体外冲击波治疗颞下颌关节紊乱病的疗效观察
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摘要
目的观察体外冲击波治疗颞下颌关节紊乱病(TMD)的临床效果。方法选取首发TMD患者80例,随机分为两组。冲击波组40例,采用体外冲击波治疗,1次/周,共2周;联合治疗组40例,采用超短波结合超声波治疗,6次/周,共2周。采用Fricton指数法、视觉疼痛模拟评分法(VAS)、最大开口度对患者的疗效进行评估。结果治疗后两组治疗有效率:冲击波组97. 5%,联合治疗组80. 0%; VAS评分:冲击波组(0. 56±0. 37),联合治疗组(1. 32±0. 54);最大开口度冲击波组(3. 44±1. 08) mm,联合治疗组(2. 92±0. 83) mm;颞下颌关节紊乱指数(CMI):冲击波组(0. 24±0. 06),联合治疗组(0. 11±0. 03),上述指标组内、组间比较差异有显著性意义(P <0. 05),其中治疗有效率、VAS、最大开口度两组组间比较差异具有极显著性意义(P <0. 01)。结论在缓解TMD的疼痛、肌肉压痛指数、最大开口度效果方面,体外冲击波、超短波结合超声波均有疗效,但体外冲击波效果更好,值得在临床上推广。
Objective To analyze the clinical effects of extracorporeal shock wave therapy(ESWT) on temporomandibular joint disorders(TMD). Methods Eighty patients with first-diagnosed TMD were randomly divided into 2 groups. Forty patients were in the shock wave group and were treated with ESWT for 2 weeks,once a week. Forty patients were in the combined treatment group and were treated with both ulthrashort wave and ultrasound therapy for 2 weeks,6 times a week. The therapeutic efficacy was evaluated by Fricton index,VAS and maximum opening degree.Results The therapeutic efficiencies were 97. 5% in the shock wave group and 80. 0% in the combined treatment group with Fricton indexes 0. 24 ± 0. 06 in the shock wave group and 0. 11 ± 0. 03 in the combined treatment group,VAS0. 56 ± 0. 37 in the shock wave group and 1. 32 ± 0. 54 in the combined treatment group,and maximum opening degree(3. 44 ± 1. 08) mm in the shock wave group and(2. 92 ± 0. 83) mm in the combined treatment group. The above factors showed significant difference between the groups(P < 0. 05). Among them,the therapeutic efficiency,VAS and maximum opening degree had the most significant difference(P < 0. 01). Conclusion ESWT is more effective than ultrashort wave combined with ultrasound,in alleviating the pain,muscle tenderness index and maximum opening degree of temporomandibular joint disorders,and therefore is worth promoting in the clinic.
Objective To analyze the clinical effects of extracorporeal shock wave therapy(ESWT) on temporomandibular joint disorders(TMD). Methods Eighty patients with first-diagnosed TMD were randomly divided into 2 groups. Forty patients were in the shock wave group and were treated with ESWT for 2 weeks,once a week. Forty patients were in the combined treatment group and were treated with both ulthrashort wave and ultrasound therapy for 2 weeks,6 times a week. The therapeutic efficacy was evaluated by Fricton index,VAS and maximum opening degree.Results The therapeutic efficiencies were 97. 5% in the shock wave group and 80. 0% in the combined treatment group with Fricton indexes 0. 24 ± 0. 06 in the shock wave group and 0. 11 ± 0. 03 in the combined treatment group,VAS0. 56 ± 0. 37 in the shock wave group and 1. 32 ± 0. 54 in the combined treatment group,and maximum opening degree(3. 44 ± 1. 08) mm in the shock wave group and(2. 92 ± 0. 83) mm in the combined treatment group. The above factors showed significant difference between the groups(P < 0. 05). Among them,the therapeutic efficiency,VAS and maximum opening degree had the most significant difference(P < 0. 01). Conclusion ESWT is more effective than ultrashort wave combined with ultrasound,in alleviating the pain,muscle tenderness index and maximum opening degree of temporomandibular joint disorders,and therefore is worth promoting in the clinic.
引文
[1]Randhawa K,Bohay R,C8téP,et al. The effectiveness of non-invasive interventions for temporomandibular disorders:a systematic review by the Ontario Protocol for Traffic Injury Management(OPTIMa)Collaboration[J]. Clin J Pain,2016,32(3):260-278.
[2] Okeson JP. Management of temporomandibular disorders and occlusion[M]. 7th ed. Brazil:Elsevier,2013:103-110.
