运动疗法联合物理因子治疗颞下颌关节紊乱病的疗效观察

Efficacy of exercise therapy combined with physio-factors therapy in the treatment of temporomandibular joint disorder

目的观察运动疗法联合物理因子治疗颞下颌关节紊乱病(TMD)的临床疗效。方法将2018年1月至2020年1月浙江大学医学院附属邵逸夫医院进行康复治疗的40例TMD患者按随机数字表法分为研究组和对照组,每组20例。对照组采用物理因子治疗(包括超声波和经皮神经电刺激),研究组采用运动疗法[包括关节松动、肌肉强化运动(抗阻训练)、协调运动和筋膜松解]联合物理因子治疗。分别于治疗前、治疗后2周采用视觉模拟评分法(VAS)、最大张口距离、咬肌的静息和收缩时的表面肌电图均方根值(RMS)、下颌功能限制量表(JFLS)对患者进行疗效评估。结果治疗后,两组患者VAS评分均较治疗前有明显改善(均P<0.05),且两组间比较差异有统计学意义(P<0.05);最大张口距离、JFLS评分较治疗前均有明显改善(均P<0.05),且两组间比较差异均有统计学意义(均P<0.05);患侧咬肌静息RMS值也较治疗前均有明显改善(均P<0.05)。研究组患侧咬肌收缩时RMS均优于对照组,差异均有统计学意义(均P<0.05);对照组的患侧咬肌收缩时RMS与治疗前比较差异无统计学意义(P>0.05)。结论运动疗法联合物理因子治疗TMD效果更好。

Objective To investigate the clinical efficacy of exercise therapy combined with physio-factors therapy in the treatment of temporomandibular joint disorder(TMD).Methods Forty patients with TMD who underwent rehabilitation treatment at the Sir Run Run Shaw Hospital,Zhejiang University School of Medicine from January 2018 to January 2020 were randomly assigned to study group and control group with 20 cases in each group.The control group was given physio-factors therapy alone,including ultrasound and transcutaneous electrical stimulation;the study group received physio-factors therapy combined with exercise therapy.The visual analogue scale(VAS),maximum mouth opening distance,root mean square(RMS)of surface electromyography(sEMG)of the occlusal muscles at rest and during contraction,and the jaw functional limitation scale(JFLS)were applied for evaluation of patients before and 2 weeks after treatment.Results After treatment,both groups showed significant improvement in VAS scores,the maximum mouth opening distance and JFLS scores(all P<0.05),and there was significant difference between the two groups(P<0.05).The resting RMS values of the affected occlusal muscles were improved after treatment in both groups(both P<0.05).The RMS during contraction of the affected occlusal muscles in the study group was better than that in the control group(P<0.05);while that was not changed before and after treatment in the control group(P>0.05).Conclusion Exercise therapy combined with physio-factors therapy is more effective in the treatment of temporomandibular joint disorder.