摘要
目的观察软硬颌垫结合综合康复治疗颞下颌关节盘不可复性前移位复位固定术后咬合的临床疗效。方法对云南大学附属医院2017年1月至2021年4月收治的单侧颞下颌关节不可复性盘前移位行关节盘复位固定术的患者60例,通过辅助颌垫维持术后髁突位置。实验对象完全随机分为2组,实验组为软颌垫治疗组(n=30例),对照组为硬颌垫治疗组(n=30例)。术后行为期3个月左右的综合康复治疗及张口训练,在术后1、3、6个月进行随访,并在术后即刻、3、6个月进行MRI检查。研究采用Fricton颞下颌关节紊乱指数、核磁共振评价标准评价关节盘复位效果、张口度改善程度、疼痛程度VAS值及患者佩戴颌垫的舒适度,研究2种颌垫的疗效。结果所有患者术后均出现不同程度的患侧后牙开颌,中线偏向健侧情况,戴用颌垫3~6个月后,开颌情况改善。术后2组Friction指数较术前均有明显下降,统计学分析显示,术后1个月,软颌垫组CMI(0.149±0.054)较硬颌垫组(0.221±0.051)下降明显。术后即刻MRI评价结果,软硬颌垫治疗有效率达100%(30/30);术后3个月及术后6个月MRI评价结果相同,软硬颌垫治疗有效率达97%(29/30)。2组患者术后1个月软颌垫组张口度(2.73±0.27)cm优于硬颌垫组的(2.07±0.39)cm,差异有统计学意义(P<0.05)。2组患者术后1个月软颌垫组疼痛指数(2.18±0.54)明显低于硬颌垫组的(3.03±0.29),差异有统计学意义(P<0.05)。2组患者术后1个月佩戴舒适度调查显示,软颌垫组患者舒适率86.7%明显高于硬颌垫组的73.3%(P<0.05)。结论软颌垫和硬颌垫治疗效果相似,但术后1个月软颌垫治疗效果明显优于硬颌垫,患者软颌垫佩戴舒适度也明显优于硬颌垫。结合软硬颌垫优缺点,即刻至术后1个月可先采用软颌垫,待术后1~3个月患者张口度明显改善后配合硬颌垫治疗,或视具体错颌畸形采用固定矫治器进行治疗。
Objective To observe the effect of comprehensive rehabilitation combined with soft and hard occlusion therapy for disc anchor surgery of anterior disc displacement with reduction. Methods A total of 60patients with anterior disc displacement with reduction who underwent unilateral disc anchor surgery from January2017 to April 2021 were treated in The Affiliated Hospital of Yunnan University. The position of the postoperative condyle was maintained by assisted occlusion therapy. The subjects were randomly divided into two groups:the experimental group was the soft occlusion therapy group (n=30 cases),and the control group was the hard occlusion therapy group (n=30 cases).Comprehensive physical therapy and open-mouth training were performed 3months after the operation,followed up 1,3 and 6 months after the operation,and MRI was performed immediately,3 and 6 months after the operation.Fricton index and MRI evaluation criteria were used to evaluate the reduction effect of joint disc,improvement degree of mouth opening,the comfort of patients wearing occlusion and visual analog scales.To study the efficacy of two occlusion therapy.Results Postoperative malocclusion occurred in all patients.The use of occlusion therapy for 3-6 months may decrease the proportion of malocclusion.The postoperative Friction index in both groups was significantly decreased compared with that before surgery.1 month after surgery,CMI of the soft occlusion therapy group (0.149±0.054) was significantly lower than that of the hard occlusion therapy group (0.221±0.052).Immediate postoperative MRI evaluation showed that the effective rate of soft and hard occlusion was 100%(30/30).MRI evaluation results at 3 and 6 months after surgery were the same,and the effective rate of soft and hard occlusion treatment was 97%(29/30).One month after surgery,the mouth opening degree in the soft occlusion therapy group was (2.73±0.27) mm better than that in the hard occlusion therapy group (2.07±0.39) mm,with statistical significance (P<0.05).One month afte
作者
张莉
薛林佳
包译
陈涌
孙承锋
丁昱
Li ZHANG;Linjia XUE;Yi BAO;Yong CHEN;Chengfeng SUN;Yu DING(Dept.of Stomatology Center,Affiliated Hospital of Yunnan University,Kunming Yunnan 650021,China;Rehabilitation Medical Center,Affiliated Hospital of Yunnan University,Kunming Yunnan 650021,China)
出处
《昆明医科大学学报》
CAS
2022年第11期90-98,共9页
Journal of Kunming Medical University
基金
云南省教育厅科学研究基金资助项目(2022J0018)
云南省康复临床医学中心建设项目(ZX2019-04-02)。
关键词
颞下颌关节
关节盘移位
手术复位
颌垫治疗
Temporomandibular joint disorder
Disc displacement
Reset operation
Occlusion therapy
