超声技术配合小针刀松解治疗颞颌关节紊乱综合征的临床效果观察

田涛涛; 王媛; 杜信; 杜奋飞

doi:10.16766/j.cnki.issn.1674-4152.002941

超声技术配合小针刀松解治疗颞颌关节紊乱综合征的临床效果观察

doi: 10.16766/j.cnki.issn.1674-4152.002941

东阳市人民医院康复科, 浙江金华 322100

基金项目:

浙江省医药卫生科技计划项目 2022ZH065

详细信息

通讯作者:
杜奋飞, E-mail: dilj42@163.com

中图分类号: R782.6 R493
计量
- 文章访问数: 177
- HTML全文浏览量: 84
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2022-11-08
- 网络出版日期: 2023-05-31

Clinical observation on the treatment of temporomandibular joint disorder syndrome using ultrasonic technique combined with a small needle knife

Department of Rehabilitation, Dongyang People's Hospital, Jinhua, Zhejiang 322100, China

摘要

摘要: 目的探讨超声技术配合小针刀松解治疗颞颌关节紊乱综合征（TMD）的临床疗效及对患者疼痛程度、紊乱指数的影响，为临床规范治疗TMD提供参考依据，使更多TMD患者获益。方法将2021年1月—2022年9月于东阳市人民医院治疗的108例TMD患者根据不同的治疗方法分为对照组（54例）和观察组（54例）。对照组按照常规康复技术治疗，包括物理疗法、手法复位、运动治疗，观察组在常规康复技术治疗的基础上采用超声技术配合小针刀松解治疗。比较2组临床疗效、疼痛程度[视觉模拟评分法（VAS）]、Fricton颞颌关节紊乱指数[功能障碍指数（DI）、肌肉压痛指数（PI）、颞颌关节紊乱指数（CMI）]以及张口活动度。结果观察组治疗总有效率为96.3%（52/54），对照组治疗总有效率为83.3%（45/54），P＜0.05。观察组患者治疗后、治疗后1个月、治疗后3个月在不同状态下（静息、运动、咀嚼）的VAS疼痛评分均显著低于对照组（P＜0.05）。治疗后、治疗后1个月、治疗后3个月，观察组患者DI、PI、CMI均显著低于对照组，张口活动度均显著大于对照组，差异有统计学意义（均P＜0.05）。结论超声技术配合小针刀松解治疗颞颌关节紊乱综合征的临床疗效显著，可有效减轻患者疼痛程度，改善颞颌关节功能障碍和张口活动度。
- 超声技术 /
- 小针刀 /
- 颞颌关节紊乱综合征 /
- 疼痛程度 /
- 张口活动度
Abstract: Objective To investigate the clinical efficacy of ultrasound technology combined with small needle knife release in the treatment of temporomandibular joint disorder syndrome (TMD) and its effect on patients' pain level and disorder index, so as to provide a reference basis for the standardized clinical treatment of TMD and benefit more patients with TMD. Methods A total of 108 patients with TMD who were treated in Dongyang People's Hospital from January 2021 to September 2022 were divided into a control group (54 cases) and an observation group (54 cases) according to different treatment methods. The control group was treated with conventional rehabilitation techniques, including physiotherapy, manual reduction, and exercise therapy. The observation group was treated with ultrasound technique combined with small needle knife release based on conventional rehabilitation techniques. The clinical efficacy, pain degree(VAS), Fricton temporomandibular joint disorder index [dysfunction index (DI), muscle pressure pain index (PI) and temporomandibular disorder index (CMI)] and mouth opening mobility were compared between the two groups. Results The total effective rate was 96.3% (52/54) in the observation group and 83.3% (45/54) in the control group, with a statistically significant difference (P < 0.05). The VAS pain scores of patients in the observation group were significantly lower than those in the control group in different states(rest, exercise and chewing) after treatment, 1 month after treatment and 3 months after treatment (P < 0.05).After treatment, 1 month after treatment, and 3 months after treatment, DI, PI, CMI of patients in the observation group were significantly lower than those in the control group, and mouth opening mobility was significantly higher than that in the control group, with a statistically significant difference (all P < 0.05). Conclusion The clinical effect of ultrasound technology combined with small needle knife release in the treatment of TMD is significant, which can effectively reduce the patient's pain, improve temporomandibular joint dysfunction and mouth-opening range of motion.
- Ultrasonic technology /
- Small needle knife /
- Temporomandibular joint disorder syndrome (TMD) /
- Degree of pain /
- Mouth opening mobility

