手法复位联合稳定性咬合板治疗颞下颌关节紊乱病的效果观察

Clinical efficacy of manual reduction combined with stable occlusal plate in the treatment of temporomandibular disorders

目的分析手法复位联合稳定性咬合板在颞下颌关节紊乱病(TMD)患者治疗中的应用价值。方法选取2019年8月至2022年2月郑州人民医院收治的200例TMD患者进行前瞻性研究,根据患者意愿分为常规组98例和联合组102例。常规组男51例、女47例,年龄(31.74±5.13)岁,实施稳定性咬合板治疗;联合组男64例、女38例,年龄(30.65±5.28)岁,实施手法复位联合稳定性咬合板治疗。比较两组临床疗效、外观满意度、疼痛程度[视觉模拟评分量表(VAS)评分]、颞下颌关节开口指数(TOI)、颞下颌关节功能量表(Helkimo)评分、静息状态下表面肌电图[左侧颞肌前束(LTA)、右侧颞肌前束(RTA)、左侧咬肌(LMM)、右侧咬肌(RMM)]。采用t检验、χ^(2)检验。结果联合组临床总有效率[96.08%(98/102)]、外观总满意率[93.14%(95/102)]高于常规组[82.65%(81/98)、75.51%(74/98)](χ^(2)=9.586、P=0.002,χ^(2)=11.857、P=0.001)。治疗后联合组VAS评分[(2.09±0.45)分]、Helkimo评分[(1.27±0.35)分]均低于常规组[(3.26±0.53)分、(2.04±0.33)分],TOI[(3.87±0.52)cm]高于常规组[(3.35±0.48)cm](t=16.852、15.944、7.341,均P<0.001)。治疗后联合组LTA[(2.31±0.33)μV]、RTA[(2.18±0.36)μV]、LMM[(1.37±0.24)μV]、RMM肌电值[(1.25±0.25)μV]均低于常规组[(2.87±0.35)μV、(2.79±0.38)μV、(1.68±0.23)μV、(1.74±0.26)μV](t=6.639、6.646、5.314、7.746,均P<0.001)。结论手法复位联合稳定性咬合板治疗TMD患者效果显著,能缓解咀嚼肌痉挛,恢复颞下颌关节功能,减轻患者疼痛和改善张口受限程度,且能提高美容效果。

Objective To analyze the value of manual reduction combined with stable occlusal plate in the treatment of temporomandibular disorders(TMD).Methods A total of 200 patients with TMD admitted in Zhengzhou People's Hospital from August 2019 to February 2022 were selected as the study objects.According to the patients'intention,they were divided into a conventional group and a combined group.In the conventional group,there were 51 males and 47 females,aged(31.74±5.13)years;in the combined group,there were 64 males and 38 females,aged(30.65±5.28)years.The combined group was treated with manual reduction combined with stable occlusal plate,and the conventional group was treated with stable occlusal plate.The clinical efficacy,appearance satisfaction,pain degree[Visual Analogue Scale(VAS)score],temporomandibular joint opening index(TOI),Temporomandibular Joint Function Scale(Helkimo)score,surface electromyography(EMG)at rest[left anterior temporalis muscle(LTA),right anterior temporalis muscle(RTA),left masseter muscle(LMM),and right masseter muscle(RMM)]were compared between the two groups.t test andχ^(2) test were used.Results The total clinical effective rate[96.08%(98/102)]and overall appearance satisfaction rate[93.14%(95/102)]of the combined group were higher than those of the conventional group[82.65%(81/98)and 75.51%(74/98)](χ^(2)=9.586,P=0.002;χ^(2)=11.857,P=0.001).After treatment,the VAS score[(2.09±0.45)points]and Helkimo score[(1.27±0.35)points]in the combined group were lower than those in the conventional group[(3.26±0.53)points and(2.04±0.33)points],and the TOI[(3.87±0.52)cm]was higher than that in the conventional group[(3.35±0.48)cm](t=16.852,15.944,and 7.341;all P<0.001).After treatment,the electromyography values of LTA[(2.31±0.33)μV],RTA[(2.18±0.36)μV],LMM[(1.37±0.24)μV],and RMM[(1.25±0.25)μV]in the combined group were lower than those in the conventional group[(2.87±0.35)μV,(2.79±0.38)μV,(1.68±0.23)μV,and(1.74±0.26)μV](t=6.639,6.646,5.314,and 7.746;all P<0.001).Conclusion Manual reduction combined with stable occlusal plate has a significant effect on TMD patients,which can relieve the spasm of masticatory muscles,restore the function of temporomandibular joint,relieve the patients'pain,improve the degree of mouth opening limitation,and improve the cosmetic effect.