在伴有躯体功能障碍和无躯体功能障碍的颞下颌关节牙畸形和肌肉骨骼功能障碍患者中,正畸和骨科矫正的有效性

E. V. Basieva, Yu. A. Milutka, N. A. Tarasov, A. Silin, D. Mokhov
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引用次数: 3

摘要

介绍。几十年来,牙科器械对直立身体平衡的影响在文献中得到了广泛的讨论。对患者进行体位平衡检查,可以澄清错颌合引起的颅颈疼痛综合征治疗效果低的原因,以及与姿势障碍相关的颞下颌关节肌肉骨骼功能障碍(MSD TMJ)矫正无效的原因。本研究的目的是评估用正畸和整骨矫正方法治疗牙畸形和颞下颌关节肌肉骨骼功能障碍以及伴随的躯体功能障碍(如果有的话)患者的有效性。材料和方法。这项研究涉及102名年龄在18岁到45岁之间的颞下颌关节患者。所有患者均行正畸及整骨检查。形成了3组患者:第1组-仅接受正畸治疗的牙齿异常TMJ(闭塞功能障碍),第2组伴有躯体(闭塞外)功能障碍,仅接受正畸治疗,第3组伴有躯体(闭塞外)功能障碍,接受正畸和整骨治疗。颞下颌关节肌肉骨骼功能障碍的正畸治疗包括闭塞性卡帕制造。考虑到确定的躯体功能障碍,单独进行整骨矫正,平均3次。患者还接受了药物治疗,并对咀嚼肌进行了肌肉体操。临床功能障碍指数(Helkimo M.)用于控制颞下颌关节肌肉骨骼功能障碍症状的消除动态。采用视觉模拟量表(VAS)评估颞下颌关节疼痛动态。在计算机稳定性测量数据和骨科检查数据的基础上对整骨疗法的疗效进行评估。稳定性测量研究在Romberg样品的«ST-150»(«Biomera»)稳定平台上进行(欧洲足部安装),在下颌的两个位置上打开和关闭眼睛:1)处于生理休息状态(牙齿排分开);2)牙排闭合。第1组和第3组所有(100%)患者在治疗开始后10周均消除了MSD TMJ症状。在第2组患者中,只有12.1%的患者完全没有MSD TMJ症状,而该组患者的Helkimo功能障碍临床指标均有统计学意义的降低。在三分之一的组№2患者在第12周的正畸治疗,头痛和/或疼痛在其他部分的肌肉骨骼系统(颈部,背部,肩膀,手臂)盛行的投诉,这是以前指出的记忆。这发生在消除MSD颞下颌关节症状之后。绝大多数患者在组3(97,1 %)注意到头痛和/或疼痛在其他部分的肌肉骨骼系统(颈部,背部,肩膀,手臂)的完全消失。本组患者在生理休息状态和kappa状态下,各项稳定指标均归一化。患有躯体功能障碍的患者需要在整骨医生和牙医的参与下进行复杂的治疗。在评估患者的骨科状态时,重要的是要确定患者是否只有闭塞性功能障碍,还是也有闭塞性功能障碍。对于闭塞外功能障碍的患者,建议进行额外的整骨矫正,以获得在有效性和时间上可比较的治疗结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The effectiveness of orthodontic and osteopathic correction in patients with dental anomalies and musculoskeletal dysfunction of the temporomandibular joint in the presence of concomitant somatic dysfunctions and without it
Introduction. The influence of the dental apparatus on the balance of the body in an upright position has been widely discussed in the literature for several decades. Examination of the patient taking into account his postural balance makes it possible to clarify the reasons for the low effectiveness of pain syndromes treatment of the craniocervical region caused by malocclusion, as well as ineffective correction of musculoskeletal dysfunction of the temporomandibular joint (MSD TMJ) associated with posture disorders.The aim of the study is to evaluate the effectiveness of treatment of patients with dental anomalies and musculoskeletal dysfunctions of the temporomandibular joint and concomitant somatic dysfunctions (if any) by methods of orthodontic and osteopathic correction.Materials and methods. The study involved 102 patients aged from 18 to 45 years with TMJ. All patients underwent orthodontic and osteopathic examination. 3 groups of patients were formed: № 1 — exclusively with dental anomalies TMJ (occlusive dysfunction), who received only orthodontic treatment, № 2 with concomitant somatic (extra-occlusive) dysfunctions, who received only orthodontic treatment, and №3 with concomitant somatic (extra-occlusive) dysfunctions, who received both orthodontic and osteopathic treatment. Orthodontic treatment of musculoskeletal dysfunction of the TMJ consisted of the occlusive kappa manufacturing. Osteopathic correction was carried out individually, taking into account the identified somatic dysfunctions, on average 3 sessions. Patients also received drug therapy, and they performed myohymnastics for the masticatory muscles. The clinical dysfunction index (Helkimo M.) was used to control the elimination dynamics of the TMJ's musculoskeletal dysfunction symptoms. The assessment of the pain dynamics in the TMJ was carried out by a visual-analog scale (VAS). The evaluation of the osteopathic treatment effectiveness was carried out on the basis of computer stabilometry data and osteopathic examination data. A stabilometric study was performed on the «ST-150» («Biomera») stabiloplatform in the Romberg sample (European foot installation) with open and closed eyes in two positions of the lower jaw: 1) in a state of physiological rest (tooth rows are separated); 2) in the kappa with closed tooth rows.Results. The MSD TMJ symptoms were eliminated 10 weeks after the start of treatment in all (100 %) patients of group № 1 and group № 3. Among the patients in group № 2, only 12,1 % of patients had complete absence of MSD TMJ symptoms, while all patients in this group had a statistically significant decrease in the clinical index of Helkimo dysfunction. In one third of the group № 2 patients on the 12th week of orthodontic treatment, headaches and/or pains in other parts of the musculoskeletal system (neck, back, shoulders, arms) prevailed among complaints and which were previously indicated in the anamnesis. This occurred after the elimination of the MSD TMJ symptoms. The absolute majority of patients in group № 3 (97,1 %) noted the complete disappearance of headaches and/or pains in other parts of the musculoskeletal system (neck, back, shoulders, arms). Also, in patients of this group, stabilometric indicators were normalized in a state of physiological rest and in the kappa.Conclusion. Patients with somatic dysfunctions need complex treatment with the participation of an osteopath and a dentist. When assessing the osteopathic status of a patient, it is important to determine whether the patient has only occlusive dysfunctions or there are also extra-occlusive ones. Additional osteopathic correction is recommended for patients with extraocclusive dysfunctions in order to achieve treatment results comparable in effectiveness and timing.
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