体外冲击波联合肌肉能量技术对颞下颌关节紊乱疗效的临床研究

Clinical study on the effectiveness of extracorporeal shock wave therapy combined with muscle energy technology for temporomandibular disorders

目的:探究体外冲击波联合肌肉能量技术对颞下颌关节紊乱的临床效果。方法:选取符合纳入标准的颞下颌关节紊乱(TMD)患者共120例,采用计算机随机分成常规治疗组、体外冲击波(ESWT)组、肌肉能量技术(MET)组和体外冲击波联合肌肉能量技术(ESWT+MET)组4组,每组30例。常规治疗和MET每日1次,每周5次,连续4周;ESWT每周1次,治疗4周。治疗前后记录患者最大张口度(MMO)、压力疼痛阈值(PPT)、疼痛情况(VAS)和下颌功能损害问卷(MFIQ)评分。结果:治疗前4组患者的MMO、PPT、VAS及MFIQ评分差异无统计学意义。治疗4周后,4组患者的MMO及PPT均较治疗前明显增加(P<0.05),且ESWT组、MET组及ESWT+MET组高于常规组(P<0.05),ESWT+MET组高于ESWT组和MET组(P<0.05);MET组的MMO较ESWT组增加(P<0.05),ESWT组的PPT较MET组增加(P<0.05)。4组VAS及MFIQ评分均较治疗前明显下降(P<0.05),ESWT组、MET组及ESWT+MET组低于常规组(P<0.05),ESWT+MET组低于ESWT组和MET组(P<0.05);ESWT组VAS评分较MET组下降(P<0.05),MFIQ评分ESWT组与MET组比较差异无统计学意义。结论:体外冲击波和肌肉能量技术均能有效改善TMD患者的最大张口度、疼痛情况及下颌功能,但是体外冲击波和肌肉能量技术的联合效果优于单一的体外冲击波或肌肉能量技术,临床上可以考虑将二者结合用于治疗TMD。

Objective:To explore the clinical effectiveness of extracorporeal shock wave therapy(ESWT)combined with muscle energy technology for temporomandibular disorders(TMD).Methods:A total of 120 patients with TMD who met the inclusion criteria were selected.The patients were randomly divided into 4 groups:conventional treatment group,ESWT group,muscle energy technique(MET)group and ESWT combined with MET(ESWT+MET)group,with 30 cases in each group.The treatments were as follows:conventional therapy and MET,once a day,5 times a week for 4 consecutive weeks;ESWT,once a week for 4 weeks.The maximum mouth opening(MMO),pain status(VAS),pressure pain threshold(PPT)and mandibular dysfunction questionnaire(MFIQ)scores were recorded before and after treatment.Result:There were no significant differences in MMO,PPT,VAS and MFIQ scores among 4 groups before treatment.After 4 weeks of treatment,the MMO and PPT in the 4 groups increased,the VAS score and MFIQ score decreased,and the difference was statistically significant(P<0.05).Compared with the conventional treatment group,the MMO and PPT in the remaining three groups were significantly increased,and the VAS score and MFIQ score were significantly improved(P<0.05).The improvement of MMO,PPT,pain and mandibular function in the ESWT+MET group was better than that in the ESWT group and the MET group,and the difference was statistically significant(P<0.05).Conclusion:Both ESWT and MET can effectively improve the maximum mouth opening,pain and mandibular function in patients with TMD.However,the combined effectiveness of ESWT and MET is better than that of single ESWT or MET.Clinically,the combin-ation of ESWT and MET can be considered for the treatment of TMD.