本文選題：顳下頜關(guān)節(jié) + 習(xí)慣性脫位�。� 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討非直視下雙板區(qū)滑膜下注射治療顳下頜關(guān)節(jié)習(xí)慣性脫位的臨床效果,為顳下頜關(guān)節(jié)習(xí)慣性脫位治療尋求創(chuàng)傷小、定位準(zhǔn)確且療效可靠的新方法。方法:1病歷資料選擇:選取2014年10月至2016年6月期間在我院顳頜關(guān)節(jié)門診治療的32例習(xí)慣性顳下頜關(guān)節(jié)脫位的患者,其中單側(cè)22例、雙側(cè)10例,共42側(cè)關(guān)節(jié),平均病史3.61年(詳見附表1)。2研究方法:所有患者在術(shù)前都接受顳頜關(guān)節(jié)MRI檢查觀察關(guān)節(jié)盤形態(tài)、位置及髁突骨結(jié)構(gòu),采用非直視下雙板區(qū)滑膜下硬化劑注射治療,記錄術(shù)前及術(shù)后半年張口度變化以及脫位情況,術(shù)后24小時(shí)、3天、1周、2周、1月、3月分別記錄注射后關(guān)節(jié)疼痛的VAS值(表2)以及進(jìn)行頜功能問卷調(diào)查并記錄頜功能指數(shù)的變化(表3,表4),對(duì)所有患者隨訪6個(gè)月至兩年。3注射治療方法:首先將2%利多卡因與注射用生理鹽水按1:1的比例配成混合液,用5號(hào)針頭及5ml注射器抽取混合液5ml,令患者取45度仰臥位,頭偏向健側(cè),大張口,于平齊屏間切跡前約5mm處(如圖1)垂直進(jìn)針,皮下注射少許混合液,進(jìn)而向前約15°,向內(nèi)約30°,并向上進(jìn)入關(guān)節(jié)腔,注入混合液約2.5ml,然后緩慢退針,邊退針邊回吸,當(dāng)液體不能抽出時(shí)停止退針并做標(biāo)記(如圖2),注入5%魚肝油酸鈉0.5ml(如圖3),然后退針至皮下,內(nèi)外向改變進(jìn)針方向5°~10°可進(jìn)行多點(diǎn)注射,術(shù)畢,拔出針頭。4術(shù)后處理:將紗布采用十字交叉法對(duì)下頜進(jìn)行固定10天,囑患者兩周內(nèi)進(jìn)軟食流食。5統(tǒng)計(jì)方法:本研究以注射后無關(guān)節(jié)脫位為治療成功標(biāo)準(zhǔn),統(tǒng)計(jì)治療成功率。利用SPSS21.0統(tǒng)計(jì)處理軟件,分析術(shù)前及術(shù)后半年患者張口度;術(shù)后24小時(shí)、3天、1周、2周、1月的VAS值;術(shù)后24小時(shí)、3天、1周、1月、3月、半年的頜功能指數(shù),設(shè)定P0.05有統(tǒng)計(jì)學(xué)意義。結(jié)果:1成功率:有一位單側(cè)患者和一位雙側(cè)患者在半年內(nèi)進(jìn)行了二次注射,根據(jù)成功標(biāo)準(zhǔn),一次注射成功率為92.9%(39/42),隨訪兩年內(nèi),兩次注射成功率為100%(42/42)。2患者術(shù)后半年張口度(39.84±3.952)mm與術(shù)前張口度(47.69±4.115)mm采用Wilcoxon配對(duì)符號(hào)秩和檢驗(yàn)分析(z=-4.955,P=0.0000.05),差異有統(tǒng)計(jì)學(xué)意義。3采用秩和檢驗(yàn)分析術(shù)后注射區(qū)疼痛值:術(shù)后24小時(shí)(4,4)術(shù)后3天(4.47±2.170),術(shù)后1周(1,1),(?2=110.938,P=0.0000.05),兩兩比較后,發(fā)現(xiàn)術(shù)后24小時(shí)和術(shù)后3天以及術(shù)后2周和術(shù)后1月VAS無差異,其余均有差異。同理,對(duì)下頜功能的影響指數(shù)分析(?2=141.824,P=0.0000.05),術(shù)后24小時(shí)和術(shù)后3天以及術(shù)后1月和術(shù)后3月頜功能無差異,其余均有差異。結(jié)論:1非直視下雙板區(qū)滑膜下硬化劑注射治療治療習(xí)慣性脫位定位準(zhǔn)確,一次注射成功率為92.9%(39/42),兩次注射成功率為100%(42/42)。2非直視下雙板區(qū)滑膜下硬化劑注射創(chuàng)傷小,關(guān)節(jié)僅有輕度疼痛且一周內(nèi)消失,兩周至一月內(nèi)下頜功能運(yùn)動(dòng)恢復(fù)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 擄forward, 30 擄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 擄to 10 擄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 鹵3.952)mm and 47.69 鹵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 鹵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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R782.62

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