中国实用口腔科杂志

中国实用口腔科杂志 ›› 2025, Vol. 18 ›› Issue (1): 48-53.DOI: 10.19538/j.kq.2025.01.008

• 论著 • 上一篇    下一篇

关节镜引导下关节灌洗术联合再定位牙合板治疗急性不可复性盘前移位的临床效果分析

郝文杰1，张兴安2，谭小尧2，明华伟2，陈方园2，袁宗毅2，胡旗升1   

  1. 1. 川北医学院口腔医学院，四川 南充 637000；2. 首都医科大学附属北京安贞医院南充医院·南充市中心医院口腔颌面外科，四川 南充 637000
  • 出版日期:2025-01-30 发布日期:2025-01-30
  • 基金资助:
    四川省基层卫生事业发展研究中心课题（SWFZ20-C-081）；南充市科技局市校科技战略合作项目（20SXQT0261）

  • Online:2025-01-30 Published:2025-01-30

摘要： 目的    分析关节镜引导下关节灌洗术联合再定位牙合板治疗急性不可复性盘前移位（anterior disc displacement without reduction，ADDWoR）的临床效果。方法    选取2022年6月至2024年7月于首都医科大学附属北京安贞医院南充医院·南充市中心医院口腔颌面外科就诊的急性ADDWoR患者90例，采用随机数字表法将患者分为试验组（46例，行关节镜引导下关节灌洗术联合再定位牙合板治疗）和对照组（44例，行常规穿刺关节灌洗术联合再定位牙合板治疗）。记录治疗前及治疗后6个月的视觉模拟量表（visual analogue scale，VAS）评分、最大张口度（maximum mouth opening，MMO）、颞下颌关节紊乱指数（craniomandibular index，CMI）、关节盘长度、髁突高度、关节滑液中的白细胞介素-6（interleukin-6，IL-6）浓度，以及治疗后6个月的并发症发生情况并判定疗效。结果    治疗前，2组患者的VAS评分、MMO、CMI、关节盘长度、髁突高度及IL-6浓度比较，差异均无统计学意义（均P > 0.05）。治疗后6个月，2组患者的MMO较治疗前明显增加，VAS评分、CMI及IL-6浓度较治疗前明显下降，且试验组下降更明显；试验组患者的关节盘长度及髁突高度较治疗前明显增加，差异均有统计学意义（均P < 0.05）。2组患者均未发生相关并发症。试验组治疗有效率为87.0%（40/46），明显高于对照组［72.7%（32/44）］，差异有统计学意义（χ2 = 6.219，P = 0.045）。结论    关节镜引导下关节灌洗术联合再定位牙合板治疗急性ADDWoR效果较佳，其不仅可较好改善患者的主观疼痛症状，还可促进髁突高度和关节盘长度、功能的恢复，是一种安全、有效、微创的新型治疗方法。

关键词: 关节镜, 关节灌洗术, 再定位牙合板, 急性不可复性盘前移位

Abstract: Objective    To analyze the clinical effect of arthroscopic irrigation combined with repositioning splint in the treatment of acute anterior disc displacement without reduction（ADDWoR）. Methods    A total of 90 patients with acute ADDWoR who visited the Department of Oral and Maxillofacial Surgery of Nanchong Hospital Affiliated to Beijing Anzhen Hospital，Capital Medical University（Nanchong Central Hospital）from June 2022 to July 2024 were selected and randomly divided into the experimental group（46 patients，treated with arthroscopic irrigation combined with repositioning splint）and the control group（44 patients，treated with conventional puncture irrigation combined with repositioning splint）using a random number table. The visual analogue scale（VAS）score，maximum mouth opening（MMO）craniomandibular index（CMI），disc length，condylar height and interleukin-6（IL-6）concentration in synovial fluid before treatment and at 6 months after treatment were recorded. Complications at 6 months after treatment were also recorded，and the therapeutic effects were evaluated. Results    Before treatment，there were no statistically significant differences in VAS score，MMO，CMI，disc length，condylar height or IL-6 concentration between the two groups（all P > 0.05）. Six months after treatment，MMO significantly increased，while VAS score，CMI and IL-6 concentration significantly decreased in both groups compared with before treatment，with more pronounced decrease in the experimental group. Additionally，disc length and condylar height significantly increased in the experimental group compared with before treatment（all P < 0.05）. No related complications occurred in either group. The effective rate of treatment in the experimental group was 87.0%（40/46），significantly higher than that in the control group ［72.7%（32/44）］，with a statistically significant difference（χ2 = 6.219，P = 0.045）. Conclusion    Arthroscopic irrigation combined with repositioning splint is an effective treatment for acute ADDWoR. It not only significantly improves the patient′s subjective pain symptoms but also promotes the recovery of condylar height，disc length and function. It is a safe，effective and minimally invasive novel treatment method.

Key words: arthroscope, articular irrigation, repositioning splint, acute anterior disc displacement without reduction