Department of Oral & Maxillofacial Surgery, Stomatology Clinic, 1st Medical Faculty of Charles University and General Teaching Hospital (VFN) Prague, U Nemocnice 2, 120 00, Praha 2, Czech Republic.
Oral Maxillofac Surg. 2021 Dec;25(4):463-470. doi: 10.1007/s10006-020-00935-7. Epub 2021 Jan 13.
The aim of this study was to determine the efficacy of arthroscopic lysis and lavage on pain in patients with unilateral Wilkes stage III derangement of the temporomandibular joint. Authors retrospectively evaluated whether the arthroscopic lysis and lavage has an impact on pain decrease in patients with moderate osteoarthritis.
Patients with unilateral Wilkes III of temporomandibular joint were included in this study. All patients underwent arthroscopic lysis and lavage (ASC-L), assessed pain before and after the procedure (primary outcome variable), maximal interincisal opening (MIO) was recorded as secondary outcome variable. The patients also subjectively assessed whether they were satisfied with the outcome of the arthroscopy or whether their condition required further interventions. The disc position was evaluated by magnetic resonance imaging (MRI) 24 months after the arthroscopy and compared with the disc position on the MRI prior to the arthroscopy. The R Project for Statistical Computing 3.4.1 and the Gretl Pro programs were used for statistical analysis. In addition to the descriptive statistics methods, the Shapiro-Wilk normality test was used to verify data normality and the two sample t test used to test the hypotheses themselves.
The sample consisted of 62 patients who underwent arthroscopic lysis and lavage (ASC-L) in 2015 and 2016. It included 6 men and 56 women with an average age of 34.37. Pain and MIO were recorded during regular check-ups 1, 3, 6, 12, and 24 months. A therapeutic effect (MIO over 34 mm, VAS score 0-1) was recorded in 69% of cases 24 months after the ASC-L. Nonetheless, the work demonstrated the importance of subjective assessment, as 87% of patients perceived their condition as satisfactory after 24 months and not requiring further intervention, while 8 patients (13%) perceived it as unsatisfactory. Disc reposition 24 months following the ASC-L was recorded in only 44% of patients who assessed their condition as satisfactory. Patients with persistent disc dislocation 24 months after the arthroscopy were older, had a lower average maximal interincisal opening value before the ASC-L and a longer duration of mandibular movement restriction before the ASC-L (evaluated as a statistically significant difference).
In this study, the authors confirmed that ASC-L is an effective therapeutic method in patients with WIII, from both clinical and subjective perspectives. This work demonstrated that improvement in patients with Wilkes stage III is not related to disc reposition. Postoperative physiotherapy is an integral component of ASC-L and is reflected in the final results.
本研究旨在确定关节镜下松解和灌洗治疗颞下颌关节单侧威尔克斯 III 期紊乱患者疼痛的疗效。作者回顾性评估关节镜下松解和灌洗（ASC-L）是否会影响中度骨关节炎患者的疼痛减轻。
本研究纳入单侧颞下颌关节威尔克斯 III 期患者。所有患者均行关节镜下松解和灌洗（ASC-L），评估术前和术后疼痛（主要结局变量），记录最大开口度（次要结局变量）。患者还主观评估他们对关节镜结果是否满意，或者他们的病情是否需要进一步干预。关节镜检查后 24 个月通过磁共振成像（MRI）评估关节盘位置，并与关节镜检查前的 MRI 关节盘位置进行比较。使用 R 项目统计计算 3.4.1 和 Gretl Pro 程序进行统计分析。除了描述性统计方法外，还使用 Shapiro-Wilk 正态性检验来验证数据的正态性，并使用两样本 t 检验来检验假设本身。
该样本包括 2015 年和 2016 年接受关节镜下松解和灌洗（ASC-L）的 62 例患者。其中包括 6 名男性和 56 名女性，平均年龄为 34.37 岁。在定期检查时记录疼痛和最大开口度 1、3、6、12 和 24 个月。24 个月后，69%的病例记录到治疗效果（最大开口度超过 34mm，VAS 评分 0-1）。尽管如此，该研究表明主观评估的重要性，因为 24 个月后 87%的患者认为自己的病情满意，不需要进一步干预，而 8 名患者（13%）认为不满意。24 个月后，只有 44%的自认为病情满意的患者记录到关节盘复位。关节镜检查后 24 个月仍有盘状脱位的患者年龄较大，ASC-L 前平均最大开口度较低，下颌运动受限时间较长（统计学差异显著）。
本研究从临床和主观角度证实，ASC-L 是治疗 WIII 患者的有效治疗方法。本研究表明，Wilkes Ⅲ期患者的改善与关节盘复位无关。术后物理治疗是 ASC-L 的一个组成部分，反映在最终结果中。