HTML全文

图 1 正常左侧关节囊

Figure 1. Normal left joint capsule

下载: 全尺寸图片幻灯片

图 2 右侧增厚关节囊

Figure 2. Right thickening joint capsule

下载: 全尺寸图片幻灯片

图 3 超声引导下小针刀松解关节囊

Figure 3. Released joint capsule by small needle knife under ultrasonic guidance

下载: 全尺寸图片幻灯片

图 4 超声引导下小针刀松解翼外肌

Figure 4. Release the lateral pterygoid muscle by small needle knife under ultrasonic guidance

下载: 全尺寸图片幻灯片

图 5 2组颞颌关节紊乱综合征患者不同时间点DI比较

注：与对照组比较，^aP＜0.05。

Figure 5. Comparison of DI between two groups of patients with temporomandibular joint disorder syndrome at different time points

下载: 全尺寸图片幻灯片

图 6 2组颞颌关节紊乱综合征患者不同时间点PI比较

注：与对照组比较，^aP＜0.05。

Figure 6. Comparison of PI between two groups of patients with temporomandibular joint disorder syndrome at different time points

下载: 全尺寸图片幻灯片

图 7 2组颞颌关节紊乱综合征患者不同时间点CMI比较

注：与对照组比较，^aP＜0.05。

Figure 7. Comparison of CMI between two groups of patients with temporomandibular joint disorder syndrome at different time points

下载: 全尺寸图片幻灯片

表 1 2组颞颌关节紊乱综合征患者临床疗效比较[例(%)]

Table 1. Comparison of clinical efficacy between two groups of patients with temporomandibular joint disorder syndrome[cases(%)]

组别	例数	治愈	显效	有效	无效	总有效
观察组	54	18(33.3)	26(48.1)	8(14.8)	2(3.7)	52(96.3)
对照组	54	12(22.2)	18(33.3)	15(27.8)	9(16.7)	45(83.3)
统计量	-2.623^a					4.960^b
P值	0.009					0.026
注：^a为Z值，^b为χ²值。

下载: 导出CSV

表 2 2组颞颌关节紊乱综合征患者不同状态下不同时间VAS疼痛评分比较(x±s，分)

Table 2. Comparison of VAS pain scores at different times in different states between two groups of patients with temporomandibular joint disorder syndrome(x±s, points)

组别	例数	静息
组别	例数	治疗前	治疗后	治疗后1个月	治疗后3个月
观察组	54	4.74±1.07	2.30±0.74^a	0.86±0.30^a	0.59±0.21^a
对照组	54	4.71±1.11	2.94±0.81^a	1.23±0.44^a	0.88±0.31^a
t值		0.143	4.287	5.106	5.691
P值		0.887	＜0.001	＜0.001	＜0.001

组别	例数	运动
组别	例数	治疗前	治疗后	治疗后1个月	治疗后3个月
观察组	54	5.11±1.25	2.64±0.77^a	1.04±0.32^a	0.63±0.20^a
对照组	54	5.08±1.20	3.32±0.89^a	1.33±0.63^a	0.84±0.34^a
t值		0.127	4.246	3.016	3.912
P值		0.899	＜0.001	0.003	＜0.001

