肌电分析在TMD临床疗效评价中的应用  

The application of the electromyographic analysis in the evaluation of clinical curative effect of TMD

作　　者：张龙丹[1] 俞律峰[1] 邹德荣[1] 

机构地区：[1]上海交通大学附属第六人民医院口腔科,上海200233

出　　处：《临床口腔医学杂志》2015年第2期82-85,共4页Journal of Clinical Stomatology

基　　金：上海市科委西医引导项目(134119a5802)

摘　　要：目的:探讨3种不同方法治疗伴有磨牙症TMD的咀嚼肌肌电特征差异,评价3种治疗方法的效果。方法:30例伴有磨牙症的TMD患者被随机分为3组,每组10例。A组进行内毒杆菌毒素A(BTX-A)双侧咬肌肌内注射治疗,B组进行功能训练治疗,C组进行弹性颌垫治疗。对3组研究对象在治疗前、治疗1、3、6个月分别采集双侧咬肌(MM)和颞肌前束(TA)在下颌姿势位(MPP)以及牙尖交错位(ICP)最大紧咬牙时的肌电图(EMG),采用SAS 5.0统计学软件分析比较3组的峰值电位(Amp)之间是否存在统计学差异。结果:横向比较中各个治疗时间段A组患者疼痛视觉模拟评分(VAS)显著低于B组和C组(P<0.05),肌电显示MPP中A组在治疗过程中能显著降低双侧咬肌肌力(P<0.05),ICP时A组在1、3个月时显著降低双侧咬肌肌力(P<0.05),同时双侧颞肌肌力显著增强(P<0.05)。纵向比较中3组在治疗过程中均能明显降低疼痛(P<0.05),但3组时间点不同,A组缓解疼痛时间较长,肌电图显示3组均可显著降低咬肌MPP肌力(P<0.05),A、C组可降低ICP咬肌肌力(P<0.05),A组双侧颞肌肌力可代偿增强(P<0.05),B、C组颞肌肌力治疗前后均无统计学差异(P>0.05)。结论:临床症状与肌电图的结合使用能够对口颌系统行使功能过程中咀嚼肌的表现进行很好地观测,对TMD患者的咀嚼肌生物力学和结构方面有很好地理解。BTX-A肌内注射方法治疗伴有磨牙症的TMD可显著缓解患者疼痛,疗效持续时间较长。BTX-A肌内注射可显著降低咀嚼肌力,使目标肌肉(咬肌)疲劳得到缓解,促进咀嚼肌力平衡重建,较传统方式存在潜在优势。Objective：Explore differences of masticatory muscles＇ EGMs characteristics among the three clinical treatments of TMD with bruxism and evaluate the effect of three kinds of treatment. Method：30 cases of TMD patients with bruxism were randomly divided into three groups,each group of 10 cases. The group A were treated by BTX-A＇s masseter muscle injection,the group B accepted function training treatment,while the group C used the elastic jaw pad treatment. To measure the EMGs of both sides of MM and TA while MPP and ICP. Analysis differences of Amp in them by SAS 5.0. Result：Crosswise comparison of different treatments,patients＇ visual analogue scale（VAS）of group A lower than that of group B and group C（P〈0.05）,EMGs of bilateral MM in MPP in group A significantly reduced（P〈0.05）,in the ICP the EMGs of bilateral MM of group A at 1,3 months significantly reduced（P〈0.05）,while that of the TA significantly enhanced（P〈0.05）. By vertical comparison the pain of patients in group A significantly reduced and the effect lasts a long time（P〈0.05）,the pain of patients in group B and C decreased significantly at different time（P〈0.05）,data showed three groups can significantly reduce the MM in MPP（P〈0.05）,group A and C in ICP can decrease the EMGs of MM（P〈0.05）,bilateral TA of group A significantly enhanced（P〈0.05）.Data of TA in group B and C were no statistical difference（P〉0.05）.Conclusion：The combination of clinical symptoms and EMGs can observe function performance of the jaw chewing,thus has good understanding biological mechanics and structure of the chewing muscles in patients with TMD. Intramuscular injection BTX-A in TMDs with bruxism can significantly relieve patients＇ pain and last longer duration.It can significantly reduce EMGs of the masticatory muscle,release the target muscle fatigue,promote the balance of masticatory muscles,has potential more advantages compared with traditional ways.

关 键 词：肉毒杆菌毒素A(BTX-A) 颌垫 功能训练 肌电图 疼痛 磨牙症 TMD 

分 类 号：R782.6[医药卫生—口腔医学]