摘要： 目的：探讨连续注射3次玻璃酸钠注射液至关节上腔内的疗效，分析其联合再定位咬合板的疗效，以及两者在临床治疗上有无协同作用。方法：选择2016-09—2017-12期间就诊于新疆医科大学第一附属医院颞下颌关节门诊，被诊断为不可复性盘前移位（anterior discdisplacement without reduction，ADDwoR）且药物治疗无效的68例患者。进行随机分组：A组（35例）给予单纯黏弹性补充疗法，B组（33例）给予黏弹性补充疗法联合再定位咬合板，通过短期随访观察,比较两组治疗前及治疗后患者关节疼痛程度、最大张口度。在一疗程后3个月和6个月时，分别对两组患者进行MRI检查，观察关节盘和髁突在开口位和闭口位时的相对位置情况。结果：A、B 组治疗 6个月后，较同组治疗前的关节疼痛程度、最大张口度明显改善，差异有统计学意义（P＜0．05）。治疗 6个月后，B 组关节疼痛程度、最大张口度改善较 A 组明显，差异有统计学意义（P＜0．05）。MRI检查结果显示：3个月时，A组中有3例患者闭口时关节盘位于髁突前下方，开口时关节盘可完全恢复，6个月时有4例患者开闭口位时关节盘均在髁突前；B组3个月时有8例患者开闭口位时关节盘均在髁突前方，6个月时增加到17例。结论：单纯黏弹性补充疗法与黏弹性补充疗法联合再定位咬合板，对于治疗ADDwoR均有良好的效果，且黏弹性补充疗法联合再定位咬合板治疗效果优于单纯粘弹性补充疗法，即二者在临床上有协同作用。

关键词: 颞下颌关节, 黏弹性补充疗法, 玻璃酸钠, 再定位咬合板

Abstract: Objective: A retrospective review of the effectiveness of sodium hyaluronate combined with repositioning of the bite plate for the treatment of anterior disc displacement without reduction （ADDwoR）. Methods: Sixty-eight patients with ADDWoR between September 2016 to December 2017 were enrolled and randomly divided into 2 groups. Group A （35 cases）received viscosupplementation of sodium hyaluronate therapy alone. Group B(33 cases) received viscosupplementation combined with repositioning splint therapy. The short-term observation was performed to compare the TMJ joint pain and maximum mouth opening (MMO). At 3- and 6- month after one course of treatment, two groups of patients were examined by MRI, and the relative positions of the articular discs and the condylar processes at the opening and closing positions were assessed. Results: At 6- month after treatment ,TMJ pain and MM0 in patients in both group A and B improved significantly compared with those before treatment (P<0.05），In group B at 6- month after treatment, TMJ pain and MM0 of paitents were significantly improved. MRI results of 3- month follow-up, 3 patients in group A had an articular disc in the anterior and posterior condyle when closing mouth, which meaned the disc was fully recovered at the time of opening. At the 6- month follow-up, 4 patients showed the articular disc located in the front of condyle during mouth opening and closing. In group B， at 3-month follow-up, 8 patients showed articular disc located in front of the condyle during mouth opening and closing, while at 6-month follow-up, the number of those patients increased to 17. Conclusion: Viscosupplementation and viscosupplementation combined with repositioning splint both were effective methods for the treatment of patients with ADDwoR. The viscosupplementation combined with repositioning splint has a better effect, viscosupplementation and repositioning splint have collaborative effects on ADDwoR.

Key words: temporomandibular joint, viscosupplementation, repositioning splint

中图分类号: 

• R782.4