青少年/年轻成人早期退行性颞下颌关节病的髁突修复与再生：一项随机对照研究。

Condylar repair and regeneration in adolescents/young adults with early-stage degenerative temporomandibular joint disease: A randomised controlled study.

机构信息

Center for TMD & Orofacial Pain, Peking University School & Hospital of Stomatology, Beijing, China.

Department of Oral & Maxillofacial Radiology, Peking University School & Hospital of Stomatology, Beijing, China.

出版信息

J Oral Rehabil. 2019 Aug;46(8):704-714. doi: 10.1111/joor.12805. Epub 2019 May 7.

DOI:10.1111/joor.12805

PMID:31009097

Abstract

BACKGROUND

Anterior repositioning splint (ARS) can facilitate regenerative condylar remodelling.

OBJECTIVE

To determine the effect of ARS on osseous condylar changes in adolescents/young adults with early-stage degenerative joint disease (DJD).

METHODS

Sixty-nine patients with early-stage temporomandibular joint (TMJ) DJD based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and cone beam computed tomography (CBCT) imaging were recruited and randomly allocated to two treatment groups: (a) conservative therapy with ARS and (b) conservative therapy without ARS. Subjects with acute TMJ closed-lock had their displaced discs physically reduced by mandibular manipulation prior to ARS therapy. Clinical and CBCT data of 59 patients (86.4% females, mean age 17.95 ± 4.53 years, 67 joints) were attained pre- and at 6 or 12 months post-treatment. Osseous changes after treatment were categorised into (a) progressed, (b) unchanged, (c) repaired (remodelled without new bone formation) and (d) regenerated (remodelled with new bone formation). Statistical analysis including chi-square test, independent samples t test or Mann-Whitney U test was conducted.

RESULTS

About 85.5% of patients (59/69) completed the study, with 28 subjects (32 joints) in the splint group and 31 (35 joints) in the control group. The occurrence of condylar repair and regeneration was significantly higher with ARS (78.1%/[25/32] of joints) when compared to control group (48.6%/[17/35]) (P < 0.05). Moreover, condylar regeneration was exclusively observed in 50%/(16/32) of joints with ARS. For the 14 joints in splint group that received physical TMJ closed-lock reduction, 85.7%/(12/14) exhibited condylar regeneration. The splint group (3.1%/[1/32]) also had significantly lower incidence of progressive TMJ degeneration than the control (37.1%/[13/35]) (P < 0.001).

CONCLUSION

Condylar repair and regeneration in early-stage TMJ DJD are possible, and ideal spatial disc-condyle relationship appears important. The possibility of restoring TMJ form/structure by ARS therapy presents an attractive area of new basic science and clinical research (Bone defect repair in early osteoarthrosis of temporomandibular joint by joint distraction therapy: A randomized controlled trial/ChiCTR-TRC-14005172).

摘要

背景

前移位夹板（ARS）可以促进再生性髁突重塑。

目的

确定 ARS 对青少年/年轻人早期退行性关节病（DJD）患者髁突骨变化的影响。

方法

根据颞下颌关节紊乱病诊断标准（DC/TMD）和锥形束 CT（CBCT）成像，招募了 69 例早期 TMJ DJD 患者，并将其随机分为两组治疗：（a）ARS 保守治疗，（b）无 ARS 保守治疗。急性 TMJ 闭锁的患者在 ARS 治疗前通过下颌手法将移位的关节盘复位。59 例患者（86.4%女性，平均年龄 17.95±4.53 岁，67 个关节）的临床和 CBCT 数据在治疗前和治疗后 6 或 12 个月时获得。治疗后骨变化分为（a）进展，（b）不变，（c）修复（无新骨形成的重塑）和（d）再生（有新骨形成的重塑）。进行了卡方检验、独立样本 t 检验或曼-惠特尼 U 检验。

结果

约 85.5%的患者（59/69）完成了研究，夹板组 28 例（32 个关节），对照组 31 例（35 个关节）。与对照组（48.6%/[17/35]）相比，使用 ARS 时髁突修复和再生的发生率明显更高（78.1%/[25/32]的关节）（P<0.05）。此外，在接受 ARS 治疗的 32 个关节中，有 50%（16/32）的髁突发生了再生。在夹板组中，14 个关节接受了 TMJ 闭锁的物理复位，其中 85.7%（12/14）出现髁突再生。夹板组（3.1%/[1/32]）的 TMJ 退行性变进展发生率也明显低于对照组（37.1%/[13/35]）（P<0.001）。