[3]Seifi M,Ebadifar A,Kabiri S,et al. Comparative effectiveness of low level laser therapy and transcutaneous electric nerve stimulation on temporomandibular joint disorders[J]. J Lasers Med Sci,2017,8(Suppl 1):S27-S31.
[4]G9z G. Effectiveness of stabilization splints in the treatment of temporomandibular disorders[J]. J Orofac Orthop,2013,74:271-274.
[5] Liu F,Steinkeler A. Epidemiology,diagnosis,and treatment of temporomandibular disorders[J]. Dent Clinf North Am,2013,57(3):465-479.
[6]Sasaki J,Ariji Y,Sakuma S,et al. Ultrasonography as a tool for evaluating treatment of the masseter muscle in temporomandibular disorder patients with myofascial pain[J].Oral radiol,2006,22(2):55-57.
[7]Wang CJ. Extracorporeal shockwave therapy in musculoskeletal disorders[J]. J Orthop Surg Res,2012,7:11-12.
[8]傅开元.颞下颌关节紊乱病的RDC/TMD标准化诊断[J].中国口腔医学继续教育杂志,2009,12(2):55-57.
[9] Fricton JR,Schiffman EL. The craniomandibular index[J]. Prosthet Dent,1987,58(2):222-228.
[10]Fricton JR,Schiffman EL. Reliability of a craniomandibular index[J]. Dent Res,1986,65(11):1359-1364.
[11]中华口腔医学会颞下颌关节病学组.推荐使用的颞下颌关节紊乱病门诊病历[J].中华口腔医学杂志,2002,7(37),4:304-305.
[12] Sülün T. Management of Temporomandibular Disorders(TMD)in Partially Edentulous Patients[J]. Removable Partial Dentures,2016,21(10):251-257.
[13]Furquim BD,Flamengui LM,Conti PC. TMD and chronic pain:a current view[J]. Dental Press J Orthod,2015,20(1):127-133.
[14]Tanaka E,Detamore MS,Mercuri LG. Degenerative disorders of the temporomandibular joint:Etiology,diagnosis,and treatment[J]. J Dent Res,2008,87(4):296-307.
[15]Macfarlane TV,Kenealy P,Kingdon HA,et al. Twentyyear cohort study of health gain from orthodontic treatment:Temporomandibular disorders[J]. Am J Orthod Dentofacial Orthop,2009,135(6):692. e1-e8.
[16]Yildiz SK,Ozkan FU,Akta? I,et al. The effectiveness of ultrasound treatment for the management of knee osteoarthritis:a randomized,placebo-controlled,double-blind study[J]. Turk J Med Sci,2015,45(6):1187-1191.
[17] Ji HM,Jeong KH,Han SJ. Extracorporeal shock wave therapy in myofascial pain syndrome of upper trapezius[J]. Ann Rehabil Med,2012,36(5):675-681.
[18]周迪远,陶惠红,杨耀琴,等.体外冲击波对肌肉骨骼痛症的抗炎镇痛机制[J].实用骨科杂志,2017,23(7):618-625.
[19]石洋,曾瑞瑞.体外冲击波治疗肩部钙化性肌腱炎疗效的Meta分析[J].中国中医骨伤科杂志,2017,25(12):26-30.
[20]Lyon R,Liu XC,Kubin M,et al. Does extracorporeal shock wave therapy enhance healing of osteochondritis dissecans of the rabbit knee?:a pilot study[J]. Clin Orthop Relat Res,2013,471(4):1159-1170.
[21]Vural M,Bi9 M,Ersoy S,et al. Evaluation of extracorporeal shock wave therapy effectiveness in plantar fasciitis[J]. Med J Bakirkoy,2013,2(9):64-71.
[22]Aktürk,Kaya A,9etinta? D,et al. Comparision of the effectiveness of ESWT and ultrasound treatments in myofascial pain syndrome:randomized,sham-controlled study[J]. J Phys Ther Sci,2018,30(3):448-453.
[23] Hatch JP,Rugh JD,Sakai S,et al. Reliability of the craniomandibular index[J]. J Orofae Pain,2002,16(4):284-295.
[24]刘群,何霏,余波.颞下颌关节紊乱病康复评定量表的应用现状[J].中华物理医学与康复杂志,2015(37),12:965-968.
[25]Malliaropoulos N,Jury R,Pyne D,et al. Radial extracorporeal shockwave therapy for the treatment of finger tenosynovitis(trigger digit)[J]. Am J Sports Med,2016,7:143-151.
[2] Okeson JP. Management of temporomandibular disorders and occlusion[M]. 7th ed. Brazil:Elsevier,2013:103-110.
