Ulmner Mattias, Kruger-Weiner Carina, Lund Bodil
Consultant, Department of Dental Medicine, Karolinska Institutet, Stockholm; Department of Oral and Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden.
Consultant, Department of Dental Medicine, Karolinska Institutet, Stockholm; Department of Oral and Maxillofacial Surgery, Folktandvården Eastman Institute, Stockholm, Sweden.
J Oral Maxillofac Surg. 2017 Aug;75(8):1643.e1-1643.e7. doi: 10.1016/j.joms.2017.04.005. Epub 2017 Apr 13.
Although indications for the surgical treatment of internal derangement of the temporomandibular joint (TMJ) and the choice of treatment are debated, arthroscopy seems generally accepted as a minimally invasive alternative. The objective of this study was to investigate various factors and their possible correlation with an unsuccessful outcome of arthroscopic lysis and lavage in patients diagnosed with chronic closed lock, arthralgia with or without concomitant osteoarthritis of the TMJ, or systemic rheumatologic disease with involvement of the TMJ.
A retrospective analysis of 224 operations was conducted to identify pre-, peri-, and postoperative factors correlated with an adverse outcome. Criteria for success were maximum interincisal opening (MIO) of at least 35 mm and self-graded joint pain on a 10-point visual analog scale no higher than 3.
Surgical outcome was graded as successful (n = 150; 67%), improved (n = 16; 7%), minor or no improvement (n = 55; 25%), or worse (n = 3; 1%). Preoperative factors that correlated with a negative outcome were the presence of psychiatric disorders (P = .0333), high self-graded global pain (P = .0320), bilateral muscle tenderness at palpation (P = .0309), and small MIO (P = .0018). For patients with systemic arthritis, younger age was correlated with an unsuccessful outcome (P = .0317).
The results indicate that psychiatric comorbidities, high self-graded global pain, bilateral masticatory muscle tenderness, and small MIO predict an unsuccessful outcome after arthroscopic lysis and lavage. These factors could be indicators for chronic pain disorders, including chronic myofascial pain, increased pain sensitivity, and decreased coping abilities, associated with a poor outcome.
尽管颞下颌关节（TMJ）内紊乱的手术治疗指征及治疗选择仍存在争议，但关节镜检查似乎已被普遍接受为一种微创替代方法。本研究的目的是调查各种因素及其与诊断为慢性闭锁、伴或不伴TMJ骨关节炎的关节痛或累及TMJ的系统性风湿性疾病患者关节镜下松解和灌洗治疗失败结局之间的可能相关性。
对224例手术进行回顾性分析，以确定与不良结局相关的术前、术中和术后因素。成功的标准为最大切牙间开口度（MIO）至少35mm，以及在10分视觉模拟量表上自我评估的关节疼痛不高于3分。
手术结局分为成功（n = 150；67%）、改善（n = 16；7%）、轻微改善或无改善（n = 55；25%）或恶化（n = 3；1%）。与不良结局相关的术前因素包括精神障碍的存在（P = 0.0333）、自我评估的总体疼痛程度高（P = 0.0320）、触诊时双侧肌肉压痛（P = 0.0309）和MIO小（P = 0.0018）。对于系统性关节炎患者，年龄较小与治疗失败结局相关（P = 0.0317）。
结果表明，精神共病、自我评估的总体疼痛程度高、双侧咀嚼肌压痛和MIO小预示着关节镜下松解和灌洗治疗结局不佳。这些因素可能是慢性疼痛疾病的指标，包括慢性肌筋膜疼痛、疼痛敏感性增加和应对能力下降，与不良结局相关。
