不同治疗方法对特殊TMD患者髁突运动轨迹的影响  

Condylar movement trace in patients with temporomandibular disorder undergoing BTX-A or occlusal splint therapy

作　　者：张龙丹[1] 俞律峰[1] 邹德荣[1] 

机构地区：[1]上海交通大学医学院附属第六人民医院口腔科,上海200233

出　　处：《同济大学学报（医学版）》2015年第3期68-74,共7页Journal of Tongji University(Medical Science)

基　　金：上海市科委西医引导项目(134119a5802)

摘　　要：目的通过运用髁突轨迹描记仪来阐述咀嚼肌肌内注射肉毒杆菌毒素-A与咬合垫治疗伴有磨牙症TMD患者的髁突运动轨迹特征。方法 30名研究对象随机分为三组,BTX-A组进行双侧咬肌肌内注射BTX-A,咬合垫组进行咬合垫治疗,对照组进行双侧咬肌肌内注射安慰剂,对研究对象应用ARCUS digmaⅡ进行髁突轨迹描记,在治疗前、治疗后1个月、3个月及6个月分别记录每组双侧髁突的轨迹参数,运用SAS 5.0软件进行统计分析。结果下颌侧方运动过程中,BTX-A组患者的髁突运动轨迹在3个月时出现显著改变(P<0.05),咬合垫组在1个月时发生改变(P<0.05),但三组间无显著差异(P>0.05)。前伸运动中,BTX-A组在治疗前后下颌运动明显改善(P<0.05),同时与其他两组相比效果显著(P<0.05),咬合垫组及安慰剂对照组在治疗1个月时,髁突运动也出现显著变化(P<0.05),但三组间无显著差异(P>0.05)。结论三组在治疗过程中均可改变髁突运动情况,各具特点。Objective To evaluate the therapeutic effect of BTX-A and occlusal splint therapy on mandibular condylar movement in temporomandibular disorder（TMD） patients with bruxism by means of computer aided diagnosis axiograph. Methods Thirty TMD patients with bruxism were randomly assigned to received BTX-A injection into bilateral masseter muscles（BTX-A group, n = 10）, occlusal splint therapy （ splint group, n -- 10 ）, or placebo injection into bilateral masseter muscles （ control group, n = 10 ）. The movement of condyle was recorded by ARCUS digma II preoperatively and postoperatively（ 1st m, 3rd m, 6th m）. The parameters were analyzed by SAS 5. 0 software. Results During the mandibular lateral movement, the condylar movement of the BTX-A group was significantly altered in the third month （ P 〈 0.05 ）, while the splint group showed significant changes in the first month（P 〈0.05 ）. No statistically significant differences were found among the three groups （ P 〉 0.05 ）. During the protrusive motion of the mandible, the postoperative mandibular movement of the BTX-A group was significantly improved（ P 〈 0.05 ） and the performance was better than other two groups（ P 〈 0.05 ）. The control and splint group also presented remarkable changes in the first month （ P 〈 0.05 ）. However, no statistically significant differences were found among the three groups （ P 〉 0.05）. Conclusion Three treatments all produced significant changes in condylar movement, with distinctive features.

关 键 词：肉毒杆菌毒素-A(BTX-A) 咬合垫 磨牙症 颞下颌关节紊乱病(TMD) 髁突运动轨迹描记 

分 类 号：R782.6[医药卫生—口腔医学]