非直视下双板区滑膜下注射治疗习惯性脱位的临床研究

发布时间：2018-06-21 19:10

本文选题：颞下颌关节 + 习惯性脱位　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:探讨非直视下双板区滑膜下注射治疗颞下颌关节习惯性脱位的临床效果,为颞下颌关节习惯性脱位治疗寻求创伤小、定位准确且疗效可靠的新方法。方法:1病历资料选择:选取2014年10月至2016年6月期间在我院颞颌关节门诊治疗的32例习惯性颞下颌关节脱位的患者,其中单侧22例、双侧10例,共42侧关节,平均病史3.61年(详见附表1)。2研究方法:所有患者在术前都接受颞颌关节MRI检查观察关节盘形态、位置及髁突骨结构,采用非直视下双板区滑膜下硬化剂注射治疗,记录术前及术后半年张口度变化以及脱位情况,术后24小时、3天、1周、2周、1月、3月分别记录注射后关节疼痛的VAS值(表2)以及进行颌功能问卷调查并记录颌功能指数的变化(表3,表4),对所有患者随访6个月至两年。3注射治疗方法:首先将2%利多卡因与注射用生理盐水按1:1的比例配成混合液,用5号针头及5ml注射器抽取混合液5ml,令患者取45度仰卧位,头偏向健侧,大张口,于平齐屏间切迹前约5mm处(如图1)垂直进针,皮下注射少许混合液,进而向前约15°,向内约30°,并向上进入关节腔,注入混合液约2.5ml,然后缓慢退针,边退针边回吸,当液体不能抽出时停止退针并做标记(如图2),注入5%鱼肝油酸钠0.5ml(如图3),然后退针至皮下,内外向改变进针方向5°~10°可进行多点注射,术毕,拔出针头。4术后处理:将纱布采用十字交叉法对下颌进行固定10天,嘱患者两周内进软食流食。5统计方法:本研究以注射后无关节脱位为治疗成功标准,统计治疗成功率。利用SPSS21.0统计处理软件,分析术前及术后半年患者张口度;术后24小时、3天、1周、2周、1月的VAS值;术后24小时、3天、1周、1月、3月、半年的颌功能指数,设定P0.05有统计学意义。结果:1成功率:有一位单侧患者和一位双侧患者在半年内进行了二次注射,根据成功标准,一次注射成功率为92.9%(39/42),随访两年内,两次注射成功率为100%(42/42)。2患者术后半年张口度(39.84±3.952)mm与术前张口度(47.69±4.115)mm采用Wilcoxon配对符号秩和检验分析(z=-4.955,P=0.0000.05),差异有统计学意义。3采用秩和检验分析术后注射区疼痛值:术后24小时(4,4)术后3天(4.47±2.170),术后1周(1,1),(?2=110.938,P=0.0000.05),两两比较后,发现术后24小时和术后3天以及术后2周和术后1月VAS无差异,其余均有差异。同理,对下颌功能的影响指数分析(?2=141.824,P=0.0000.05),术后24小时和术后3天以及术后1月和术后3月颌功能无差异,其余均有差异。结论:1非直视下双板区滑膜下硬化剂注射治疗治疗习惯性脱位定位准确,一次注射成功率为92.9%(39/42),两次注射成功率为100%(42/42)。2非直视下双板区滑膜下硬化剂注射创伤小,关节仅有轻度疼痛且一周内消失,两周至一月内下颌功能运动恢复正常。
[Abstract]:Objective: to investigate the clinical effect of subsynovial injection in the treatment of habitual dislocation of temporomandibular joint (TMJ), and to find a new method for the treatment of habitual temporomandibular joint dislocation (TMJ) with small trauma, accurate location and reliable curative effect. Methods: from October 2014 to June 2016, 32 patients with habitual temporomandibular joint dislocation were selected from October 2014 to June 2016. The mean history was 3.61 years (see schedule 1 / 2 for details) methods: all patients received MRI examination of temporomandibular joint to observe the shape, position and condylar bone structure of temporomandibular joint before operation, and were treated by injection of subsynovial sclerosing agent in the subsynovial region. The changes of mouth opening and dislocation before and after operation were recorded. The VAS values of articular pain after injection were recorded 24 hours and 3 days after injection (table 2), and the changes of maxillary function index were recorded (table 3, table 4). All patients were followed up for 6 months to 3 months. 2 years of injection treatment: first, the mixture of 2% lidocaine and saline for injection at 1:1, 5 ml mixture was extracted with 5 ml needle and 5ml syringe. The patient was placed 45 degrees supine, the head was inclined to the healthy side, the mouth was wide open, and the needle was inserted vertically at the 5mm (as shown in figure 1) before the horizontal interscreen notch, and a little mixture was injected subcutaneously. Then 15 掳forward, 30 掳inward, and up into the articular cavity, into the mixture of about 2.5 ml, then slowly back the needle, back to the needle while suction, When the fluid cannot be drawn out, the needle is stopped and marked (as shown in figure 2, 5% sodium morrhuate is injected 0.5 ml) (see figure 3), then the needle is removed to the subcutaneous level, and the direction of the needle is changed from 5 掳to 10 掳in both directions. Post-operative treatment: the gauze was fixed on the mandible with cross method for 10 days, and the patient was told to enter the soft food flow 5 statistical method within two weeks. In this study, the successful treatment standard was no joint dislocation after injection, and the success rate of treatment was counted. SPSS 21.0 software was used to analyze the degree of mouth opening before operation and half a year after operation, the VAS value of 24 hours after operation was 1 week, 2 weeks, 1 month, and 24 hours after operation, and the maxillary function index of 1 week, 1 month, 3 month, 6 months after operation was significantly higher than that of control group (P0.05). Results 1 success rate: one unilateral patient and one bilateral patient received two injections within half a year. According to the success criteria, the success rate of one injection was 92.939 / 42, followed up for two years. The success rate of twice injection was 100% 42 / 42. 2 patients with open mouth after operation 39.84 卤3.952)mm and 47.69 卤4.115)mm before operation with Wilcoxon matched sign rank sum test analysis. The difference was statistically significant. 3. 3 the pain value of postoperative injection area was analyzed by rank sum test: 24 small postoperative pain values were analyzed by rank sum test. 3 days after operation, 4. 47 卤2. 170, 1 week after operation, 2110.938, 0.0000. 05, after 1 week of operation, 0. 000 0. 05, 0. 000, 0. 000, 0. 005, 0. 000, 0. 005, 0. 000, 0. 05, 0. 000, 0. 005. There was no difference in VAS between 24 hours after operation and 3 days after operation and 2 weeks after operation and 1 month after operation. Similarly, there was no difference in mandibular function between 24 hours after operation, 3 days after operation and 1 month and 3 months after operation. Conclusion the injection of two subsynovial sclerosing agents into the two subsynovium areas is accurate in the treatment of habitual dislocation. The success rate of one injection is 92.9% 39 / 42, and the success rate of two injections is 100% 42 / 42%. 2 the injection of subsynovial sclerosing agent in non-direct area is less invasive. The joint had mild pain and disappeared within a week, and the mandibular movement returned to normal within 2 weeks to 1 month.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R782.62

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