摘要
目的 ：探讨运动训练维持颞下颌关节盘手法复位后盘-髁关系的可行性和临床疗效。方法 ：选取2013年10月—2016年1月在我院康复医学科门诊成功复位关节盘的19例急性开口受限的颞下颌关节不可复性盘前移患者,采用手法复位成功后,即刻配戴硬质热塑再定位垫,白天自我维持下颌休息位,夜间配戴垫,同时进行运动训练,包括软管盘复位训练、下颌运动轨迹训练、关节稳定性训练和颈椎姿势训练,每周5次,连续治疗2周。测量治疗前、治疗结束后即刻、1、6、12个月最大主动开口度,以视觉模拟评分（visual analogue sore,VAS）（0~10分）法确定疼痛指数。MRI检查评估治疗结束后1、6、12个月的盘-髁关系。采用SPSS19.0软件包分析比较组内治疗前、后的差异。结果：治疗结束后即刻,最大主动开口度从（21.5±5.9）mm增加到（40.2±1.8）mm,VAS评分从0.9±1.6下降到0,与治疗前相比,差异显著（P〈0.05）。治疗结束后1、6、12个月,最大主动开口度≥40 mm,VAS评估均为0分。治疗结束后6个月,MRI显示为正常盘-髁关系18例（占95%）,可复性关节盘前移位1例（占5%）;治疗结束后12个月,MRI显示为正常盘-髁关系15例（占79%）,可复性关节盘前移位3例（占16%）,不可复性盘前移位1例（5%）。治疗结束后12个月和6个月MRI显示的盘-髁关系相比,差异无统计学意义（P〉0.05）。结论 ：运动训练可以为急性颞下颌关节不可复性盘前移手法配合垫复位后的盘-髁关系提供良好的维持。
PURPOSE： To evaluate the clinical possibility and results of maintaining disc-condyle relationship by exercise therapy after successful manual reposition of temporomandibular joint （TMJ） disc. METHODS： Nineteen patients of acute TMJ disc displacement without reduction with limited opening underwent successful manual reposition of TMJ disc from Oct. 2013 to Jan. 2016 in the Department of Rehabilitation Medicine, Shanghai Ninth People＇S Hospital, Shanghai Jiao Tong University School of Medicine, were included in the study. The patients were treated by mandibular manipulation aided by occlusal splint technique and exercises, including disc reposition exercise,jaw movement exercise, stabilization exercise and cervical posture exercise. The treatment was continued for 2 weeks, 5 times a week. Before and after treatment, and at 1, 6, 12-month of follow-up, maximum active mouth opening （mm） and visual analogue scale （VAS） of pain were evaluated. MRI was performed 1,6 and 12 months after treatment. The data were compared between pre- and post-therapy with paired t test and χ^2 test using SPSS 19.0 software package. RESULTS： Two weeks after treatment, the maximum active mouth opening was increased from （21.5±5.9）mm to （40.2±1.8）mm（P〈0.05）, VAS score dropped from 0.9±1.6 to 0（P〈0.05）. One, 6 and 12 months after treatment, the maximum active mouth opening was ≥40 mm, and VAS score was 0. Six months after treatment, 18 patients （95%） were normal, 1 patients （5%） displayed displacement with reduction on MRI. Twelve months after treatment, 15 patients （79%） were normal, 3 patients （16%） displayed displacement with reduction, 1 patients （5%） had displacement without reduction on MRI. No significant relationship was found on MRI after treatment （P 〉0.05）.CONCLUSIONS： The results indicate that exercise therapy can help to maintain disc-condyle relationship after successful reposition of acute TMJ anterior disc displacement without reduction via mandibular m
出处
《中国口腔颌面外科杂志》
CAS
2016年第5期435-439,共5页
China Journal of Oral and Maxillofacial Surgery
基金
上海市重要薄弱学科建设项目(2015ZB0404)
关键词
颞下颌关节紊乱病
不可复性关节盘前移位
运动训练
手法复位
盘-髁关系
Temporomandibular disorders
Disc displacement without reduction
Exercise therapy
Mandibular manipulation
Disc-condyle relationship
