以藥物及中心關係咬合板治療不可復位性關節盤異位的改善率－回溯性世代研究

The Improvement of Disc Displacement without Reduction under Pharmacotherapy and Centric Relation Occlusal Splint Therapy-A Retrospective Cohort Study

林靖萍(Ching-Ping Lin) ； 康家郡(Chia-Chun Kang) ； 黃怡嘉(Yi-Chia Huang) ； 楊榮武(Jung-Wu Yang)

《臺灣口腔顎面外科學會雜誌》 28卷1期 (2017/03) Pp. 1-12

摘要

目的：以保守療法治療顳顎關節障礙的療效至今仍未有定論。本研究的目的是要探討，不可復位性關節盤異位的病人在接受藥物及中心關係咬合板治療的臨床進展。方法：參與此回溯性世代研究的族群，是自2013年10月到2016年06月於台南新樓醫院口腔顎面外科接受治療的顳顎關節障礙病人中選出。預測變項爲治療方法。結果變項包括關節異聲、張口歪斜、因顳顎關節障礙引發的頭痛、肌筋膜疼痛伴隨牵引痛、關節痛以及最大正中門齒齒間張口度。本研究以McNemar卡方檢定，配對t檢定以及複迴歸來做統計分析。結果：101位病人中，31位爲男性（30.69%)，70位爲女性（69.31%)。年齡分佈自15歲到84歲（平均年齡爲42.62±15.83歲）。以藥物治療後，除了關節異聲、張口歪斜及因顳顎關節障礙引發的頭痛沒有達到統計上有意義的改善(p＞0.05)之外，其他症狀如肌筋膜疼痛伴隨牵引痛、關節痛以及最大正中門齒齒間張口度都有達到統計上有意義的改善（p＜0.05)。以中心關係咬合板治療後，所有的症狀都有到統計上有意義的減緩。結論：以中心關係咬合板治療前都應該先以藥物治療減緩病人的症狀，以中心關係咬合板治療最好要超過一年以上。

關鍵字

顳顎關節障礙 ； 中心關係咬合板 ； 不可復位性關節盤異位 ； 藥物治療

並列摘要

Purpose: So far, the efficacy of conservative treatments for treating temporomandibular disorders (TMD) has not been settled yet. The objective of this study is to explore the clinical improvement of disc displacement without reduction (DDWOR) patients receiving pharmacotherapy and centric relation occlusal splint (CROS) therapy. Methods: The population of this retrospective cohort study was selected from TMD patients treated by Department of Oral and Maxillofacial Surgery, Tainan Sin-Lau Hospital from October 2013 to June 2016. The predictor variable is the therapeutic method. The outcome variables include joint sound, deviation of the mandible (DoM), headache attributed to TMD, myofascial pain with referral, arthralgia, and maximal interincisal opening (MIO). McNemar X^2 test, paired t test and multiple regression are used for analysis. Results: Among the 101 patients, there are 31 males (30.69%) and 70 females (69.31 %). Distribution by age ranges from 15 to 84 years of age (mean age 42.62 ± 15.83 years). After pharmacotherapy, except joint sound, DoM and headache attributed to TMD which failed to achieve significant improvement (p ＞ 0.05), other symptoms such as myofascial pain with referral, arthralgia and MIO have all achieved statistically significant improvement (p ＜ 0.05). After CROS treatment, all symptoms have been relieved. Conclusion: Pharmacotherapy should be administered before CROS therapy to relieve the patients' symptoms, and CROS therapy should be administered for at least one year.

並列關鍵字

Temporomandibular disorders ； Centric relation occlusal splint ； Disc displacement without reduction ； Pharmacotherapy