Lee Kuei-Chen, Wu Yung-Tsan, Chien Wu-Chien, Chung Chi-Hsiang, Chen Liang-Cheng, Shieh Yi-Shing
Graduate Institute of Medical Sciences.
Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital.
Medicine (Baltimore). 2020 Jan;99(3):e18686. doi: 10.1097/MD.0000000000018686.
The coexistence of low back pain (LBP) and temporomandibular disorder (TMD) has often been noted clinically. However, studies of the association between these two conditions involving a large population with longitudinal evidences are lacking. Therefore, the study aimed to investigate the association between LBP and TMD in a nationwide-matched cohort population with a 15-year follow-up.Data of 65,121 patients newly diagnosed with LBP were analyzed, along with those of 195,363 (1:3) sex- and age-matched controls. Multivariate Cox regression analysis was used to determine TMD risk between the LBP and non-LBP groups. Kaplan-Meier method was used for determining the cumulative risk of first-onset TMD between groups, with a 15-year follow-up.The LBP group was more likely to develop first-onset TMD (adjusted hazards ratio (HR) = 1.561, P < .001), after adjusting for demographic variables and comorbidities. The risk factors for TMD were LBP, young age, higher insured premium, and osteoporosis. In the subgroup analysis, the LBP group had a higher risk of TMD than the non-LBP group in all stratifications.LBP is the risk factor contributing to the development of first-onset TMD. Therefore, clinicians should be reminded to manage LBP disorders concurrently when treating TMD.
临床上经常注意到下腰痛（LBP）和颞下颌关节紊乱病（TMD）并存的情况。然而，缺乏涉及大量人群并具有纵向证据的关于这两种疾病之间关联的研究。因此，本研究旨在调查在一个全国匹配的队列人群中，经过15年随访的LBP与TMD之间的关联。分析了65121例新诊断为LBP的患者的数据，以及195363例（1:3）性别和年龄匹配的对照的数据。采用多变量Cox回归分析来确定LBP组和非LBP组之间的TMD风险。采用Kaplan-Meier方法确定组间首次发生TMD的累积风险，并进行15年随访。在调整了人口统计学变量和合并症后，LBP组更有可能发生首次发作的TMD（调整后的风险比（HR）=1.561，P<0.001）。TMD的危险因素为LBP、年轻、保险费较高和骨质疏松症。在亚组分析中，在所有分层中，LBP组发生TMD的风险均高于非LBP组。LBP是导致首次发作TMD的危险因素。因此，应提醒临床医生在治疗TMD时同时处理LBP疾病。
