Nitzan D W, Samson B, Better H
Department of Oral and Maxillofacial Surgery, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel.
J Oral Maxillofac Surg. 1997 Feb;55(2):151-7; discussion 157-8. doi: 10.1016/s0278-2391(97)90233-0.
This study analyzed the long-term effect of arthrocentesis for severe closed lock of the temporomandibular joint (TMJ) and reevaluated the pathogenesis of this condition based on the data obtained.
Thirty-nine patients (40 joints) who had experienced sudden-onset, persistent limited mouth opening were the subjects of this study. After unsuccessful noninvasive treatment, arthrocentesis of the upper compartment of the affected TMJ was performed using saline. The follow-up, which consisted of patient self-assessment and clinical examination, ranged from 6 to 37 months (mean, 16.6 +/- 12.0 months). Visual analog scales were used for preoperative and postoperative self-evaluation of pain and dysfunction on forced mouth opening and for assessment of overall change in these parameters postarthrocentesis. Maximal mouth opening (MMO), contralateral movement (CLM) and protrusive movement of the jaw, and presence of joint noises were noted preoperatively and at clinical follow-up examinations.
At 6 to 37 months postarthrocentesis, MMO and CLM had increased significantly (from a mean of 23.10 +/- 5.15 mm to 44.25 +/- 4.96 mm, and from a mean of 4.81 +/- 2.36 mm to 8.20 +/- 1.90 mm, respectively; P < .001). Functional improvement was associated with a significant reduction in pain and dysfunction levels (from a mean of 9.24 +/- 2.90 to 1.45 +/- 1.74, and from a mean of 9.26 +/- 2.82 to 2.68 +/- 2.80, respectively, on a scale of 0 to 15; P < .001). The overall improvement, as expressed in pain and dysfunction levels, was about 95%, with no recurrence of severe closed lock.
Arthrocentesis for sudden-onset closed lock provided sustained normal joint function and marked pain relief. Because the available literature shows that arthrocentesis changes neither disc position nor disc shape, it places in doubt the concept of a displaced and deformed disc limiting joint function. Rather, the efficacy of lavage in resolving closed lock suggests that the condition is the result of sudden adherence of the normally shaped disc to the fossa, rendering it incapable of sliding. The characteristic features of sudden-onset, limited mouth opening warrants classification of this disorder as an independent entity within the realm of TMJ disturbances.
本研究分析了关节穿刺术对颞下颌关节（TMJ）重度闭锁的长期影响，并根据所获数据重新评估了该病症的发病机制。
本研究以39例（40个关节）突发持续性张口受限的患者为研究对象。在无创治疗失败后，使用生理盐水对患侧TMJ上腔进行关节穿刺术。随访由患者自我评估和临床检查组成，时间范围为6至37个月（平均16.6±12.0个月）。采用视觉模拟量表对术前和术后张口时的疼痛及功能障碍进行自我评估，并评估关节穿刺术后这些参数的总体变化。术前及临床随访检查时记录最大张口度（MMO）、对侧运动（CLM）、下颌前伸运动以及关节弹响情况。
关节穿刺术后6至37个月，MMO和CLM显著增加（分别从平均23.10±5.15毫米增至44.25±4.96毫米，从平均4.81±2.36毫米增至8.20±1.90毫米；P <.001）。功能改善与疼痛和功能障碍水平的显著降低相关（在0至15分的量表上，分别从平均9.24±2.90降至1.45±1.74，从平均9.26±2.82降至2.68±2.80；P <.001）。疼痛和功能障碍水平所体现的总体改善约为95%，重度闭锁未复发。
针对突发闭锁进行的关节穿刺术可提供持续的正常关节功能并显著缓解疼痛。鉴于现有文献表明关节穿刺术既不改变盘的位置也不改变盘的形状，这对盘移位和变形限制关节功能这一概念提出了质疑。相反，灌洗在解决闭锁方面的疗效表明，该病症是正常形状的盘突然附着于关节窝导致其无法滑动的结果。突发、张口受限的特征表明应将该病症归类为TMJ紊乱领域内的一个独立实体。
