手法复位联合Twin⁃Block咬合板治疗急性颞下颌关节盘不可复性前移位的临床效果评价  

Clinical evaluation of manual reduction combined with Twin⁃Block splint in the treatment of acute anterior temporomandibular joint disk displacement without reduction

作　　者：宋志强 张颖[1] 张清彬[1] Song Zhiqiang;Zhang Ying;Zhang Qingbin(Department of Temporomandibular Joint,Affiliated Stomatology Hospital of Guangzhou Medical University,Guangzhou Key Laboratory of Basic and Applied Research of Oral Regeneration Medicine,Guangzhou 510182,China)

机构地区：[1]广州医科大学附属口腔医院颞下颌关节科·广州市口腔再生医学基础与应用研究重点实验室,广州510182

出　　处：《中华口腔医学研究杂志（电子版）》2022年第3期144-149,共6页Chinese Journal of Stomatological Research(Electronic Edition)

基　　金：广东省自然科学基金(2022A1515011121);广州市临床特色技术项目(2019TS42);广州市重点研发计划农业和社会发展科技项目(202206010004)。

摘　　要：目的探讨手法复位联合Twin⁃Block咬合板治疗急性颞下颌关节盘不可复性前移位(ADDWoR)的预后及效果。方法2020年6月至2021年6月,对就诊于广州医科大学附属口腔医院颞下颌关节科的52例急性颞下颌关节ADDWoR患者进行手法复位及佩戴Twin⁃Block咬合板治疗。记录治疗前及治疗6个月后张口度、疼痛状态视觉模拟评分(VAS)和Fricton指数、影像学检查,使用配对t检验对比治疗前、后的数据评价治疗效果。结果全部52例患者中有4例治疗失败。48例患者治疗6个月后张口度为(44.1±3.3)mm,与治疗前的(25.2±2.2)mm相比差异具有统计学意义(t=30.934,P<0.001);治疗6个月后VAS评分(0.15±0.41)与治疗前(2.02±0.67)差异具有统计学意义(t=15.931,P<0.001);治疗后6个月关节功能障碍指数(0.06±0.07)较治疗前(0.37±0.04)有显著降低,差异有统计学意义(t=36.544,P<0.001),治疗后6个月颞下颌关节紊乱指数(0.04±0.03)较治疗前(0.21±0.03)降低,差异有统计学意义(t=31.435,P<0.001);磁共振成像(MRI)检查结果显示,盘-髁关系恢复正常者5例、可复性前移位27例、ADDWoR不伴张口受限16例。结论手法复位联合Twin⁃Blcok咬合板治疗急性颞下颌关节ADDWoR能较好改善患者张口度、缓解疼痛症状和恢复颞下颌关节的功能。Objective To explore the clinical effect of manual reduction combined with Twin⁃Block splint treatment on acute anterior disc displacement without reduction(ADDWoR).Methods From June 2020 to June 2021,fifty⁃two patients diagnosed with acute ADDWoR and admitted to the affiliated Stomatological Hospital of Guangzhou Medical University were taken manual reduction and Twin⁃Block splint therapy.The therapeutic effect was evaluated by maximum mouth opening,visual analog scales(VAS)pain score,Fricton index,imagological examination before treatment and after 6 months treatment.Results Four patients failed treatment among the 52 patients.The mouth opening of the other 48 patients after 6 months of treatment(44.1 ± 3.3)mm was significantly higher than that of pre⁃treatment(25.2 ±2.2)(t = 30.934,P<0.001). VAS pain score after 6 months of treatment(0.15 ± 0.41)was significantlylower than that of pre⁃treatment(2.02 ± 0.67)(t = 15.931,P<0.001). The joint dysfunction index after 6months treatment(0.06 ± 0.07)was significantly lower than that of pre⁃treatment(0.37 ± 0.04)(t =36.544,P<0.001),and the joint craniomandibular index after 6 months treatment(0.04 ± 0.03)was significantlylower than that of pre⁃treatment(0.21 ± 0.03)(t =31.435,P<0.001). Magnetic resonance imaging(MRI)showed that the disc ⁃ condyle relationship was restored to normal in five cases,while anterior discdisplacement with reduction in 27 cases,and ADDWoR without mouth opening limitation in 16 cases.Conclusions Manual reduction combined with Twin ⁃ Block splint treatment can improve the acuteADDWoR patients′ mouth opening,alleviate pain,and restore the function of TMJ.

关 键 词：颞下颌关节 关节盘不可复性前移位 手法复位 Twin⁃Block咬合板 

分 类 号：R782.6[医药卫生—口腔医学]