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
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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

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图 1 正常左侧关节囊

Figure 1. Normal left joint capsule

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图 2 右侧增厚关节囊

Figure 2. Right thickening joint capsule

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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

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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

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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

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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

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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

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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。

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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。

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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。

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