义齿咬合板联合综合物理疗法对颞下颌关节盘不可复性前移位的疗效评价

doi:10.19439/j.sjos.2024.03.011

摘要/Abstract

摘要： 目的：探讨义齿咬合板联合综合物理疗法治疗颞下颌关节盘不可复性前移位（anterior disc displacement without reduction,ADDwoR）的疗效。方法：选择2019年1月—2020年12月衡水市人民医院口腔正畸修复科就诊的牙列缺损或牙重度磨耗并诊断为ADDwoR患者60例,根据治疗方法不同,随机分为义齿咬合板组（A组）和义齿咬合板+综合物理疗法组（B组）。治疗前、治疗时每3周记录患者最大主动开口度（maximum mouth opening,MMO）、视觉模拟量表疼痛评分（visual analog pain score,VAS）。治疗前及治疗后3个月拍摄锥形束CT（CBCT）,分析2组患者治疗前、后临床疗效指标变化及颞下颌关节CBCT三维数据差异。采用 SPSS 26.0软件包对数据进行统计学分析。结果：治疗后3周,2组VAS和治疗前相比差异有统计学意义（P<0.05）且B组VAS降低较多;治疗后3周起,B组MMO、VAS和治疗前相比差异有统计学意义（P<0.05）。治疗后9周起,A组MMO与治疗前相比差异有统计学意义(P<0.05),但A组与B组MMO、VAS无统计学差异（P>0.05）。CBCT显示,治疗后关节前间隙变窄,关节后间隙增宽,关节上间隙增大,髁突水平角减小,关节结节斜度、髁突高度增大（P<0.05）;关节窝深度、髁突前后径、内外径相比差异无统计学意义（P>0.05）。与A组相比,B组治疗后关节前、上、后间隙,髁突水平角,关节结节斜度差异有统计学意义（P<0.05）。结论：义齿咬合板可有效改善ADDwoR症状,义齿咬合板联合综合物理疗法能迅速改善患者开口度,减轻患者关节区疼痛。

关键词: 义齿咬合板, 综合物理疗法, 不可复性盘前移位, 视觉模拟疼痛评分, 锥形束CT

Abstract: PURPOSE: To explore the efficacy of denture occlusal plate combined with comprehensive physical therapy for temporomandibular joint disc displacement without reduction(ADDwoR). METHODS: Sixty patients of ADDwoR and dentition defect or severely worn teeth who visited the Department of Orthodontics and Prosthodontics of Hengshui People's Hospital from January 2019 to December 2020 were selected and randomly divided into denture occlusal plate group (group A) and denture occlusal plate + comprehensive physical therapy group (group B) according to the treatment methods. Maximum mouth opening (MMO) and visual analog pain score(VAS) among all patients were recorded before treatment and every three weeks during three months of treatment. Cone-beam CT(CBCT) was taken before and 3 months after treatment. The changes in clinical efficacy indicators before and after treatment and CBCT data between the two groups were analyzed. Statistical analysis was performed with SPSS 26.0 software package. RESULTS: The differences of VAS of group A and B were statistically significant from before treatment to three weeks after treatment(P<0.05), and group B decreases more. From 3 weeks after treatment, there was a significant difference of group B for MMO and VAS before treatment (P<0.05). From 9 weeks after treatment, there was a significant difference of group A for MMO before treatment (P<0.05), but there was no significant difference in MMO and VAS between group A and B(P>0.05). CBCT showed narrowed anterior joint space, widened posterior joint space, enlarged superior joint space, decreased horizontal angle of the condyle and increased slope of joint nodules (P<0.05). The difference between joint depth, anteroposterior diameter of the condyle, internal and external diameter was not significant (P>0.05). There was significant differences in anterior, superior, and posterior joint space, condylar level angle, and slope of joint nodules of group B compared with group A(P<0.05). CONCLUSIONS: Denture occlusal plate can effectively improve symptoms of ADDwoR, and denture occlusal plate combined with comprehensive physical therapy can quickly improve mouth opening and reduce pain in the joint area.

Key words: Denture occlusal plate, Comprehensive physical therapy, Anterior disc displacement without reduction, Visual analogue scale, Cone-beam CT

中图分类号:

R782.6

李苏娜, 宋文尚, 刘子略, 杜月茹, 蔡世新. 义齿咬合板联合综合物理疗法对颞下颌关节盘不可复性前移位的疗效评价[J]. 上海口腔医学, 2024, 33(3): 273-278.

LI Su-na, SONG Wen-shang, LIU Zi-lue, DU Yue-ru, CAI Shi-xin. Evaluation of efficacy of denture occlusal plate combined with comprehensive physical therapy for temporomandibular joint disc displacement without reduction[J]. Shanghai Journal of Stomatology, 2024, 33(3): 273-278.

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