Zhao H, Luo D, Yang J J, Yuan M J, Liu L, Yu W H
Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266003, China.
Zhonghua Kou Qiang Yi Xue Za Zhi. 2022 Jul 2;57(7):701-707. doi: 10.3760/cma.j.cn112144-20220314-00109.
To explore the clinical efficacy of (stomatognathic system functional exercise(SSFE) in the treatment of temporomandibular joint osteoarthritis (TMJOA), and to provide reference for the clinical treatment of TMJOA. Choose between January 2020 and June 2020 in the Affiliated Hospital of Qingdao University of Temporomandibular Disorder (TMD) Clinics, pain in the temporomandibular joint (TMJ), limited openings for complained of symptoms of TMD patients, diagnosed by clinical examination and cone beam CT (CBCT) examination of TMJOA patients 60 patients (64 joints), including 20 males and 45 females, the age was (42.6±2.5) years (33-47 years old). The patients were randomly divided into the experimental group (30 cases, 34 joints) and the control group (30 cases, 30 joints) according to the odd and even numbers of their treatment numbers. The experimental group was treated with SSFE method. The control group was treated with maxillary full dentition occlusal splint. Visual analogue score (VAS), natural mouth opening and maximal mouth opening (MMO) of each patient in each group were recorded at initial diagnosis, 2 weeks, 3 and 6 months after treatment, and CBCT imaging was compared for the changes of condylar bone at initial diagnosis, 3 and 6 months after treatment. VAS values of the experimental groups were (2.90±1.42), (0.90±0.37), (0.87±0.23) at 2 weeks, 3 and 6 months after treatment, respectively. The VAS values of the control group were (4.57±1.94), (4.17±2.09), (3.73±2.21), respectively. The VAS score of the experimental group was significantly lower than that of the control group (=42.93, <0.001). Before SSFE treatment, all the patients in the experimental group had different degrees of restricted opening and characteristic abnormal opening and closing pattern. Two weeks after SSFE treatment, the opening degree of the patients was (37.69±2.4)mm, the opening shape "↓" and the closing shape "↑" were normal. At 3 and 6 months after treatment, the oral opening was (38.98±1.08) mm and (39.73±1.76) mm, respectively. The opening degree of control group was (36.85±2.33) mm 2 weeks after treatment, and the characteristic abnormal opening and closing pattern still existed. The opening degree of control group was (37.82±1.85) mm and (37.40±1.75) mm 3 and 6 months after treatment, respectively. The characteristic abnormal opening and closing pattern (stuffy, awkward, deliberate, unnatural) did not improve significantly. The openness of the experimental group was significantly higher than that of the control group (=25.20, <0.001). In the experimental group, 82.4% (28/34) had benign remodeling of condylar bone 6 months after treatment, and 17.6% (6/34) had no change of condylar bone. There was no significant change in condylar bone in control group. CBCT scores of the experimental group were (2.43±1.74) and (1.70±1.26) at 3 and 6 months after treatment, respectively. CBCT scores of the control group at 3 and 6 months after treatment were (4.23±1.50) and (4.10±1.37), they were significantly lower in the experimental group than in the control group (=27.20, <0.001). Full dentition occlusal splint can alleviate the pain in the joint area of TMJOA patients, but can not improve the characteristic abnormal mandibular movement, and the condyle bone repair is not obvious. SSFE can effectively relieve the symptoms and signs of TMJOA patients, especially improve the abnormal characteristic mandibular movement, and promote the normal reconstruction and repair of condylar bone.
探讨口颌系统功能锻炼（SSFE）治疗颞下颌关节骨关节炎（TMJOA）的临床疗效，为TMJOA的临床治疗提供参考。选取2020年1月至2020年6月在青岛大学附属医院颞下颌关节紊乱病（TMD）门诊就诊、主诉颞下颌关节（TMJ）疼痛、开口受限等TMD症状的患者，经临床检查及锥形束CT（CBCT）检查确诊为TMJOA患者60例（64个关节），其中男性20例，女性45例，年龄为（42.6±2.5）岁（33 - 47岁）。根据治疗编号的奇偶性将患者随机分为实验组（30例，34个关节）和对照组（30例，30个关节）。实验组采用SSFE方法治疗。对照组采用上颌全牙列咬合板治疗。记录每组患者初诊时、治疗后2周、3个月和6个月时的视觉模拟评分（VAS）、自然开口度和最大开口度（MMO），并比较治疗初诊时、治疗后3个月和6个月时CBCT影像中髁突骨的变化。实验组治疗后2周、3个月和6个月时的VAS值分别为（2.90±1.42）、（0.90±0.37）、（0.87±0.23）。对照组的VAS值分别为（4.57±1.94）、（4.17±2.09）、（3.73±2.21）。实验组的VAS评分显著低于对照组（=42.93，<0.001）。SSFE治疗前，实验组所有患者均有不同程度的开口受限及特征性异常开闭颌型。SSFE治疗2周后，患者开口度为（37.69±2.4）mm，开口形状“↓”及闭口形状“↑”正常。治疗后3个月和6个月时，开口度分别为（38.98±1.08）mm和（39.73±1.76）mm。对照组治疗2周后开口度为（36.85±2.33）mm，特征性异常开闭颌型仍存在。对照组治疗3个月和6个月时开口度分别为（37.82±1.85）mm和（37.40±1.75）mm。特征性异常开闭颌型（闷、涩、刻意、不自然）无明显改善。实验组的开口度显著高于对照组（= 25.20，<0.001）。实验组治疗6个月后，82.4%（28/34）髁突骨呈良性改建，17.6%（6/34）髁突骨无变化。对照组髁突骨无明显变化。实验组治疗后3个月和6个月时CBCT评分分别为（2.43±1.74）和（1.70±1.26）。对照组治疗后3个月和6个月时CBCT评分分别为（4.23±1.50）和（4.10±1.37），实验组显著低于对照组（=27.20，<0.001）。全牙列咬合板可缓解TMJOA患者关节区疼痛，但不能改善特征性下颌运动异常，髁突骨修复不明显。SSFE能有效缓解TMJOA患者的症状和体征，尤其能改善特征性下颌运动异常，促进髁突骨的正常改建和修复。
