透明质酸注射联合咀嚼肌功能训练治疗老年性颞下颌关节骨关节炎患者的临床研究
|
摘要
目的:探讨透明质酸关节腔注射联合咀嚼肌功能训练在老年性颞下颌关节骨关节炎患者治疗中的作用及意义。方法:在武汉大学口腔医院颞下颌关节专科就诊的老年患者,经临床检查和影像学检查确诊为颞下颌关节骨关节炎后随机分为2组,实验组30人,对照组30人。对照组采用咀嚼肌功能训练进行治疗,实验组采用透明质酸关节腔注射治疗联合咀嚼肌功能训练的方法进行治疗,所有患者在治疗完成后3月、6月进行复诊,每次就诊时记录患者的关节疼痛(视觉模拟评分法,visual analog scale,VAS),最大张口度(maximal mouth opening,MMO)和关节杂音(joint noise, JN),对结果进行统计学分析。结果:治疗效果方面,关节腔注射未见明显并发症,实验组和对照组VAS和MMO较治疗前均有好转,实验组JD较治疗前好转,差异具有统计学意义(P<0.05),对照组治疗前后关节杂音没有差异(P>0.05)。实验组和对照组相比,VAS、MMO、JN均有显著性改善(P<0.05)。结论:采用透明质酸关节腔注射联合咀嚼肌功能训练治疗老年性颞下颌关节骨关节炎患者,临床应用安全,能改善患者的临床症状,治疗效果优于单纯的咀嚼肌功能训练。
Objective: To observe the effects of hyaluronic acid(HA) injection combined with masticatory muscle exercise on geriatric temporomandibular joint osteoarthrosis. Methods: The subjects were recruited from Stomatological Hospital of Wuhan University. After clinical and X-ray examination, 60 patients were divided into the experimental group and the control group. The experimental group received intra-articular injection of HA in combination with masticatory muscle exercise, and the control group received the masticatory muscle exercise only. The subjects were followed after 3 months and 6 months. Clinical parameters such as joint pain(VAS), maximal mouth opening(MMO), and joint noise(JN) were recorded at each visit. Comparative analysis was then performed. Results: No serious complications were observed in the treatment process. After treatment, there were significant improvements in the VAS and MMO in the experimental group and control group, and improvement in the JN in the control group(P<0.05). There was significant improvement for all the clinical scores in the experimental group compared with the control group(P<0.05). Conclusion: Intra-articular injection of HA combined with masticatory muscle exercise is a safe, effective method in the treatment of geriatric temporomandibular joint osteoarthrosis, which is better than masticatory muscle exercise only.
Objective: To observe the effects of hyaluronic acid(HA) injection combined with masticatory muscle exercise on geriatric temporomandibular joint osteoarthrosis. Methods: The subjects were recruited from Stomatological Hospital of Wuhan University. After clinical and X-ray examination, 60 patients were divided into the experimental group and the control group. The experimental group received intra-articular injection of HA in combination with masticatory muscle exercise, and the control group received the masticatory muscle exercise only. The subjects were followed after 3 months and 6 months. Clinical parameters such as joint pain(VAS), maximal mouth opening(MMO), and joint noise(JN) were recorded at each visit. Comparative analysis was then performed. Results: No serious complications were observed in the treatment process. After treatment, there were significant improvements in the VAS and MMO in the experimental group and control group, and improvement in the JN in the control group(P<0.05). There was significant improvement for all the clinical scores in the experimental group compared with the control group(P<0.05). Conclusion: Intra-articular injection of HA combined with masticatory muscle exercise is a safe, effective method in the treatment of geriatric temporomandibular joint osteoarthrosis, which is better than masticatory muscle exercise only.
引文
[1] Gauer RL, Semidey MJ. Diagnosis and treatment of temporomandibular disorders[J]. Am Fam Physician, 2015, 15,91(6):378-386.
[2] Graff-Radford SB, Abbott JJ. Temporomandibular disorders and headache [J]. Oral Maxillofac Surg Clin North Am, 2016, 28(3):335-349.
[3] de Siqueira SR, Vilela TT, Florindo AA. Prevalence of headache and orofacial pain in adults and elders in a Brazilian community: an epidemiological study [J]. Gerodontology, 2015, 32(2):123-131.
[4] Martins WR, Blasczyk JC, Aparecida Furlan de Oliveira M, et al. Efficacy of musculoskeletal manual approach in the treatment of temporomandibular joint disorder: A systematic review with meta-analysis [J]. Man Ther, 2016, 21:10-17.
