颞下颌关节上腔封闭—扩张联合灌洗及粘弹补充治疗不可复性关节盘前移位

Intraarticular injection-dilatation and later lavage plus viscosupplementation of TMJ for the treatment of anterior disc displacement without reduction

目的:评价颞下颌关节上腔封闭-扩张术联合灌洗及粘弹补充疗法治疗不可复性关节盘前移位的临床效果。方法:对29例不可复性关节盘前移位患者行关节上腔封闭-扩张治疗,3～5d后行灌洗术,结束时注入1%透明质酸钠1ml。在治疗的同时配合被动张口训练。以配对t检验对数据进行处理。结果:封闭-扩张术后张口度及健侧侧向运动度较治疗前、灌洗及粘弹补充治疗术后张口度及健侧侧向运动度较灌洗术前均有显著增加(P<0.01),疼痛基本消失。治疗过程中有5例患者出现健侧关节疼痛,经用封闭-扩张治疗后疼痛消失,张口度相应增加3～5mm。结论:(1)颞下颌关节上腔封闭-扩张联合灌洗及粘弹补充疗法能有效改善不可复性关节盘前移位患者的张口度及侧向运动度,缓解关节疼痛。(2)封闭-扩张术与灌洗及粘弹补充疗法两者有互补及累加作用。(3)及时发现对侧关节的隐匿病变并进行治疗,能提高整体疗效。

PURPOSE:To evaluate the clinical efficacy of the TMJ intraarticular injection-dilatation and later lavage plus viscosupplementation as a treatment for anterior disc displacement without reduction of the TMJ. METHODS: 29 patients with anterior disc displacement without reduction of the TMJ were treated by using intraarticular injection-dilatation. Arthrocentesis and lavage was conducted after 3-5 days, a volume of 1ml of sodium hyaluronate was injected into the super cavity at the end of lavage. The passive exercise mouth opening was done twice every day. Paired t test was used for statistical analysis. RESULTS: The maximum mouth opening was increased from (23.66±4.39)mm before treatment to (34.93±4.50)mm after intraarticular injection-dilatation(P<0.01),(39.17±4.38)mm after lavage plus viscosupplementation(P<0.01). The mandibular healthy side direction motion increased significantly (P<0.01) at different periods. 2 patients had mandibular motion pain after a series of treatments. 5 cases had pain on the opposite joints during treatment. CONCLUSION: (1) The TMJ intraarticular injection-dilatation and later lavage plus viscosupplementation is useful for patients with anterior disc displacement without reduction of the TMJ . The new therapy can increase mandibular motion and reduce pain. (2) The TMJ intraarticular injection-dilatation and lavage plus viscosupplementation are complementary and accumulated. (3) The opposite joint's pathological changes that is found and treated can increase the overall effect.