上海口腔医学

上海口腔医学 ›› 2015, Vol. 24 ›› Issue (5): 441-445.

• 临床研究 • 上一篇    下一篇

2种方法治疗颞下颌关节WilkesⅢ~Ⅴ期结构紊乱的疗效比较

张楠1, 张晓红2, 焦国良1, 李岩1, 方圆1, 吴仲寅1   

  1. 1.中国人民解放军白求恩国际和平医院 口腔科,河北 石家庄 050082;
    2.武安市第一人民医院 口腔科,河北 武安 056300
  • 收稿日期:2014-12-17 修回日期:2015-02-10 出版日期:2015-10-20 发布日期:2015-11-03
  • 通讯作者: 焦国良，E-mail：jiaog163@sina.com
  • 作者简介:张楠（1988-）,女,硕士,医师,E-mail: 770161342@qq.com

Comparative clinical and MRI study on two methods for treatment of patients with temporomandibular joint internal derangement of Wilkes Ⅲ—Ⅴ stages

ZHANG Nan1, ZHANG Xiao-hong2, JIAO Guo-liang1, LI Yan1, FANG Yuan1, WU Zhong-yin1   

  1. 1.Department of Stomatology, Bethune International Peace Hospital of PLA. Shijiazhuang 050082;
    2.Department of Stomatology, Wu’an First People’s Hospital. Wu’an 056300, Hebei Province, China
  • Received:2014-12-17 Revised:2015-02-10 Online:2015-10-20 Published:2015-11-03

摘要： 目的：评价并比较颞下颌关节上腔灌洗术及颞下颌关节锚固术治疗WilkesⅢ~Ⅴ期结构紊乱的总体疗效。方法选择2011年1月—2014年1月接受颞下颌关节锚固术及关节灌洗术的患者286例,根据治疗方法不同分为A、B 2组,A组164例接受颞下颌关节上腔灌洗术,B组122例接受关节盘复位锚固术,分别于术前、术后6个月对患者的颞下颌关节MRI表现、关节杂音、开口度、关节疼痛视觉模拟评分（VAS）值及头痛进行评价,通过手术前、后对比,评价2种治疗方法的临床效果,并进行长期随访（6~42个月）。采用SPSS13.0软件包对数据进行χ2检验及t检验。结果B组杂音和头痛的治愈率显著大于A组（χ12=14.33,χ22=57.24,P<0.05）。VAS及开口度的改善效果B组也显著优于A组（t1=30.30, t2=21.37, P<0.05）。2组患者治疗前与治疗后随访期内MRI检查结果进行比较,A组患者无关节盘解剖复位病例,9例（5.5%）出现关节盘双板区类盘样改变,B组患者全部达到关节盘解剖复位。结论颞下颌关节灌洗术后伴随临床症状的消失,关节内可以出现双板区类盘样改变,但发生率仅为5.5%。综合临床疗效及影像学表现评价,对WilkesⅢ~Ⅴ期关节结构紊乱的治疗,关节盘锚固术优于关节灌洗术。

关键词: 颞下颌关节, 灌洗术, 锚固术

Abstract: PURPOSE: To evaluate the effectiveness of arthrocentesis vs disc anchorage for treatment of temporomandibular joint internal derangement of Wilkes Ⅲ-Ⅴ stages. METHODS: From January 2011 to January 2014,286 patients who accepted arthrocentesis and disc anchorage were included in this study and were divided into 2 groups according to the treatment modality: 164 patients in group A ( arthrocentesis),122 patients in group B(disc anchorage). MRI and clinical examination including crepitus, opening degree between incisors, VAS and headache were taken pretreatment and 6 months postoperatively and the follow-up time was 6 to 42 months. SPSS 13.0 software package was used for statistical analysis. RESULTS: There were significant differences in crepitus, opening degree, headache and VAS between group A and group B(χ21=14.33and χ22=57.24,P<0.05; t1=30.30, t2=21.37, P<0.05). The follow-up MRI showed no disc reduction in group A, except 5.5% of the patients experienced adaptive remodeling (disc-like changes) in bilaminar zone of the disc, while normal disc-condyle relationship was found in all patients of group B. CONCLUSIONS: As the symptoms disappeared, adaptive remodeling(disc-like changes) in bilaminar zone of the disc could occur but only in 5.5% of the patients after arthrocentesis. Combined clinical effect and MRI findings we conclude that disc anchorage is superior to arthrocentesis for treatment of TMJID of Wilkes Ⅲ-Ⅴ stages .

Key words: Temporomandibular joint, Arthrocentesis, Disc anchorage