Cho Jungsuk, Israel Howard
PGY3 Resident, Department of Surgery, Division of Oral and Maxillofacial Surgery and Dentistry, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY.
Professor of Clinical Surgery and Attending Oral and Maxillofacial Surgeon, Department of Surgery, Division of Oral and Maxillofacial Surgery and Dentistry, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY.
J Oral Maxillofac Surg. 2017 Jun;75(6):1144-1150. doi: 10.1016/j.joms.2016.10.038. Epub 2016 Nov 9.
Although temporomandibular joint (TMJ) disorders encompass all age groups, it is generally considered to affect young to middle-age adults. The aim of this investigation was to study patients who met the criteria for TMJ arthroscopy and to determine whether there was a difference in outcomes between younger and older patients.
This was a retrospective chart review of patients who underwent TMJ operative arthroscopy. The primary variable studied was patient age. Major outcome variables included changes in subjective pain measured by a visual analog scale (VAS) and changes in maximum interincisal opening (MIO) after arthroscopic surgery. Other variables of interest included the presence of systemic disease, synovitis, and osteoarthritis diagnosed arthroscopically. Data analysis included the Student t test, regression analysis (R Studio, Boston, MA), and χ test with a P value less than .05 indicating statistical significance.
The study population consisted of 103 patients diagnosed with internal derangement and severe inflammatory or degenerative TMJ disease (Wilkes stages II to V) who underwent operative arthroscopy. Patients were divided into 2 groups based on age (group Y, <40 yr old, n = 51, mean age, 26 yr; group O, >40 yr old, n = 52, mean age, 56 yr). The presence of osteoarthritis diagnosed arthroscopically was significantly greater in group O than in group Y (P < .01). There was significant postoperative improvement in pain (VAS) and MIO in group Y (P < .01) and group O (P < .01). Although the 2 groups showed substantial improvement after arthroscopy, when comparing differences in outcomes between the groups, the absolute postoperative pain level for group O was significantly lower than for group Y (P < .05). Comparison of postoperative MIO did not show a significant difference between group Y and group O (P = .286).
Groups Y and O showed substantial improvement in pain (VAS) and mandibular mobility (MIO) after surgical TMJ arthroscopy. Group O had a higher prevalence of arthroscopically diagnosed osteoarthritis and lower postoperative pain levels compared with group Y. Older patients with advanced TMJ disease responded well to TMJ arthroscopy.
虽然颞下颌关节（TMJ）疾病涵盖所有年龄组，但一般认为其好发于中青年。本研究旨在对符合TMJ关节镜检查标准的患者进行研究，并确定年轻患者和老年患者的治疗效果是否存在差异。
这是一项对接受TMJ手术关节镜检查患者的回顾性病历审查。研究的主要变量是患者年龄。主要结局变量包括通过视觉模拟量表（VAS）测量的主观疼痛变化以及关节镜检查术后最大切牙间开口度（MIO）的变化。其他感兴趣的变量包括全身疾病、滑膜炎和关节镜诊断的骨关节炎的存在情况。数据分析包括Student t检验、回归分析（R Studio，马萨诸塞州波士顿）和χ检验，P值小于.05表示具有统计学意义。
研究人群包括103例被诊断为内部紊乱以及严重炎症或退行性TMJ疾病（Wilkes II至V期）并接受手术关节镜检查的患者。患者根据年龄分为两组（Y组，年龄<40岁，n = 51，平均年龄26岁；O组，年龄>40岁，n = 52，平均年龄56岁）。关节镜诊断的骨关节炎在O组中的发生率显著高于Y组（P <.01）。Y组（P <.01）和O组（P <.01）术后疼痛（VAS）和MIO均有显著改善。虽然两组在关节镜检查后均有显著改善，但在比较两组的治疗效果差异时，O组术后的绝对疼痛水平显著低于Y组（P <.05）。Y组和O组术后MIO的比较未显示出显著差异（P =.286）。
Y组和O组在TMJ手术关节镜检查后疼痛（VAS）和下颌活动度（MIO）均有显著改善。与Y组相比，O组关节镜诊断的骨关节炎患病率更高，术后疼痛水平更低。患有晚期TMJ疾病的老年患者对TMJ关节镜检查反应良好。
