手法治疗颞下颌关节紊乱病的疗效及表面肌电图变化

Effect of manipulation therapy on temporomandibular disorder and related changes in surface electromyography

目的探讨手法治疗颞下颌关节盘不可复性前移位伴肌筋膜疼痛患者的效果及表面肌电图变化。方法选取2017年6-12月解放军总医院第一医学中心康复医学科收治的颞下颌关节紊乱病(temporomandibular disorders,TMD)患者30例,男6例,女24例,年龄16~65(27.0±11.4)岁。采用软组织松动术、关节松动术治疗5次,比较治疗前后的最大张口度(maximum active mouth opening,MMO)、视觉模拟评分法(visual analogue scale,VAS)疼痛评分以及咬肌表面肌电图(surface electromyography,sEMG)。结果经过5次手法治疗,30例患者的MMO、VAS疼痛评分、sEMG测试平均值均有改善。治疗后的MMO明显优于治疗前[(38.37±5.20) mm vs (31.23±7.77) mm,P <0.001],VAS疼痛评分明显低于治疗前[(1.93±1.53) vs(3.70±1.57),P <0.001]。患者治疗后下颌姿势位咬肌sEMG测试平均值均低于治疗前[右(2.40±1.36)μV vs (4.45±2.79)μV;左(2.65±1.09)μV vs (5.16±4.62)μV,P均<0.05];紧咬棉棒sEMG测试平均值均高于治疗前[右(135.83±38.90)μV vs (90.53±20.55)μV;左(136.97±42.77)μV vs (89.74±21.03)μV,P均<0.05];牙间交错位最大自主紧咬s EMG测试平均值均高于治疗前[右(184.92±34.45)μV vs (134.13±33.69)μV;左(191.72±38.51)μV vs (138.34±42.62)μV,P均<0.05]。结论手法治疗可以改善颞下颌关节紊乱患者的疼痛以及张口受限。

Objective To investigate the therapeutic effect of manual therapy on temporomandibular anterior disc displacement without reduction combined masticatory muscles pain and related surface electromyography(EMG)changes.Methods From June 2017 to December 2017,30 patients[6 males and 24 females aged from 16 to 65 years and average age of(27.0±11.4)years]with temporomandibular disorders(TMD)were treated with soft tissue mobilization and joint mobilization for 5 times.Maximum mouth opening(MMO),visual analogue score(VAS)and surface electromyography(sEMG)indexes of masseter muscle were compared before and after treatment.Results After 5 times of manual therapy,the MMO increased,and VAS decreased significantly(MMO,(38.37±5.20)mm vs(31.23±7.77)mm;VAS,(1.93±1.53)vs(3.70±1.57);P<0.05,respectively)sEMG at rest[right:2.40±1.36)μV vs(4.45±2.79)μV;left:(2.65±1.09)μV vs(5.16±4.62)μV]decreased,sEMG during maximum teeth clenching on cotton rolls[right:(135.83±38.90)μV vs(90.53±20.55)μV;left:(136.97±42.77)μV vs(89.74±21.03)μV]and sEMG during maximum teeth clenching in intercuspal position[right:(184.92±34.45)μV vs(134.13±33.69)μV;left:(191.72±38.51)μV vs(138.34±42.62)μV]were all increased after treatment(all P<0.05).Conclusion Manual therapy can reduce the pain and increase the degree of mouth opening in patients with temporomandibular disorder.