de Wijer A, Steenks M H, de Leeuw J R, Bosman F, Helders P J
Department of Oral-Maxillofacial Surgery, Utrecht University, The Netherlands.
J Oral Rehabil. 1996 Nov;23(11):742-50. doi: 10.1046/j.1365-2842.1996.d01-187.x.
This study was performed to assess the prevalence of signs and symptoms related to cervical spine disorders (CSD) in subgroups of patients with temporomandibular disorders (TMD) and to compare TMD patients and CSD patients with regard to the results of orthopaedic cervical spine tests. One hundred and eleven consecutive patients with TMD and 103 consecutive patients with signs and symptoms of CSD were examined. The results indicated that there is a considerable overlap in the signs and symptoms of patients with TMD and patients with CSD. Signs and symptoms on neck extension occurred more often in CSD patients than in subgroups of TMD patients. No significant differences in upper cervical extension, neck flexion, and shoulder girdle function were found between CSD patients and subgroups of patients with TMD. Patients with CSD reported neck pain during active and passive movements of the neck more often than the subgroups of patients with TMD. TMD patients and CSD patients did not differ with regard to pain on shoulder girdle function and palpation of the shoulder girdle. Logistic regression analyses showed that orthopaedic tests of the cervical spine are of minor importance in discriminating between patients with TMD and patients with CSD. It is concluded that TMD with a myogenous involvement in contrast to TMD with only an arthrogenous involvement should no longer be viewed as a local disorder of the stomatognathic system. The upper quarter, including the stomatognathic system, cervical spine, and shoulder girdle, should be evaluated in patients with more complex or persistent symptoms in the head and neck region.
本研究旨在评估颞下颌关节紊乱症（TMD）患者亚组中与颈椎疾病（CSD）相关的体征和症状的患病率，并比较TMD患者和CSD患者在颈椎骨科检查结果方面的差异。对111例连续的TMD患者和103例连续的有CSD体征和症状的患者进行了检查。结果表明，TMD患者和CSD患者的体征和症状有相当大的重叠。CSD患者颈部伸展时的体征和症状比TMD患者亚组更常见。CSD患者和TMD患者亚组在上颈椎伸展、颈部屈曲和肩胛带功能方面未发现显著差异。CSD患者比TMD患者亚组更常报告在颈部主动和被动运动时出现颈部疼痛。TMD患者和CSD患者在肩胛带功能疼痛和肩胛带触诊方面没有差异。逻辑回归分析表明，颈椎骨科检查在区分TMD患者和CSD患者方面的重要性较小。结论是，与仅有关节源性参与的TMD相比，伴有肌源性参与的TMD不应再被视为口颌系统的局部疾病。对于头颈部区域有更复杂或持续症状的患者，应评估包括口颌系统、颈椎和肩胛带在内的上半身。
