口腔内肌筋膜治疗与教育及自我护理在慢性肌源性颞下颌关节紊乱症治疗中的比较：一项随机临床试验

Intra-oral myofascial therapy versus education and self-care in the treatment of chronic, myogenous temporomandibular disorder: a randomised, clinical trial.

作者信息

Kalamir Allan, Graham Petra L, Vitiello Andrew L, Bonello Rodney, Pollard Henry

机构信息

Department of Chiropractic, Faculty of Science, Macquarie University, North Ryde, NSW, Australia.

Department of Statistics, Faculty of Science, Macquarie University, North Ryde, NSW, Australia.

出版信息

Chiropr Man Therap. 2013 Jun 5;21:17. doi: 10.1186/2045-709X-21-17. eCollection 2013.

BACKGROUND

Myogenous temporomandibular disorders (TMD) are considered to be a common musculoskeletal condition. No studies exist comparing intra-oral myofascial therapies to education, self-care and exercise (ESC) for TMD. This study evaluated short-term differences in pain and mouth opening range between intra-oral myofascial therapy (IMT) and an ESC program.

METHODS

Forty-six participants with chronic myogenous TMD (as assessed according to the Research Diagnostic Criteria Axis 1 procedure) were consecutively block randomised into either an IMT group or an ESC group. Each group received two sessions per week (for five weeks) of either IMT or short talks on the anatomy, physiology and biomechanics of the jaw plus instruction and supervision of self-care exercises. The sessions were conducted at the first author's jaw pain and chiropractic clinic in Sydney, Australia. Primary outcome measures included pain at rest, upon opening and clenching, using an eleven point ordinal self reported pain scale. A secondary outcome measure consisted of maximum voluntary opening range in millimetres. Data were analysed using linear models for means and logistic regression for responder analysis.

RESULTS

After adjusting for baseline, the IMT group had significantly lower average pain for all primary outcomes at 6 weeks compared to the ESC group (p < 0.001). These differences were not clinically significant but the IMT group had significantly higher odds of a clinically significant change (p < 0.045). There was no significant difference in opening range between the IMT and ESC groups. Both groups achieved statistically significant decreases in all three pain measures at six weeks (p ≤ 0.05), but only the IMT group achieved clinically significant changes of 2 or more points.

CONCLUSION

This study showed evidence of superiority of IMT compared to ESC over the short-term but not at clinically significant levels. Positive changes over time for both IMT and ESC protocols were noted. A longer term, multi-centre study is warranted.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry ACTRN12610000508077.

背景

肌源性颞下颌关节紊乱病（TMD）被认为是一种常见的肌肉骨骼疾病。目前尚无研究比较口内肌筋膜治疗与针对TMD的教育、自我护理和锻炼（ESC）的效果。本研究评估了口内肌筋膜治疗（IMT）与ESC方案在疼痛和开口度方面的短期差异。

方法

46名慢性肌源性TMD患者（根据研究诊断标准轴1程序评估）被连续整群随机分为IMT组或ESC组。每组每周接受两次治疗（共五周），治疗内容为IMT或关于颌骨解剖学、生理学和生物力学的简短讲座，以及自我护理锻炼的指导和监督。治疗在澳大利亚悉尼第一作者的颌面部疼痛和整脊诊所进行。主要结局指标包括静息、开口和紧咬时的疼痛，采用11点序贯自我报告疼痛量表。次要结局指标为最大自主开口度（毫米）。数据采用均值线性模型和反应者分析的逻辑回归进行分析。

结果

在调整基线后，与ESC组相比，IMT组在6周时所有主要结局的平均疼痛均显著更低（p < 0.001）。这些差异在临床上不显著，但IMT组出现临床显著变化的几率显著更高（p < 0.045）。IMT组和ESC组在开口度方面无显著差异。两组在6周时所有三项疼痛指标均有统计学显著下降（p≤0.05），但只有IMT组实现了2分或更多分的临床显著变化。