少,差异有统计学意义(P<0.01),试验2组治疗后DI值亦有明显减少;试验1,2组治疗后和安慰剂组两两比较PI值减少明显(P<0.05),试验3组DI无明显减少(P>0.05);仅有试验1组CMI总分较治疗后和安慰剂组比较有明显下降(P<0.05)。结论选择10 Hz,100 ms,1.5 W,50 mJ/cm2参数Nd:YAG的LLLT治疗患咀嚼肌功能紊乱飞行员疗效显著,无创伤,依从性好,适合临床推广应用。

Objective To analyze the clinical effect of low level laser therapy of Nd:YAG in patients with masticatory dysfunction exposed to high acceleration.Methods Eighty pilots with masticatory dysfunction and Gz were randomly divided into four groups according to the laser frequency(wave length:1064 nm,pulse width:100 ms,power:1.5 W,energy density:50 MJ/cm2,frequency of test 1:5 Hz,frequency of test 2:10 Hz,frequency of test 3:20 Hz;frequency of placebo group:0 Hz;n=20).The temporomandibular joint(TMJ)area and temporalis muscle,masseter muscle,anterior abdomen of digastric muscle and sternocleidomastoid muscle underwent quantitative and directional treatment with Nd:YAG laser LLLT for 60 s/site,6 times/W.After one course of treatment and one week of follow-up,the disorder index of Fricton's temporomandibular joint dysfunction syndrome(TMJDS)was used to observe the improvement of symptoms and signs of masticatory muscle dysfunction.Results In group 1 after treatment with Nd:YAG laser LLLT,there was a significant decrease in DI(P<0.05)rather than in PI and CMI(P>0.05).In group 2,there was a significant decrease in PI(P<0.05),DI and CMI(P<0.01)while in group 3,there was only a significant decrease in CMI(P<0.05).In the placebo group,there was no statistical difference in the total decrease of DI,PI and CMI(P<0.05).Compared with the placebo group,DI was significantly decreased in group 1 with statisticallysignificant difference(P<0.01). The DI value was obviously reduced in group 2, Compared with the placebo group, the PI value of groups 1 and 2 decreased significantly(P<0.05), but the DI value of the group 3 did not decrease significantly(P>0.05). Compared with the placebo group, the total score of CMI in group 1 alone was obviously decreased(P<0.05). Conclusion LLLT can help reduce the symptoms of masticatory muscle dysfunction, which is an effective and efficient treatment for masticatory muscle dysfunctionamong pilots exposed to high positive acceleration.