Emshoff Rüdiger, Rudisch Ansgar
University of Innsbruck, Innsbruck, Austria.
J Oral Maxillofac Surg. 2004 Jul;62(7):816-23. doi: 10.1016/j.joms.2003.12.020.
Arthrocentesis and hydraulic distention of the temporomandibular joint (TMJ) has been described as an effective modality in the treatment of patients demonstrating clinical findings consistent with the diagnosis of disc displacement without reduction. The purpose of this study was to investigate whether the clinical variable of TMJ pain chronicity and the magnetic resonance (MR) imaging variable of osteoarthrosis (OA) may predict treatment outcomes of arthrocentesis and hydraulic distention of the TMJ.
The study consisted of 29 TMJ pain patients, who were assigned a unilateral clinical temporomandibular disorder (TMD) of "TMJ pain associated with an internal derangement (ID) type III (disc displacement without reduction)," and a TMJ pain side-related MR imaging diagnosis of disc displacement without reduction. Bilateral sagittal and coronal MR images were obtained immediately preoperatively to establish the presence or absence of ID and OA. TMJ pain level of function and mandibular range of motion were assessed preoperatively and compared with the respective 2-month follow-up findings. Outcome criteria of success were 1). an absence of signs and symptoms characteristic of a diagnosis of ID type III and/or 2). a reduction in pain level of 85% or greater. A multiple logistic regression analysis was used to compute the odds ratio for TMJ pain chronicity (duration >6 months and <2 years) and OA for successful outcomes versus nonsuccessful outcomes.
The pretreatment data revealed no significant relationship between the clinical disorder "TMJ pain associated with ID type III" and the MR imaging finding of OA (P =.103). At 2-month follow-up, clinical evaluation showed a significant reduction in TMJ pain during function (P =.000), a significant reduction in clinical diagnoses of TMDs (P =.000), and a significant increase in mandibular range of motion (P =.000). Significant increase in risk of a nonsuccessful outcome (pain reduction <85%) occurred with TMJ pain chronicity (odds ratio of 41.0) (P =.018). Significant increase in benefit of a successful outcome (absence of ID type III) occurred with TMJ OA (odds ratio 1:16.7, P =.06) (P =.044).
Arthrocentesis in chronic TMJ pain patients was less successful than in nonchronic patients with regard to treatment outcome of pain reduction. Arthrocentesis in patients with TMJ OA was more beneficial with regard to the disappearance of ID type III than in non-OA patients. Predictive modeling may provide clinicians with the opportunity to identify "at-benefit" patients early and initiate specific treatments.
颞下颌关节（TMJ）穿刺及液压扩张已被描述为治疗表现出与不可复性盘移位诊断相一致的临床症状的患者的一种有效方法。本研究的目的是调查TMJ疼痛慢性化的临床变量及骨关节炎（OA）的磁共振（MR）成像变量是否可预测TMJ穿刺及液压扩张的治疗结果。
本研究包括29例TMJ疼痛患者，他们被诊断为单侧临床颞下颌关节紊乱病（TMD）“与III型内部紊乱（ID）相关的TMJ疼痛（不可复性盘移位）”，且TMJ疼痛侧的MR成像诊断为不可复性盘移位。术前立即获取双侧矢状位和冠状位MR图像以确定是否存在ID和OA。术前评估TMJ功能疼痛水平和下颌运动范围，并与各自2个月的随访结果进行比较。成功的结果标准为：1）不存在III型ID诊断的特征性体征和症状，和/或2）疼痛水平降低85%或更多。采用多元逻辑回归分析计算TMJ疼痛慢性化（持续时间>6个月且<2年）和OA对于成功结果与非成功结果的优势比。
治疗前数据显示临床疾病“与III型ID相关的TMJ疼痛”与OA的MR成像表现之间无显著相关性（P = 0.103）。在2个月的随访中，临床评估显示功能期间TMJ疼痛显著减轻（P = 0.000），TMD的临床诊断显著减少（P = 0.000），下颌运动范围显著增加（P = 0.000）。TMJ疼痛慢性化会使非成功结果（疼痛减轻<85%）的风险显著增加（优势比为41.0）（P = 0.018）。TMJ OA会使成功结果（不存在III型ID）的获益显著增加（优势比1:16.7，P = 0.06）（P = 0.044）。
就疼痛减轻的治疗结果而言，慢性TMJ疼痛患者的关节穿刺术不如非慢性患者成功。就III型ID的消失而言，TMJ OA患者的关节穿刺术比非OA患者更有益。预测模型可为临床医生提供机会，以便早期识别“受益”患者并启动特定治疗。