组别	例数	咀嚼
组别	例数	治疗前	治疗后	治疗后1个月	治疗后3个月
观察组	54	5.64±1.34	2.95±0.97^a	1.34±0.51^a	0.69±0.25^a
对照组	54	5.51±1.41	3.81±1.03^a	1.64±0.75a	0.93±0.42^a
t值		0.491	4.467	2.431	3.608
P值		0.624	＜0.001	0.017	0.001
注：与同组治疗前比较，^aP＜0.05。

下载: 导出CSV

表 3 2组颞颌关节紊乱综合征患者张口活动度比较(x±s，mm)

Table 3. Comparison of mouth opening activity between two groups of patients with temporomandibular joint disorder syndrome (x±s, mm)

组别	例数	治疗前	治疗后	治疗后1个月	治疗后3个月
观察组	54	25.78±4.31	39.77±4.12^a	41.23±4.07^a	41.91±4.20^a
对照组	54	26.03±4.12	34.87±4.65^a	36.62±4.77^a	37.01±4.15^a
t值		0.308	5.796	5.403	6.089
P值		0.759	＜0.001	＜0.001	＜0.001
注：与同组治疗前比较，^aP＜0.05。

下载: 导出CSV

参考文献(20)

[1]	HERPICH C M, LEAL-JUNIOR E, POLITTI F, et al. Intraoral photobiomodulation diminishes pain and improves functioning in women with temporomandibular disorder: a randomized, sham-controlled, double-blind clinical trial[J]. Laser Med Sci, 2020, 35(2): 439-445. doi: 10.1007/s10103-019-02841-1
[2]	SENA L, PALMA L F, MARQUES S R, et al. A home-based multidisciplinary programme for down syndrome adults with muscular temporomandibular disorder[J]. J Oral Rehabil, 2020, 47(8): 939-943. doi: 10.1111/joor.13027
[3]	张开祥, 徐锦程. 基于数字化三维重建的髁突解剖学测量与单侧颞下颌关节紊乱病常见症状的相关性分析[J]. 中华全科医学, 2022, 20(11): 1856-1859. doi: 10.16766/j.cnki.issn.1674-4152.002719 ZHANG K X, XU J C. Correlation between condylar anatomical measurement based on digital three-dimensional reconstruction and common symptoms of unilateral temporomandibular joint disorder[J]. Chinese Journal of General Practice, 2022, 20(11): 1856-1859. doi: 10.16766/j.cnki.issn.1674-4152.002719
[4]	胡阿特·哈德尔, 周伟, 帕尔哈提·艾买提, 等. 小针刀联合运动疗法治疗颞下颌关节盘不可复性前移位的效果评价[J]. 中国口腔颌面外科杂志, 2019, 17(4): 327-331. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGKQ201904012.htm HUATE·HADEER, ZHOU W, PALAHATI·AIMAITI, et al. Clinical application of small needle knife therapy combined with exercise therapy in the treatment of displacement of temporomandibular joint disc without reduction[J]. China Journal of Oral and Maxillofacial Surgery, 2019, 17(4): 327-331. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGKQ201904012.htm
[5]	谢明花, 刁俊鹏, 杨伟. 针刀调脊与传统针刺治疗对颞下颌关节紊乱综合征患者的临床研究[J]. 中国医药科学, 2018, 8(13): 76-79. https://www.cnki.com.cn/Article/CJFDTOTAL-GYKX201813022.htm XIE M H, DIAO J P, YANG W. Clinical study of acupotomy spinal adjustment and traditional acupuncture treatment for patients with temporomandibular joint disorder syndrome[J]. China Medicine and Pharmacy, 2018, 8(13): 76-79. https://www.cnki.com.cn/Article/CJFDTOTAL-GYKX201813022.htm
[6]	王翰章, 郑谦. 口腔颌面外科学[M]. 北京: 科学技术文献出版社, 2010. WANG H Z, ZHENG Q. Oral and maxillofacial surgery[M]. Beijing: Science and Technology Documentation Press, 2010.
