摘要
目的归纳关节镜下黏连(Intraarticular adhesion,IA)的分级及分布,阐明不同颞下颌关节(Temporomandibular joint,TMJ)结构紊乱(internal derangement,ID)分期中IA的发生率;探讨IA与患者年龄、可视化疼痛测量值(Visual Analogue Scale,VAS)、弹响持续时间、张口受限持续时间及术前张口度之间的关系;比较镜下IA治疗方法。方法关节镜诊断IA及其疗效评价,按九分法记录IA分布及分级,统计各区IA比例。将患者分为IA组和无IA组,对两组患者年龄、关节弹响持续时间、锁合期、VAS值和术前张口度进行t检验;对IA患者行临床疗效评价。结果关节镜诊断证实1822侧关节中,有524侧有IA,其比例为28.86%。IA分布为I区82.13%,Ⅱ区8.40%,Ⅲ区9.47%;各级IA为1级68.89%,2级20.61%;3级4.58%;4级5.92%;IA在ID中构成比为II期13.89%,Ⅲ期25.47%,Ⅳ期37.99%,Ⅴ期40.37%;IA术后临床评价有效率90.14%,IA组与无IA组患者平均年龄(t=10.41 P<0.001)、术前平均张口度(t=9.54 P<0.001)、疼痛持续时间(t=3.66,P<0.001)、术前平均锁合期(t=3.89 P<0.001)均有显著性差异;而弹响持续时间(t=1.08P>0.05)则无显著性差异。结论关节镜证实IA发生率是较高的,主要发生在年龄大,锁合期长和张口度小的患者;ID分期越高,IA分级亦升高。
Objective To sum up the classification and distribution of arthroscopic adhesion（Intraarticular adhesion,IA）,and clarify the incidence of IA in different structural disorder（internal derangement,ID） stage;to discuss the relationship between IA and the patients′ age,paining duration,snapping duration,limited mouth opening and preoperative duration of mouth opening;to compare the treatment of IA under arthroscopy.Methods This study was carried out of the arthroscopic diagnosis and efficacy evaluation of IA according to nine points,recorded the distribution and classification of IA,and made statistical analysis of the proportion of IA in different districts.The patients were divided into the IA group and non-IA group.The relations between the two groups with respect to interincisal opening,clicking duration,locking duration and patients′ age were statistically analyzed by adopting a t-test;and clinical evaluation of patients with IA were conducted.Results Arthroscopy confirmed the occurrences of adhesion in 28.76% of the joints（524 joints out of a total of 1822）.Grade 1 adhesion was found in 68.89% of those cases;grade 2 in 20.61%;grade 3 in 4.58%;and grade 4 in 5.92%.The percentages of the instances of adhesion in different stages were as follows： 13.89% of the joints in Stage II had adhesion,25.47% in Stage III,37.99% in Stage IV,and 40.37% in Stage V.There were statistically significant differences for patients′ age（t =10.41,P0.001）,interincisal opening（t = 9.54,P 0.001）,paining duration（t=3.66,P0.001） and locking duration（t=3.89,P0.001） between the two groups,while no statistically significant difference was found for clicking duration（t= 1.08,P0.05）.Conclusions The arthroscopic findings confirmed that the incidence rate of adhesion was high,mainly occurring in the older patients with longer locking duration and less interincisal opening.As the stage of ID increased,the adhesion′ grade rose.
出处
《口腔材料器械杂志》
2010年第4期187-191,共5页
Chinese Journal of Dental Materials and Devices
基金
上海市重点学科建设项目资助(S30206)
上海市卫生局课题资助(2008160)
上海交通大学医工交叉基金(YG2009MS42)
上海交通大学医学院"博士创新基金"资助项目(BXJ0926)
上海市自然基金(10ZR1418200)
教育部博士点基金(20090073110068)~~
关键词
颞下颌关节
囊内黏连
关节镜
Temporomandibular joint Intraarticular adhesions Arthroscopy