[5] De Rossi SS, Greenberg MS, Liu F, et al. Temporomandibular disorders: evaluation and management [J]. Med Clin North Am, 2014, 98(6):1353-1384.
[6] Manfredini D. Occlusal equilibration for the management of temporomandibular disorders [J]. Oral Maxillofac Surg Clin North Am, 2018, 30(3):257-264.
[7] Camacho JG, Oltramari-Navarro PV, Navarro Rde L, et al. Signs and symptoms of temporomandibular disorders in the elderly [J]. Codas, 2014,26(1):76-80.
[8] Liu F, Steinkeler A. Epidemiology, diagnosis, and treatment of temporomandibular disorders [J]. Dent Clin North Am,2013,57(3):465-479.
[9] Honda M, Iida T, Komiyama O, et al. Characteristics of middle-aged and older patients with temporomandibular disorders and burning mouth syndrome [J]. J Oral Sci, 2015,57(4):355-360.
[10] Milam SB. Pathogenesis of degenerative temporomandibular joint arthritides [J]. Odontology, 2005, 93(1):7-15.
[11] Navrátil L, Navratil V, Hajkova S, et al. Comprehensive treatment of temporomandibular joint disorders [J]. Cranio, 2014, 32(1):24-30.
[12] Calixtre LB, Grüninger BL, Haik MN, et al. Effects of cervical mobilization and exercise on pain, movement and function in subjects with temporomandibular disorders: a single group pre-post test [J]. J Appl Oral Sci, 2016,24(3):188-197.
[13] 张玲阁,张睿,李喜红,等.透明质酸钠关节腔注射联合合垫治疗不可复性关节盘前移位的疗效评价[J].口腔医学研究,2016,32(8):865-868.
[14] Abate M, Vanni D, Pantalone A, et al. Hyaluronic acid in knee osteoarthritis: preliminary results using a four months administration schedule [J].Int J Rheum Dis, 2017, 20(2):199-202.
[2] Graff-Radford SB, Abbott JJ. Temporomandibular disorders and headache [J]. Oral Maxillofac Surg Clin North Am, 2016, 28(3):335-349.
[3] de Siqueira SR, Vilela TT, Florindo AA. Prevalence of headache and orofacial pain in adults and elders in a Brazilian community: an epidemiological study [J]. Gerodontology, 2015, 32(2):123-131.
[4] Martins WR, Blasczyk JC, Aparecida Furlan de Oliveira M, et al. Efficacy of musculoskeletal manual approach in the treatment of temporomandibular joint disorder: A systematic review with meta-analysis [J]. Man Ther, 2016, 21:10-17.
[5] De Rossi SS, Greenberg MS, Liu F, et al. Temporomandibular disorders: evaluation and management [J]. Med Clin North Am, 2014, 98(6):1353-1384.
[6] Manfredini D. Occlusal equilibration for the management of temporomandibular disorders [J]. Oral Maxillofac Surg Clin North Am, 2018, 30(3):257-264.
[7] Camacho JG, Oltramari-Navarro PV, Navarro Rde L, et al. Signs and symptoms of temporomandibular disorders in the elderly [J]. Codas, 2014,26(1):76-80.
[8] Liu F, Steinkeler A. Epidemiology, diagnosis, and treatment of temporomandibular disorders [J]. Dent Clin North Am,2013,57(3):465-479.
[9] Honda M, Iida T, Komiyama O, et al. Characteristics of middle-aged and older patients with temporomandibular disorders and burning mouth syndrome [J]. J Oral Sci, 2015,57(4):355-360.
[10] Milam SB. Pathogenesis of degenerative temporomandibular joint arthritides [J]. Odontology, 2005, 93(1):7-15.
[11] Navrátil L, Navratil V, Hajkova S, et al. Comprehensive treatment of temporomandibular joint disorders [J]. Cranio, 2014, 32(1):24-30.
[12] Calixtre LB, Grüninger BL, Haik MN, et al. Effects of cervical mobilization and exercise on pain, movement and function in subjects with temporomandibular disorders: a single group pre-post test [J]. J Appl Oral Sci, 2016,24(3):188-197.
[13] 张玲阁,张睿,李喜红,等.透明质酸钠关节腔注射联合合垫治疗不可复性关节盘前移位的疗效评价[J].口腔医学研究,2016,32(8):865-868.
[14] Abate M, Vanni D, Pantalone A, et al. Hyaluronic acid in knee osteoarthritis: preliminary results using a four months administration schedule [J].Int J Rheum Dis, 2017, 20(2):199-202.