[7]	陈果, 贲定严, 向娟, 等. 下关穴水针刀微创技术治疗颞下颌关节紊乱综合征30例[J]. 中国针灸, 2017, 37(4): 394. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZE201704017.htm CHEN G, BEN D Y, XIANG J, et al. Treatment of 30 cases of temporomandibular joint disorder syndrome with water needle knife at Xiaguan[J]. Chinese Acupuncture & Moxibustion, 2017, 37(4): 394. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZE201704017.htm
[8]	张皓, 李斯文, 付佳欢, 等. 改良型治疗性义齿在颞下颌关节紊乱综合征患者咬合重建中的应用[J]. 华西口腔医学杂志, 2018, 36(2): 162-166. https://www.cnki.com.cn/Article/CJFDTOTAL-HXKQ201802014.htm ZHANG H, LI S W, FU J H, et al. Improved temporary and treatment partial denture in the rehabilitation of patients with temporomandibular joint disorder syndrome[J]. West China Journal of Stomatology, 2018, 36(2): 162-166. https://www.cnki.com.cn/Article/CJFDTOTAL-HXKQ201802014.htm
[9]	刘小雅, 罗寒, 杨春. 光生物调节治疗颞下颌关节紊乱病的研究进展[J]. 口腔医学, 2020, 40(10): 960-964. https://www.cnki.com.cn/Article/CJFDTOTAL-KQYX202010019.htm LIU X Y, LUO H, YANG C, et al. Research progress on efficacy of photobiomodulation therapy in the treatment of TMD[J]. Stomatology, 2020, 40(10): 960-964. https://www.cnki.com.cn/Article/CJFDTOTAL-KQYX202010019.htm
[10]	SCHIFFMAN E, OHRBACH R, TRUELOVE E, et al. Diagnostic criteria for temporomandibular disorders (DG/TMD) for clinical and research applications: recommendations of the international RDC/TMD consortium network and orofacial pain special interest group[J]. J Oral Facial Pain Headache, 2014, 28(1): 6-27. http://smartsearch.nstl.gov.cn/paper_detail.html?id=cb0df9966fe37afa82a848789f4ad8c6
[11]	谢强文, 陈水金, 何伟秀, 等. 深层肌肉刺激联合本体感觉神经肌肉促进技术治疗颞下颌关节紊乱病的效果分析[J]. 中外医学研究, 2021, 19(3): 4-6. https://www.cnki.com.cn/Article/CJFDTOTAL-YJZY202103003.htm XIE Q W, CHEN S J, HE W X, et al. Effect of deep muscle stimulation combined with proprioceptive neuromuscular stimulation technique in the treatment of temporomandibular joint disorder[J]. Chinese and Foreign Medical Research, 2021, 19(3): 4-6. https://www.cnki.com.cn/Article/CJFDTOTAL-YJZY202103003.htm
[12]	王璞, 韦丽宾, 张少嘉, 等. 基于颈部核心稳定训练的康复模式治疗颞下颌关节紊乱病的临床疗效观察[J]. 现代口腔医学杂志, 2021, 35(3): 166-169. https://www.cnki.com.cn/Article/CJFDTOTAL-XDKY202103006.htm WANG P, WEI L B, ZHANG S J, et al. The efficacy of neck core stability training in the treatment of temporomandibular disorders[J]. Journal of Modern Stomatology, 2021, 35(3): 166-169. https://www.cnki.com.cn/Article/CJFDTOTAL-XDKY202103006.htm
[13]	傅开元, 胡敏, 余强, 等. 颞下颌关节紊乱病锥形束CT检查规范及诊断标准的专家共识[J]. 中华口腔医学杂志, 2020, 55(9): 613-616. FU K Y, HU M, YU Q, et al. Experts consensus on cone-beam CT examination specification and diagnostic criteria of temporomandibular disorders[J]. Chinese Journal of Stomatolog, 2020, 55(9): 613-616.
