透明质酸钠注射治疗不可复性关节盘前移位的CBCT影像学评价  

Sodium hyaluronate injection for the treatment of anterior disc displacement without reduction in the temporomandibular joint: A CBCT evaluation

作　　者：李菁[1] 郭艳莉 刘坚 龙星[1] 

机构地区：[1]武汉大学口腔医院颌面外科,430079 [2]兰州市口腔医院颌面外科

出　　处：《实用口腔医学杂志》2016年第5期682-687,共6页Journal of Practical Stomatology

基　　金：中华口腔医学会西部行口腔临床科研基金(编号:CSAW2013-03);兰州市卫生青年人才培养工程(编号:2014)

摘　　要：目的：对比治疗前后CBCT影像，观察透明质酸钠治疗颞下颌关节不可复性盘前移位后髁突位置及形态变化。方法：对40例患者进行3次透明质酸钠关节上腔注射治疗。通过治疗前、治疗后3、9、12个月CBCT影像学检查及临床检查，从髁突位置形态变化、疼痛度（VAS）、最大开口度（MMO）、Fricton指数观察透明质酸钠对颞下颌关节不可复性关节盘前移位的治疗效果。结果：CBCT显示不可复性关节盘前移位伴骨关节病患者治疗前与治疗后9、12个月比较，髁突骨质有明显改建，骨面变得平整光滑，骨赘减小（P=0．026，P=0．001），部分单纯不可复性关节盘前移位患者治疗后9个月髁突可以向前移动（P=0．038）；治疗后患者MMO增大，VAS减小（P〈0．05），Fricton指数降低。治疗后3～12个月Fricton指数无显著变化（P〉0．05）。结论：CBCT显示透明质酸钠可促进已破坏髁突表面骨质改建，但不能使后移位的髁突回到关节窝中央。Objective： To provide imaging evidence for the treatment of anterior disc displacement without reduction by the injection of sodium hyaluronate into temporomandibular joint（TMJ）. Methods： 40 patients with anterior disc displacement without reduction were injected 3 times with sodium hyaluronate into the TMJ. Patient＇s TMJ and clinical symptoms were examined 3, 9 and 12 months after treatment. The clinical parameters of Fricton＇s Craniomandibular Index（ Fricton index）, maximal mouth opening（ MMO）, pain intensity of a visual analog scale （ VAS ） and CBCT radiographic data of 48 TMJs from 40 patients were analysed. Results： The CBCT images showed that at 9 and 12 months follow-up the surface of the candylus became smooth, the density of the eortical bone and the adjacent subeortical bone inereased and osteophyte in condylar head decreased （ P = 0. 026, P = 0. 001 ）. As for disc displacement without osteoarthritis, 9 months after treatment condylus were moved forward （ P = 0. 038 ）. VAS and Fricton index were reduced （ P 〈 0. 05 ）, MMO was increased（ P 〈 0. 05 ）. 3 - 12 mouths after treatment, there was no statistical difference of Fricton index（ P 〉 0.05 ）. Conclusion： Injection of sodium hyaluronate into TMJ can remodel the condylar bone surface but cant make condyle back to the middle of acetabulum.

关 键 词：颞下颌关节 不可复性关节盘前移位 透明质酸钠 锥形束CT(CBCT) 

分 类 号：R782.6[医药卫生—口腔医学]