目的:比较体外电磁式冲击波和再定位咬合板治疗颞下颌关节可复性盘前移位的临床疗效。方法:回顾分析2021年3月至2023年1月在皖南医学院第一附属医院弋矶山医院口腔颌面外科诊治的51例颞下颌关节可复性盘前移位患者,根据治疗方法不同分为体外电磁式冲击波治疗组28例和再定位咬合板组23例,两组均连续治疗3个月。采用视觉模拟疼痛评分(visual analogue scale,VAS)、张口度、颞下颌关节功能障碍指数DI值(dysfunction index,DI)和生活质量SF-36评分(short form 36 questionnaire,SF-36)比较两种治疗方法的治疗效果。结果:两组治疗前,VAS评分、张口度、DI值以及生活质量SF-36评分的比较,差异无统计学意义(P＞0.05);经过治疗,体外电磁式冲击波治疗组VAS评分低于再定位咬合板治疗组(P＜0.05);再定位咬合板治疗组DI值低于体外电磁式冲击波治疗组(P＜0.05);两组在张口度和生活质量SF-36评分上差异无统计学意义(P＞0.05)。结论:在关节疼痛方面,体外电磁式冲击波治疗效果好;在颞下颌关节临床障碍方面,再定位咬合板治疗效果好,两种方法在治疗张口度和生活质量SF-36评分上无明显区别。
Objective:To compare the clinical effect of extracorporeal electromagnetic shock wave and anterior repositioning splint on anterior disc displacement with reduction. Methods:A total of 51 patients with anterior disc displacement with reduction that were treated in the Oral and Maxillofacial Surgery Department of Yijishan Hospital,the First Affiliated Hospital of Wannan Medical College from March 2021 to January 2023 were retrospectively analyzed. The patients were divided into the extracorporeal electromagnetic shock wave therapy group 28 cases and the anterior repositioning splint group,with 23 cases in each group. Both groups were treated for 3 months. The visual analogue scale (VAS) score,degree of mouth opening,temporomandibular joint dysfunction index (DI) value,and SF-36 score on quality of life of the two groups were analyzed to compare the clinical efficacy of the two different treatment methods. Results:The differences in VAS score,degree of mouth opening,DI value,and SF-36 score on quality of life between the two groups before the treatment was not statistically significant (P＞0.05). After treatment,the VAS score of the extracorporeal electromagnetic shock wave therapy group was lower than the anterior repositioning splint group,and the difference was statistically significant (P＜0.05). The anterior repositioning splint group have a lower DI value than the extracorporeal electromagnetic shock wave therapy group,and the difference was statistically significant (P＜0.05). Conclusion:The extracorporeal electromagnetic shock wave therapy is better at treating joint pain. The anterior repositioning splint is better in the treatment of TMJ dysfunction. There is no significant difference between the two methods in improving the degree of mouth opening and SF-36 score on quality of life.
[1] Sousa BM,Lopez-Valverde N, Lopez-Valverde A, et al. Different treatments in patients with temporomandibular joint disorders: a comparative randomized study[J]. Medicina (Kaunas), 2020, 56(3): 113.
[2] Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic criteria for temporomandibular disorders(DC/TMD) for clinical and research applications: recommendations of the international RDC/TMD consortium network* and orofacial pain special interest group[J]. J Oral Facial Pain Headache, 2014, 28(1): 6-27.
[3] 雷杰, 傅开元. 垫治疗颞下颌关节盘可复性盘前移位的机制及对临床治疗的启示[J]. 中国实用口腔科杂志, 2017, 10(6): 321-325.
[4] 张玲阁, 龙星, 蔡恒星. 两种不同垫治疗颞下颌关节紊乱病的临床疗效分析[J]. 口腔医学研究, 2017, 6(23): 614-617.
[5] 陈伟生, 郑雪华, 林雪峰. 应用RDc/TMD评估我国颞下颌关节紊乱病患者轴II诊断的研究[J]. 中国实用口腔科杂志, 2013, 6(9): 525-528.
[6] Oliveira LK, de Araújo Almeida G, Lelis éR, et al. Temporomandibular disorder and anxiety, quality of sleep, and quality of life in nursing professionals[J]. Braz Oral Res, 2015, 29(1): 1-7.
[7] Ma ZG, Xie QY, Yang C, et al. Can anterior repositioning splint effectively treat temporomandibular joint disc displacement[J]. Sci Rep, 2019, 9(1): 534.
[8] 宋琰, 段振芳, 马宇锋. 颞下颌关节可复性盘移位的咬合治疗进展[J]. 口腔医学, 2022, 42(2): 188-192.
[9] 李雯燕, 武俊英, 张青. 体外电磁式冲击波联合运动疗法对颞下颌关节紊乱病的疗效观察[J]. 中华物理医学与康复杂志, 2019, 41(11): 838-841.
[10] 刘莉菲, 陆宇, 王银妹. 体外电磁式冲击波治疗颞下颌关节紊乱病的疗效观察[J]. 大连医科大学学报, 2018, 40(5): 434-437, 449.
[11] Feichtinger X, Monforte X, Keibl C, et al. Substantial biomechanical improvement by extracorporeal shockwave therapy after surgical repair of rodent chronic rotator cuff tears[J]. Am J Sports Med, 2019, 47(9): 2158-2166.
[12] 赵景春, 咸春静, 于家傲, 等. 体外电磁式冲击波疗法对促进创面血管生成及愈合作用的研究进展[J]. 中华损伤与修复杂志(电版), 2014, 9(1): 71-75.
[13] 沃春新, 徐正涛, 秦乐, 等. 体外电磁式冲击波治疗大鼠肌筋膜疼痛及其机制初探[J]. 中国疼痛医学杂志, 2018, 24(8): 586-592.
[14] 任佳悦, 杨燕冰, 季晶俊, 等. 体外冲击波穴位治疗对肩关节周围炎患者肩部疼痛及血清5-HT、PGE_2影响的临床观察[J]. 上海中医药杂志, 2019, 53(8): 68-71.
[15] 刘莉菲, 陆宇, 王银妹. 体外电磁式冲击波治疗颞下颌关节紊乱病的疗效观察[J]. 大连医科大学学报, 2018, 40(5): 434-437, 449.
[16] 赵晓燕, 李英. 咬合板治疗颞下颌关节紊乱病疼痛和弹响的治疗进展[J]. 中华老年口腔医学杂志, 2019, 17(6): 362-366.
