Quintessence Int. 2023 Jul 17;54(7):570-578. doi: 10.3290/j.qi.b4007423.
The technique of lysis and lavage has shown excellent success rates in treating internal derangement of the temporomandibular joint (TMJ). This procedure has been shown to reduce pain and improve joint mobility, sometimes even in patients suffering from advanced stages of degenerative joint disease (Wilkes IV to V). There are two different approaches to lavage and arthrolysis: arthrocentesis and TMJ arthroscopy. The objective was to assess both approaches' efficacy in managing internal derangement of TMJ.
In total, 92 patients with clinical and radiographic documentation of internal derangement of the TMJ unresponsive to nonsurgical therapy were randomized to one of two surgical groups: arthroscopic lysis and lavage level 1 (64 patients) and arthrocentesis (28 patients). Radiologic changes in the joint, pain (visual analog scale), interincisal distance, lateral and protrusive movements, and clicks and sounds of the joints were recorded. Data were compared presurgically (T0) and in postoperative periods of 1 week (T1), and 1 (T2), 3 (T3), and 6 (T4) months.
Both surgical modalities achieved a similar outcome. A gradual improvement was demonstrated during the follow-up periods with no reliance on radiologic changes to the joint or the TMJ diagnosis. More than that, significant differences were encountered in all parameters but protrusion between T0 and T4. Pain decreased from 7.16 ± 2.48 to 1.75 ± 1.98 for the arthroscopic group and from 7.53 ± 2.69 to 1.00 ± 1.86 for the arthrocentesis group (P = .000).
Both the approaches of arthrocentesis and arthroscopic level 1 reduced pain and improved mouth opening and lateral and protrusive movements over time.
松解灌洗技术在治疗颞下颌关节（TMJ）内部紊乱方面取得了优异的成功率。该方法已被证明可减轻疼痛并改善关节活动度，有时甚至在患有退行性关节病晚期的患者中也有效（Wilkes IV 至 V 期）。灌洗和关节松解有两种不同的方法：关节穿刺术和 TMJ 关节镜检查。目的是评估这两种方法在治疗 TMJ 内部紊乱方面的疗效。
共有 92 例临床和影像学证实的 TMJ 内部紊乱患者，对非手术治疗无反应，随机分为两组手术治疗：关节镜下松解灌洗 1 级（64 例）和关节穿刺术（28 例）。记录关节的放射学变化、疼痛（视觉模拟评分）、切牙间距、侧向和前伸运动以及关节的咔嗒声和响声。在术前（T0）和术后 1 周（T1）、1 个月（T2）、3 个月（T3）和 6 个月（T4）时比较数据。
两种手术方式均取得相似的结果。在随访期间，关节均逐渐改善，且不依赖于关节的放射学变化或 TMJ 诊断。此外，在所有参数中，除了前伸运动外，T0 与 T4 之间均存在显著差异。疼痛从关节镜组的 7.16±2.48 降至 1.75±1.98，从关节穿刺组的 7.53±2.69 降至 1.00±1.86（P=0.000）。
关节穿刺术和关节镜下 1 级松解均能减轻疼痛，并随着时间的推移改善张口度和侧向及前伸运动。
