摘要：

目的：评价手法复位联合运动疗法及压膜正位器对青少年急性不可复盘前移位的短期疗效。方法：选取15例张口受限（病程在4个月内），且经MRI证实颞下颌关节盘不可复性前移的患者。对患者关节周围肌肉进行按摩放松，随后进行关节盘手法复位，复位后2周内对患者进行下颌运动轨迹训练、关节稳定性训练和关节盘复位训练，白天自我维持下颌姿势位，夜间配戴压膜正位器，以保持良好的盘-髁关系。分别在治疗前、治疗后评价患者的最大主动开口度和疼痛视觉类比评分（visual analogue score，VAS），复位即刻、3、6个月MRI 复查盘-髁关系。结果：经过2周治疗，患者开口度明显改善，疼痛明显缓解。复位即刻、3、6个月，最大开口度均>40 mm，VAS评分均小于1。复位后半年MRI结果显示，9例为正常盘-髁关系，5例为可复性关节盘前移，1例为不可复性关节盘前移。结论：关节盘手法复位联合运动治疗及压膜正位器，可以恢复急性盘前移位患者开口度，缓解疼痛，对维持正常盘-髁关系有一定疗效。

Abstract:

Objective: This study aims to evaluate the short-term effect of manipulative reduction combined with physicotherapy and pressing membrane positioner on treatment of acute anterior disc displacement without reduction (ADDWoR) of the young patients. Methods: A total of 15 young patients (12 women and 3 men) were included in this study, with limited mouth opening confirmed by MR and diagnosed as ADDWoR (within 4 months). The local soft tissue relaxation was performed, followed by articular disc manual reduction. After 2 weeks, the patients underwent mandibular movement trajectory training, joint stability training and articular disc reduction training. During the day, the mandibular postural position was maintained by themselve, and the pressure film was used at night to maintain a good disc-condylar relationship. The maximum interincisal opening (MIO) and pain visual analogical score (VAS) (0-10 points) were evaluated before and after treatment. After finishing the whole treatment, the disc condyle relationship was checked by MRI within 6 months. Results: After 2 weeks of treatment, the MIO of the patients was obviously improved, increasing from 22.4±4.6 mm to 38.3±3.4 mm, and the VAS was significantly improved, reducing from 3.2±1.2 mm to 0.47±0.62 mm. All the patients underwent MRI examination at three months and six months after the treatment respectively. Among the included patients, 9 cases were diagnosed as normal disc-condylar relationship, and 5 case presented disc displacement with reduction (ADDWR), with only 1 case diagnosed as ADDWoR. Conclusion: The joint disc manipulation reduction combined with physical therapy and pressure membrane positioner can restore the opening of the patients with acute ADDWoR, relieve the pain, and have a certain effect on the maintenance of the normal disc-condyle relationship.

Key words:

font-size: 10.5pt, mso-spacerun: 'yes', mso-ascii-font-family: Calibri, mso-hansi-font-family: Calibri, mso-bidi-font-family: 'Times New Roman', mso-font-kerning: 1.0000pt">acute anterior disc displacement, MRI, manipulative reduction, physical training, pressing membrane positioner

中图分类号: 

• R782.4