多模式物理治疗结合体外冲击波对颞下颌关节紊乱症患者的影响

doi:10.3760/cma.j.issn.1007-1245.2024.23.004

摘要/Abstract

摘要：

目的　探讨多模式物理治疗结合体外冲击波（ESWT）对颞下颌关节紊乱症患者的影响。方法　本研究为前瞻性临床对照研究。选取2021年1月至2023年1月在空军军医大学第二附属医院口腔科治疗的240例颞下颌关节紊乱症患者作为研究对象，通过随机数字表法分为对照组（120例）和观察组（120例）。对照组男68例、女52例，年龄（39.25±4.14）岁，病程（61.59±8.54）d，予以多模式物理治疗；观察组男70例、女50例，年龄（39.37±4.28）岁，病程（61.71±8.62）d，予以多模式物理治疗结合ESWT治疗。对比两组临床疗效、治疗前及治疗2周后的颞下颌关节功能［下颌功能受损问卷（MFIQ）］、疼痛程度［视觉模拟评分法（VAS）］、颞下颌关节紊乱程度［肌肉压痛指数（PI）、功能障碍指数（DI）、颞下颌关节紊乱指数（CMI）］、最大张口度、口腔质量［口腔健康影响程度量表（OHIP-14）］、Fricton指数（关节杂音、下颌运动、肌肉触压诊、关节触压诊）。统计学方法采用t检验、χ²检验。结果　观察组治疗总有效率为95.83%（115/120），高于对照组的82.50%（99/120），差异有统计学意义（χ²=11.042，P<0.001）。治疗前，两组患者MFIQ、VAS、PI、DI、CMI、OHIP-14、关节杂音、下颌运动、肌肉触压诊、关节触压诊评分及最大张口度比较，差异均无统计学意义（均P>0.05）；治疗后，观察组MFIQ、VAS、PI、DI、CMI、OHIP-14、关节杂音、下颌运动、肌肉触压诊、关节触压诊评分均低于对照组［（9.64±1.59）分比（19.57±2.68）分、（2.62±0.62）分比（3.90±0.78）分、（0.35±0.07）分比（0.58±0.09）分、（0.26±0.06）分比（0.44±0.08）分、（0.20±0.07）分比（0.31±0.11）分、（11.23±2.17）分比（22.16±3.04）分、（1.36±0.35）分比（3.12±0.64）分、（2.01±0.57）分比（4.66±1.03）分、（6.37±1.46）分比（9.28±2.54）分、（1.34±0.46）分比（3.45±0.87）分］，最大张口度大于对照组［（3.25±0.68）mm比（2.02±0.51）mm］，差异均有统计学意义（t=34.908、14.072、22.098、19.718、9.242、32.056、26.431、24.660、10.881、23.487、15.852，均P<0.05）。结论　多模式物理治疗结合ESWT对颞下颌关节紊乱症患者具有较好治疗效果，可改善关节功能及口腔健康状况，降低疼痛和紊乱程度，增加最大张口度，提高治疗有效率。

关键词:

颞下颌关节紊乱症, 多模式物理治疗, 体外冲击波, 颞下颌关节功能, 疼痛程度

Abstract:

Objective　To explore the effect of multimodal physical therapy combined with extracorporeal shock wave therapy (ESWT) on patients with temporomandibular joint disorders. Methods　This prospective controlled study included 240 patients with temporomandibular disorders treated at Second Hospital, Air Force Military Medical University from January 2021 to January 2023. The patients were randomly divided into a control group and an observation group by the random number table method, with 120 cases in each group. There were 68 males and 52 females in the control group; they were (39.25±4.14) years old; their disease course was (61.59±8.54) d. There were 70 males and 50 females in the observation group; they were (39.37±4.28) years old; their disease course was (61.71±8.62) d. The control group took multimodal physical therapy. The observation group took multimodal physical therapy and ESWT. The clinical efficacies and the scores of temporomandibular joint function [Mandibular Function Impairment Questionnaire (MFIQ)], pain [Visual Analogue Scale (VAS)], temporomandibular joint disorder degree [pain index (PI), dysfunction index (DI), and comprehensive mandibular index (CMI)], oral health quality [Oral Health Impact Profile-14 (OHIP-14)], and Fricton index [joint noise (JN), mandibular movement (MM), muscle palpation (MP), and joint palpation (JP)] and maximum mouth opening before and after 2 weeks' treatment were compared between the two groups. t and χ² tests were applied. Results　The effective rate in the observation group was higher than that in the control group [95.83% (115/120) vs. 82.50% (99/120)], with a statistical difference (χ²=11.042; P<0.001). Before the treatment, there were no statistical differences in the scores of MFIQ, VAS, PI, DI, CMI, OHIP-14, JN, MM, MP, and JP and maximum mouth opening between the two groups (all P>0.05). After the treatment, the scores of MFIQ, VAS, PI, DI, CMI, OHIP-14, JN, MM, MP, and JP in the observation group were lower than those in the control group (9.64±1.59 vs. 19.57±2.68, 2.62±0.62 vs. 3.90±0.78, 0.35±0.07 vs. 0.58±0.09, 0.26±0.06 vs. 0.44±0.08, 0.20±0.07 vs. 0.31±0.11, 11.23±2.17 vs. 22.16±3.04, 1.36±0.35 vs. 3.12±0.64, 2.01±0.57 vs. 4.66±1.03, 6.37±1.46 vs. 9.28±2.54, and 1.34±0.46 vs. 3.45±0.87); the maximum mouth opening in the observation group was bigger than that in the control group [(3.25±0.68) mm vs. (2.02±0.51) mm]; there were statistical differences (t=34.908, 14.072, 22.098, 19.718, 9.242, 32.056, 26.431, 24.660, 10.881, 23.487, and 15.852; all P<0.05). Conclusion　Multimodal physical therapy combined with ESWT for patients with temporomandibular disorders is effective and can improve their joint function and oral health, reduce their pain and disorder levels, and increase their maximum mouth opening.

Key words:

Temporomandibular disorders, Multimodal physical therapy, Extracorporeal shock wave, Temporomandibular joint function, Pain level

宋薇陈静涛陈新钊王燕李宝东.

多模式物理治疗结合体外冲击波对颞下颌关节紊乱症患者的影响 [J]. 国际医药卫生导报, 2024, 30(23): 3900-3905.

Song Wei, Chen Jingtao, Chen Xinzhao, Wang Yan, Li Baodong.

Impact of multimodal physical therapy combined with extracorporeal shock wave therapy on patients with temporomandibular joint disorders [J]. International Medicine and Health Guidance News, 2024, 30(23): 3900-3905.

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