Hôpital Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre-Bénite, France; Clinique Trénel, Rue du Dr Trénel 575, 69560 Sainte-Colombe, France.
Hôpital Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre-Bénite, France.
Br J Oral Maxillofac Surg. 2024 Jul;62(6):580-587. doi: 10.1016/j.bjoms.2024.02.011. Epub 2024 Mar 6.
The purpose of the study was to determine whether the duration of preoperative pain affects outcomes of temporomandibular joint replacement (TMJR). Twenty-seven patients who underwent primary TMJR between 1 July 2020 and 31 October 2022 were retrospectively assessed for duration of preoperative pain, level of preoperative and postoperative pain on a visual analogue scale (VAS; 0, none; 10, severe), preoperative and postoperative range of motion (ROM), and net change in quality of life (much better, better, same, worse, much worse), reporting the longest available follow up for each patient. Surgical success was defined as postoperative pain of ≤4 and postoperative ROM of ≥30 mm, or net change (Δ) in ROM of ≥10 mm. Regression analyses evaluated associations between independent variables and postoperative pain and ROM. At a mean follow-up of 17.8 (SD: 6.8, range 3-32) months , pain (5.1, SD: 2.2, p < 0.001) and ROM (9.3 mm, SD: 8.0, p<0.001) significantly improved. Quality of life was much better in 16 patients, better in eight, the same in one, and worse in two. Longer duration of preoperative pain tended to be negatively associated with postoperative ROM (β = -0.27; 95% CI -0.6 to 0.0; p = 0.078) but was not associated with severity of postoperative pain. Surgical success was achieved in 23/27 patients. The successful group tended to have lower pain on VAS preoperatively (5.9, SD: 1.9) vs 7.5, SD: 1.3) and postoperatively (0.4, SD: 0.8 vs 4.8, SD: 2.6), and greater improvement in quality of life (much better: 14/23 vs 2/4). In conclusion, longer duration of preoperative pain tended to be associated with worse postoperative ROM following TMJR. Higher preoperative pain may be a predictor for unsuccessful surgery.
本研究旨在确定术前疼痛持续时间是否会影响颞下颌关节置换术（TMJR）的结果。回顾性评估了 2020 年 7 月 1 日至 2022 年 10 月 31 日期间接受初次 TMJR 的 27 例患者的术前疼痛持续时间、术前和术后视觉模拟评分（VAS）上的疼痛程度（0，无；10，严重）、术前和术后的活动范围（ROM）以及生活质量的净变化（明显改善、改善、相同、恶化、明显恶化），为每位患者报告最长的随访时间。手术成功定义为术后疼痛≤4 分，术后 ROM≥30mm，或 ROM 净变化（Δ）≥10mm。回归分析评估了自变量与术后疼痛和 ROM 之间的关系。在平均随访 17.8（SD：6.8，范围 3-32）个月时，疼痛（5.1，SD：2.2，p<0.001）和 ROM（9.3mm，SD：8.0，p<0.001）显著改善。16 例患者的生活质量明显改善，8 例患者改善，1 例相同，2 例恶化。术前疼痛持续时间较长与术后 ROM 呈负相关（β=-0.27；95%CI -0.6 至 0.0；p=0.078），但与术后疼痛严重程度无关。27 例患者中有 23 例手术成功。成功组患者术前 VAS 疼痛评分（5.9，SD：1.9）和术后疼痛评分（0.4，SD：0.8）均低于不成功组（7.5，SD：1.3 和 4.8，SD：2.6），生活质量改善程度更大（明显改善：14/23 例 vs 2/4 例）。总之，术前疼痛持续时间较长与 TMJR 后术后 ROM 较差相关。较高的术前疼痛可能是手术不成功的预测因素。