[14]	姬晓兰, 李东, 霍则军, 等. 针刺与针刀治疗第三腰椎横突综合征临床疗效比较[J]. 中国中医基础医学杂志, 2018, 24(1): 101-103. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJC201801036.htm JI X L, LI D, HUO Z J, et al. Comparison of Clinical Effects of Acupuncture and Needle Knife Therapy on Third Lumbar Transverse Process Syndrome[J]. Chinese Journal of Basic Medicine in Traditional Chinese Medicine, 2018, 24(1): 101-103. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJC201801036.htm
[15]	张旭明, 吴晓刚, 王海东, 等. 王海东教授针刀治疗腰大肌损伤腰痛经验[J]. 中医临床研究, 2022, 14(16): 56-58. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYLY202216016.htm ZHANG X M, WU X G, WANG H D, et al. Clinical experience of Professor WANG Haidong in treating low back pain due to psoas major muscle injury by acupotomy[J]. Clinical Journal of Chinese Medicine, 2022, 14(16): 56-58. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYLY202216016.htm
[16]	王媛, 单玲玲, 杜信. 探讨微针刀联合3M康复技术治疗颞下颌关节紊乱综合征的疗效分析[J]. 中国现代医生, 2022, 60(24): 32-35. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDYS202224007.htm WANG Y, SHAN L L, DU X. Analysis of the curative effect of micro-needle knife combined with 3M rehabilitation technology in the treatment of temporomandibular joint disorder syndrome[J]. China Modern Doctor, 2022, 60(24): 32-35. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDYS202224007.htm
[17]	董佳容, 施问民, 张黎瑛. 小针刀疗法联合玻璃酸钠对慢性筋骨病患者关节疼痛和局部功能障碍的影响[J]. 世界中西医结合杂志, 2020, 15(1): 9-11. https://www.cnki.com.cn/Article/CJFDTOTAL-SJZX202001003.htm DONG J R, SHI W M, ZHANG L Y, et al. Effect of small needle knife therapy combined with sodium hyaluronate on joint pain and local dysfunction in patients with chronic fascial and osteopathy[J]. World Journal of Integrated Traditional and Western Medicine, 2020, 15(1): 9-1 https://www.cnki.com.cn/Article/CJFDTOTAL-SJZX202001003.htm
[18]	汪洋, 韩澍鹏, 张丽仙. 温针疗法对颞下颌关节紊乱综合征患者fricton指数的影响[J]. 云南中医中药杂志, 2021, 42(3): 50-53. https://www.cnki.com.cn/Article/CJFDTOTAL-YZYY202103016.htm WANG Y, HAN S P, ZHANG L X, et al. Discussion on the effect of warm acupuncture therapy on fricton index in patients with temporomandibular joint disorder syndrome[J]. Yunnan Journal of Traditional Chinese Medicine and Materia Medica, 2021, 42(3): 50-53. https://www.cnki.com.cn/Article/CJFDTOTAL-YZYY202103016.htm
[19]	李美静, 徐庚池, 徐昌豪. 颞下颌关节紊乱病与牙列咬合因素的相关性分析[J]. 中国医疗美容, 2019, 9(2): 75-79. https://www.cnki.com.cn/Article/CJFDTOTAL-YLMR201902023.htm LI M J, XU G C, XU C H. Analysis of the correlation between temporomandibular joint disorders and occlusal factors[J]. China Medical Cosmetology, 2019, 9(2): 75-79. https://www.cnki.com.cn/Article/CJFDTOTAL-YLMR201902023.htm
[20]	姚远, 蔡斌, 徐丽丽, 等. 颞下颌关节紊乱病患者颈部压力疼痛阈值和头前伸姿势的相关性研究[J]. 中华口腔医学杂志, 2021, 56(8): 759-763. YAO Y, CAI B, XU L L, et al. Correlation between neck pressure pain threshold and forward head posture in patients with temporomandibular joint disorders[J]. Chinese Journal of Stomatology, 2021, 56(8): 759-763.