Murakami K, Hosaka H, Moriya Y, Segami N, Iizuka T
Faculty of Medicine, Kyoto University, Japan.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995 Sep;80(3):253-7. doi: 10.1016/s1079-2104(05)80379-8.
The aim of this study is to compare the clinical short-term results and efficacy of arthrocentesis with those of nonsurgical treatments and arthroscopic surgery for the management of temporomandibular joint closed lock.
The three groups consisted of 63 consecutive patients treated nonsurgically, 20 patients treated with arthrocentesis, and 25 patients treated with arthroscopic surgery. All patients rated their pain level on a visual analogue scale and completed a pain, jaw dysfunction, and activity-limiting questionnaire before and 6 months after the procedure. Each patient's jaw opening was also scaled. The success rate of each procedure was calculated according to our success criteria. The clinical efficacy of each procedure was evaluated in successfully treated subgroups in which the between-group and within-group differences of the obtained data were statistically tested.
The success rate was 55.6% in the nonsurgically treated group, 70% in the arthrocentesis group, and 91% in the arthroscopy group. With respect to efficacy, all posttreatment scores showed significant improvements in within-group differences, but no between-group differences were found between the arthrocentesis group and the other two groups.
Arthrocentesis was considered as an intervening treatment modality between nonsurgical treatment and arthroscopic surgery on the basis of its short-term outcome. Although the treatment efficacy was comparable with arthroscopic surgery, this procedure was thought to be indicated for the patients with acute temporomandibular joint closed lock who were refractory to medication and mandibular manipulation rather than the alternative of arthroscopic surgery.
本研究旨在比较关节穿刺术与非手术治疗及关节镜手术治疗颞下颌关节闭锁的临床短期结果和疗效。
三组分别为连续接受非手术治疗的63例患者、接受关节穿刺术治疗的20例患者和接受关节镜手术治疗的25例患者。所有患者在视觉模拟量表上对疼痛程度进行评分，并在手术前和手术后6个月完成疼痛、下颌功能障碍及活动受限问卷。对每位患者的张口度也进行了测量。根据我们的成功标准计算每种手术的成功率。在成功治疗的亚组中评估每种手术的临床疗效，并对所得数据进行组间和组内差异的统计学检验。
非手术治疗组的成功率为55.6%，关节穿刺术组为70%，关节镜手术组为91%。在疗效方面，所有治疗后评分在组内差异均有显著改善，但关节穿刺术组与其他两组之间未发现组间差异。
基于其短期结果，关节穿刺术被认为是介于非手术治疗和关节镜手术之间的一种干预治疗方式。尽管治疗效果与关节镜手术相当，但该手术被认为适用于对药物治疗和下颌手法治疗无效的急性颞下颌关节闭锁患者，而非关节镜手术的替代方法。