[3]Seifi M,Ebadifar A,Kabiri S,et al. Comparative effectiveness of low level laser therapy and transcutaneous electric nerve stimulation on temporomandibular joint disorders[J]. J Lasers Med Sci,2017,8(Suppl 1):S27-S31.
[4]G9z G. Effectiveness of stabilization splints in the treatment of temporomandibular disorders[J]. J Orofac Orthop,2013,74:271-274.
[5] Liu F,Steinkeler A. Epidemiology,diagnosis,and treatment of temporomandibular disorders[J]. Dent Clinf North Am,2013,57(3):465-479.
[6]Sasaki J,Ariji Y,Sakuma S,et al. Ultrasonography as a tool for evaluating treatment of the masseter muscle in temporomandibular disorder patients with myofascial pain[J].Oral radiol,2006,22(2):55-57.
[7]Wang CJ. Extracorporeal shockwave therapy in musculoskeletal disorders[J]. J Orthop Surg Res,2012,7:11-12.
[8]傅开元.颞下颌关节紊乱病的RDC/TMD标准化诊断[J].中国口腔医学继续教育杂志,2009,12(2):55-57.
[9] Fricton JR,Schiffman EL. The craniomandibular index[J]. Prosthet Dent,1987,58(2):222-228.
[10]Fricton JR,Schiffman EL. Reliability of a craniomandibular index[J]. Dent Res,1986,65(11):1359-1364.
[11]中华口腔医学会颞下颌关节病学组.推荐使用的颞下颌关节紊乱病门诊病历[J].中华口腔医学杂志,2002,7(37),4:304-305.
[12] Sülün T. Management of Temporomandibular Disorders(TMD)in Partially Edentulous Patients[J]. Removable Partial Dentures,2016,21(10):251-257.
[13]Furquim BD,Flamengui LM,Conti PC. TMD and chronic pain:a current view[J]. Dental Press J Orthod,2015,20(1):127-133.
[14]Tanaka E,Detamore MS,Mercuri LG. Degenerative disorders of the temporomandibular joint:Etiology,diagnosis,and treatment[J]. J Dent Res,2008,87(4):296-307.
[15]Macfarlane TV,Kenealy P,Kingdon HA,et al. Twentyyear cohort study of health gain from orthodontic treatment:Temporomandibular disorders[J]. Am J Orthod Dentofacial Orthop,2009,135(6):692. e1-e8.
[16]Yildiz SK,Ozkan FU,Akta? I,et al. The effectiveness of ultrasound treatment for the management of knee osteoarthritis:a randomized,placebo-controlled,double-blind study[J]. Turk J Med Sci,2015,45(6):1187-1191.
[17] Ji HM,Jeong KH,Han SJ. Extracorporeal shock wave therapy in myofascial pain syndrome of upper trapezius[J]. Ann Rehabil Med,2012,36(5):675-681.
[18]周迪远,陶惠红,杨耀琴,等.体外冲击波对肌肉骨骼痛症的抗炎镇痛机制[J].实用骨科杂志,2017,23(7):618-625.
[19]石洋,曾瑞瑞.体外冲击波治疗肩部钙化性肌腱炎疗效的Meta分析[J].中国中医骨伤科杂志,2017,25(12):26-30.
[20]Lyon R,Liu XC,Kubin M,et al. Does extracorporeal shock wave therapy enhance healing of osteochondritis dissecans of the rabbit knee?:a pilot study[J]. Clin Orthop Relat Res,2013,471(4):1159-1170.
[21]Vural M,Bi9 M,Ersoy S,et al. Evaluation of extracorporeal shock wave therapy effectiveness in plantar fasciitis[J]. Med J Bakirkoy,2013,2(9):64-71.
[22]Aktürk,Kaya A,9etinta? D,et al. Comparision of the effectiveness of ESWT and ultrasound treatments in myofascial pain syndrome:randomized,sham-controlled study[J]. J Phys Ther Sci,2018,30(3):448-453.
[23] Hatch JP,Rugh JD,Sakai S,et al. Reliability of the craniomandibular index[J]. J Orofae Pain,2002,16(4):284-295.
[24]刘群,何霏,余波.颞下颌关节紊乱病康复评定量表的应用现状[J].中华物理医学与康复杂志,2015(37),12:965-968.
[25]Malliaropoulos N,Jury R,Pyne D,et al. Radial extracorporeal shockwave therapy for the treatment of finger tenosynovitis(trigger digit)[J]. Am J Sports Med,2016,7:143-151.