手法复位配合运动与垫治疗急性颞下颌关节盘不可复性前移位的近期疗效评价

上海口腔医学 ›› 2016, Vol. 25 ›› Issue (5): 570-573.

手法复位配合运动与垫治疗急性颞下颌关节盘不可复性前移位的近期疗效评价

姜鑫, 范帅, 蔡斌, 方仲毅, 徐丽丽, 刘丽琨

上海交通大学医学院附属第九人民医院康复医学科,上海 200011

收稿日期:2016-02-17 修回日期:2016-04-07 出版日期:2016-10-25 发布日期:2016-11-10
通讯作者: 范帅,E-mail: shuaifantasy@163.com
作者简介:姜鑫（1984-）,女,学士, E-mail: jiangxinkylie@163.com
基金资助:
上海市重要薄弱学科建设项目（2015ZB0404）; 上海交通大学医学院附属第九人民医院院级课题（2013B10）

Mandibular manipulation technique followed by exercise therapy and occlusal splint for treatment of acute anterior TMJ disk displacement without reduction

JIANG Xin, FAN Shuai, CAI Bin, FANG Zhong-yi, XU Li-li, LIU Li-kun

Department of Rehabilitation Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China

Received:2016-02-17 Revised:2016-04-07 Online:2016-10-25 Published:2016-11-10

摘要/Abstract

摘要： 目的探讨手法复位关节盘继以运动与垫治疗对急性不可复性盘前移位患者的短期疗效;通过MRI评价复位后短期内颞下颌关节盘-髁关系。方法选取44例患者急性开口受限（病程在2个月以内）且经MRI证实颞下颌关节盘不可复性关节盘前移位的患者（男7侧,女37侧）,施予软组织放松技术,随后行手法复位关节盘。复位后指导患者进行为期2周的下颌运动轨迹训练、关节稳定性训练和软管盘复位训练。白天自我维持下颌休息位,夜间配戴硬质热塑再定位垫,以保持良好的盘-髁关系。分别在治疗前、后评估患者的最大主动开口度和疼痛视觉类比评分（visual analogue score,VAS）（0~10分）,治疗结束后1~3个月内MRI复查盘-髁关系。采用SPSS17.0软件包对数据进行t检验。结果经过2周治疗后,患者开口度明显改善,由治疗前的（22.6±6.1） mm增加到（43.9±3.3） mm;疼痛明显缓解,由治疗前的3.6±1.5下降到0.7±0.25。44例患者在治疗结束后平均4.6±4.7周经MRI复查显示,20例（占46%）为正常盘-髁关系; 16例（占36%）为可复性关节盘前移位; 8例（占18%）仍为不可复性关节盘前移位。结论关节盘手法复位后继以运动治疗及配戴垫,对急性盘前移位患者能够恢复开口度,缓解疼痛,对维持正常盘-髁关系有一定疗效。

关键词: 颞下颌关节紊乱病, MRI, 手法复位, 运动训练, 垫

Abstract: PURPOSE: This study aimed to evaluate the short-term efficiency of mandibular manipulation technique combined with exercise therapy and splint treatment of acute anterior TMJ disc displacement without reduction (ADDW), and TMJ disc-condyle relationship by magnetic resonance imaging (MRI). METHODS: Forty-four patients (37 females, 7 males) were diagnosed as acute ADDW and confirmed by MRI. All patients underwent mandibular manipulation, combined with exercise therapy, including jaw movement exercise, stabilization exercise, disc reposition exercise, and splint treatment. Anterior repositioning splint was wore only at night during sleep, while the mandible was kept in rest position during the day. The treatment was continued for 2 weeks. The baseline and endpoint outcome assessment measures were maximum active mouth opening, visual analogue scale (VAS) score of TMJ pain. Consecutive MRI was performed 1~3 months after treatment. SPSS 17.0 software package was used for statistical analysis. RESULTS: Two weeks after treatment, the patients' maximum active mouth opening increased from(22.6±6.1) mm to (43.9±3.3) mm, VAS score of pain decreased from 3.6±1.5 to 0.7±0.25. After treatment of 4.6±4.7 weeks on average, 20 patients (46%) displayed normal dis-condyle relationship, 16 patients(36%) had displacement with reduction, and 8 patients（18%) had displacement without reduction on MRI. CONCLUSIONS: Mandibular manipulation technique combined with exercise therapy and splint treatment seems to be useful in the treatment of anterior TMJ disc displacement with reduction, which can help to maintain the complete anatomic disc-condyle relationship.

Key words: Temporomandibular joint disorders, MRI, Mandibular manipulation technique, Exercise therapy, Splint

中图分类号:

R782.6

姜鑫, 范帅, 蔡斌, 方仲毅, 徐丽丽, 刘丽琨. 手法复位配合运动与垫治疗急性颞下颌关节盘不可复性前移位的近期疗效评价[J]. 上海口腔医学, 2016, 25(5): 570-573.

JIANG Xin, FAN Shuai, CAI Bin, FANG Zhong-yi, XU Li-li, LIU Li-kun. Mandibular manipulation technique followed by exercise therapy and occlusal splint for treatment of acute anterior TMJ disk displacement without reduction[J]. Shanghai Journal of Stomatology, 2016, 25(5): 570-573.

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