颞下颌关节紊乱病患者轴Ⅱ测评临床调查研究

Clinical investigation and research on AxisⅡevaluation of patients with temporomandibular disorders

目的通过颞下颌关节紊乱病诊断标准(diagnostic criteria for temporomandibular disorders,DC/TMD)的轴Ⅱ评价量表调查,筛查引发TMD的身体、心理及行为因素,为临床制订个性化诊疗方案及疾病预防提供参考。方法选择2018年10月至2021年2月就诊于武汉大学口腔医学院口腔颌面外科颞下颌关节门诊的TMD患者141例(TMD组),其中女性121例,男性20例,平均年龄30岁;2021年1至2月于武汉市在校大学生、教师、公职人员等人群中招募普通健康者90名作为对照组,其中女性66名,男性24名,平均年龄30岁。对所有受试者进行问卷调查,问卷包括一般状况调查表和TMD症状问卷;轴Ⅱ评价量表包括:慢性疼痛等级量表、下颌功能受限量表、口腔行为检查、患者健康问卷-9(抑郁情绪)、广泛性焦虑症量表、患者健康问卷-15(躯体化症状)等评价量表。主要观察指标包括疼痛程度、疼痛对患者影响分级、慢性疼痛整体分级、下颌功能受限量表指标得分、抑郁得分、焦虑得分、躯体化症状得分和口腔行为得分。比较TMD组不同诊断患者之间轴Ⅱ各量表评价指标的差异。结果TMD组具有不同程度疼痛的患者占60.3%(85/141);疼痛影响分级1~3级者占24.1%(34/141);慢性疼痛整体分级为Ⅰ~Ⅳ级者占61.0%(86/141)。TMD组咀嚼功能受限、运动功能受限、交流功能受限及总体下颌功能受限得分均显著高于对照组(P<0.05)。TMD组轻度抑郁以上患者占59.6%(84/141),轻度焦虑以上患者占56.7%(80/141),46.1%(65/141)患者有躯体化症状。TMD组患者的等级分布均显著高于对照组(P<0.05)。颞下颌关节骨关节病和关节半脱位患者中出现躯体化症状者显著多于关节盘移位患者(P<0.05)。TMD组内不同的慢性疼痛状态分级之间在下颌功能障碍各指标以及抑郁、焦虑和躯体化症状等方面差异均有统计学意义(P<0.05)。结论TMD患者比普通健康人口腔行为异常增加,下颌功能活动受到不同程度的限制,同时抑郁、焦虑情绪以及躯体化症状方面更严重。颞下颌关节骨关节病和关节半脱位患者更易出现躯体化症状。TMD患者伴有疼痛症状者下颌功能障碍受限及抑郁、焦虑和躯体化方面症状较重。

Objective To screen the physical,psychological and behavioral factors related to patients with temporomandibular disorders(TMD)by using AxisⅡassessment instruments of diagnostic criteria for TMD(DC/TMD).And to provide a reference to establish personalized diagnosis and treatment plans for TMD patients so as to prevent TMD and reduce predisposing factors.Methods A total of 141 TMD patients,who were admitted in the Department of Oral and Maxillofacial Surgery in School and Hospital of Stomatology,Wuhan University from October 2018 to February 2021 were selected.There were 121 females and 20 males,with an average age of 30 years.A total of 90 healthy people were included as controls.A full-time psychologist conducted relevant questionnaire surveys.The questionnaires include general clinical survey forms and TMD symptom questionnaire.In addition,AxisⅡassessment instruments include graded chronic pain scale,jaw functional limitation scale,oral behaviors checklist,patient health questionnaire-9(depression),generalized anxiety disorder scale,patient health questionnaire-15(physical symptoms),etc.The main observational indicators include:pain level,pain impact rates,overall classification of chronic pain,limited chewing function score,limited motor function score,limited communication function score,total jaw function restricted score,depression score,anxiety score,somatic symptom score and oral behavior score.The survey data were imported into SPSS 22.0 software for statistical analysis.Results In the TMD group 60.3%(85/141)patients had various degrees of pain,24.1%(34/141)of those with pain effect grades from 1 to 3 and 61.0%(86/141)showed chronic pain overall grades fromⅠtoⅣ.The chewing function restricted score was 2.67(1.17,4.25),motor function restricted score was 4.25(1.75,6.12),communication function restricted score was 1.13(1.00,2.25)and total jaw function restricted score was 2.56(1.47,4.15)respectively.Patients with mild depression or above accounted for 59.6%(84/141),patients with mild anxiety or above accounted for 56.7%(80/141),46.1%(65/141)patients had somatization symptoms.Statistical differences(P<0.05)were determined between TMD group and control group in various scores of jaw function,oral behavior grading,depression,anxiety,and physical symptoms.Physical symptoms had significantly statistical difference between different diagnostic classification(P<0.05).Meanwhile,among the different chronic pain levels in the TMD group,there were statistical differences in the various scales of mandibular dysfunction,depression,anxiety,and somatization.In the TMD group,other significant differences were noticed between males and females in terms of the average score of mouth opening,verbal and facial communication,the total score of mandibular dysfunction as well as physical symptoms(P<0.05).Conclusions Compared with the healthy people,patients with TMD had more abnormal oral behaviors,different restriction of the mandibular functional activities.At the same time,depression,anxiety,and somatization were more serious.Patients with osteoarthritis and subluxation of temporomandibular joint were more likely to suffer physical symptoms.TMD patients suffering from pain had more severe mandibular dysfunction and symptoms of depression,anxiety,and somatization.