Doctoral Candidate, University of Michigan Medical School, Ann Arbor, MI, USA.
Clinical Instructor, University of Michigan, Department of Oral and Maxillofacial Surgery, Ann Arbor, MI, USA.
J Oral Maxillofac Surg. 2022 Jun;80(6):980-988. doi: 10.1016/j.joms.2022.02.009. Epub 2022 Feb 25.
A proportion of subjects with internal derangements of the temporomandibular joint (TMJ) may have a central sensitization disorder that may affect pain perception after surgery. This study aims to estimate the association between fibromyalgianess (FMness) score, a summed score of the Widespread Pain Index (WPI) and Symptom Severity Sore (SSS), and outcomes following TMJ arthroscopy.
A retrospective cohort study including individuals who received arthroscopy for TMJ internal derangement at Michigan Medicine between 2011 and 2020 was performed. A predictor variable, FMness score, was assigned via the sum of WPI and SSS. Univariate and bivariate analyses were performed. Linear-mixed effects models were used to analyze 6 different outcomes, each in their own model: pain, jaw functional limitation scale (JFLS), JFLS-mobility domain, pain-related disability, comfortable maximum interincisal opening, and active maximum interincisal opening. Covariance structure was selected based on null model fit separately for each outcome.
Thirty-one subjects were included in the study sample. Twenty-eight subjects were female. Average age was 45.9 years. Bivariate analysis demonstrated that subject's FMness score was not correlated with pain (b = 0.03 [-0.10, 0.17] P = .59) or JFLS score (b = 1.00 [-.80, 2.81] P = .27). However, subject's FMness score was significant for predicting JFLS-mobility domain score (b = .61, [0.05, 1.18] P = .04).
A greater extent of central sensitization was associated with lower comfortable mouth opening after surgery, greater limitations in opening wide enough to eat various foods (higher JFLS-mobility scores), and higher pain-related disability. Future studies with larger sample sizes and reconstructive TMJ operations such as total TMJ arthroplasty may help clarify the impact of SSS and WPI scores on outcomes of TMJ surgery.
一部分颞下颌关节（TMJ）内部紊乱的患者可能存在中枢敏化障碍，这可能会影响手术后的疼痛感知。本研究旨在评估纤维肌痛指数（FMness）评分（WPI 广泛疼痛指数和 SSS 症状严重程度评分的总和）与 TMJ 关节镜术后结果之间的相关性。
对密歇根大学医学中心 2011 年至 2020 年间接受 TMJ 关节内紊乱关节镜治疗的患者进行回顾性队列研究。通过 WPI 和 SSS 的总和分配预测变量 FMness 评分。进行了单变量和双变量分析。使用线性混合效应模型分析了 6 种不同的结果，每种结果都有自己的模型：疼痛、下颌功能限制量表（JFLS）、JFLS-移动域、与疼痛相关的残疾、舒适最大开口度和主动最大开口度。根据每个结果的空模型拟合情况，选择协方差结构。
本研究样本包括 31 名患者。28 名女性，平均年龄 45.9 岁。双变量分析表明，患者的 FMness 评分与疼痛（b=0.03[-0.10, 0.17]，P=0.59）或 JFLS 评分（b=1.00[-0.80, 2.81]，P=0.27）均无相关性。然而，患者的 FMness 评分与 JFLS-移动域评分显著相关（b=0.61[0.05, 1.18]，P=0.04）。
中枢敏化程度越高，术后张口舒适度越低，张口足以进食各种食物的限制越大（JFLS-移动域评分越高），与疼痛相关的残疾程度越高。未来更大样本量的研究和 TMJ 重建手术（如全 TMJ 关节置换术）可能有助于阐明 SSS 和 WPI 评分对 TMJ 手术结果的影响。
