Department of Advanced General Dentistry, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Oral and Maxillofacial Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
J Oral Rehabil. 2020 Mar;47(3):307-312. doi: 10.1111/joor.12897. Epub 2019 Oct 20.
The efficacy of a combination treatment of arthrocentesis and stabilisation splint for patients with bilateral anterior disc displacement without reduction (ADDWoR) and erosive change of the TMJ remains controversial. To evaluate clinical outcomes of patients with ADDWoR and erosive change of the TMJ after performance of unilateral arthrocentesis and stabilisation splint therapy. A retrospective study of 44 patients (37 females, 7 males, mean age of 34 years) with bilateral ADDWoR and erosive change of the TMJ were included in this study. Their clinical outcomes before and after arthrocentesis and stabilisation splint therapy were compared. Evaluation criteria were as follows: (a) Maximal mouth opening (MMO); (b) Right and left maximal lateral movement (RLM, LLM) and maximal protrusive movement (PM); (c) Visual analog scale (VAS) pain score during MMO, RLM, LLM and PM; and (d) VAS pain score during palpation of masticatory muscles. Wilcoxon signed-rank test, Mc Nemar test and paired t test were used for statistical analysis. Differences in VAS pain score between arthrocentesis and non-arthrocentesis sites were not statistically significant except MMO and LLM (P < .05) after 6 months. Differences in mean VAS pain scores for all variables between before arthrocentesis and 6 months follow-up in the arthrocentesis site were statistically significant. (P < .01). Unilateral arthrocentesis on more symptomatic TMJ and subsequent stabilisation splint therapy was highly successful for pain and achievement of normal range of mandibular movements in patients with both ADDWoR and bony change.
关节腔穿刺术和稳定夹板治疗双侧不可复性前关节盘移位伴 TMJ 侵蚀性改变患者的疗效仍存在争议。本研究旨在评估单侧关节腔穿刺术和稳定夹板治疗双侧不可复性前关节盘移位伴 TMJ 侵蚀性改变患者的临床效果。回顾性分析 44 例（37 例女性，7 例男性；平均年龄 34 岁）双侧不可复性前关节盘移位伴 TMJ 侵蚀性改变患者的临床资料。比较关节腔穿刺术和稳定夹板治疗前后的临床效果。评估标准如下：（a）最大张口度（MMO）；（b）右侧和左侧最大侧方运动（RLM、LLM）和最大前伸运动（PM）；（c）MMO、RLM、LLM 和 PM 时 VAS 疼痛评分；（d）咀嚼肌触诊时 VAS 疼痛评分。采用 Wilcoxon 符号秩检验、Mc Nemar 检验和配对 t 检验进行统计学分析。除 MMO 和 LLM 外（P＜.05），关节腔穿刺术后 6 个月时，关节穿刺部位 VAS 疼痛评分与非关节穿刺部位差异无统计学意义。关节穿刺部位所有变量的 VAS 疼痛评分在关节腔穿刺术前和 6 个月随访时差异均有统计学意义（P＜.01）。对于双侧不可复性前关节盘移位伴骨改变患者，对症状更明显的 TMJ 行单侧关节腔穿刺术，随后行稳定夹板治疗，可显著缓解疼痛，恢复正常下颌运动范围。
