摘要：

目的：评价关节灌洗术联合自体富血小板血浆注射术对不同年龄段颞下颌关节骨关节炎患者的疗效。方法：将60例颞下颌关节骨关节炎患者按年龄段分为3组：青年组（<45岁），中年组（45~65岁），老年组（>65岁）。所有患者均接受5周一个疗程的关节灌洗联合透明质酸钠关节腔注射术。在试验基线及治疗完成后的第1、3、6个月利用非辅助最大开口度、休息时及咀嚼时的疼痛感、关节运动功能障碍4项临床指标对各试验组结果进行评价。使用口腔健康影响程度（OHIP-14）量表评估各组患者治疗后的生存质量改善情况。采用Wilcoxon秩和检验对各组治疗前后试验结果进行比较，采用SNK-q检验法进行试验结果的组间两两比较。结果：3组患者治疗后生存质量显著提高（P<0.05）；青年组及中年组试验对象各项试验指标与治疗前比较疗效显著（P<0.05）；青年组咀嚼时关节疼痛感、关节运动功能障碍改善程度优于中年组及老年组（P<0.05）。老年组试验对象开口度明显提升（P<0.05），休息时疼痛感明显缓解（P<0.05），但咀嚼时疼痛感、关节运动功能障碍改善程度与治疗前相比无改善（P>0.05）。结论：自体富血小板血浆关节腔注射术的临床疗效与年龄相关，青年组患者能获得更好的整体疗效。

关键词: 颞下颌关节, 富血小板血浆, 骨关节炎, 关节腔注射

Abstract:

Objective: To evaluate the effect of joint lavage combined with platelet rich plasma injection on the treatment of temporomandibular joint osteoarthritis(TMJOA) patients of different ages. Methods: 60 cases of patients with TMJOA were selected and divided into 3 groups: the young group (<45 years old), middle-aged group (45-65 years old), and senior group (>65 years old). All the patients underwent a course of 5-weeks joint lavage combined with platelet rich plasma injection. Non-assisted maximum opening degree of mouth, the joint pain at rest and during chewing, and the joint movement disorders were measured in each test group at baseline and 1, 3, 6 months after treatment. The patients were measured for the quality of life at baseline and 6 months after treatment by using OHIP-14 scale. The results of patients from different aging groups before and after treatment were compared by using Wilcoxon rank sum test. Pairwise comparison of efficacy among groups was conducted by using the SNK-q test method. Results: The qualities of life were significantly improved in each group(P<0.05). The curative effect of young group and middle-aged group was significant compared with that before treatment (P<0.05). The improvement of the joint pain during chewing and the mandibular movement dysfunctions in the young group was better than that in the middle-aged group and the senior group(P<0.05). The rest pain in patients of the senior group has been significantly alleviated after treatment(P<0.05). And the maximum mouth opening was significantly increased (P<0.05). However, the improvement of the joint pain during chewing and joint motor dysfunction during mastication was not improved compared with those before treatment（P>0.05）. Conclusion: The clinical efficacy of articular cavity injection of autologous platelet rich plasma is related to age. The young patients can obtain better overall efficacy.

Key words: temporomandibular joint, platelet-rich plasma, osteoarthritis, articular cavity injection