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北京大学学报（医学版） ›› 2024, Vol. 56 ›› Issue (2): 338-344. doi: 10.19723/j.issn.1671-167X.2024.02.022

• 论著 • 上一篇    下一篇

关节腔冲洗联合液态浓缩生长因子注射治疗单侧颞下颌关节骨关节炎的初步研究

李红光1,韩玮华1,吴训1,冯继玲2,李刚2,孟娟红1,3,*()   

  1. 1. 北京大学口腔医学院·口腔医院口腔颌面外科，北京 100081
    2. 北京大学口腔医学院·口腔医院口腔医学影像科，北京 100081
    3. 北京大学口腔医学院·口腔医院颞下颌关节病及口颌面疼痛诊治中心，国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔生物材料和数字诊疗装备国家工程研究中心，口腔数字医学北京市重点实验室，国家卫生健康委员会口腔医学计算机应用工程技术研究中心，国家药品监督管理局口腔生物材料重点实验室，北京 100081
  • 收稿日期:2023-10-09 出版日期:2024-04-18 发布日期:2024-04-10
  • 通讯作者: 孟娟红 E-mail:jhmeng@263.com

Preliminarily study of arthrocentesis combined with liquid phase concentrated growth factor injection in the treatment of unilateral temporomandibular joint osteoarthritis

Hongguang LI1,Weihua HAN1,Xun WU1,Jiling FENG2,Gang LI2,Juanhong MENG1,3,*()   

  1. 1. Department of Oral and Maxillofacial Surgery, Beijing 100081, China
    2. Department of Oral and Maxillofacial Radiology, Beijing 100081, China
    3. Center for Temporomandibular Joint Disorder and Orofacial Pain, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
  • Received:2023-10-09 Online:2024-04-18 Published:2024-04-10
  • Contact: Juanhong MENG E-mail:jhmeng@263.com

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摘要：

目的: 观察关节腔冲洗联合液态浓缩生长因子(concentrated growth factor, CGF)注射治疗单侧颞下颌关节骨关节炎(temporomandibular joint osteoarthritis, TMJOA)的短期临床效果, 以期为TMJOA患者提供新的治疗选择。方法: 采用非随机对照研究, 选择2021年6月至2023年1月于北京大学口腔医院颞下颌关节病及口颌面疼痛诊治中心就诊的单侧TMJOA患者作为研究对象, 分为试验组和对照组, 由患者自行选择入组。试验组行关节腔冲洗联合液态CGF注射治疗, 对照组行关节腔冲洗联合透明质酸(hyaluronic acid, HA)注射治疗, 分别治疗3次, 每两周1次。治疗完成后6个月通过最大自主张口度、疼痛值和下颌功能受限程度等指标评价临床治疗效果, 通过治疗前后的锥形束CT(cone beam CT, CBCT)图像融合技术评价髁突骨质的变化。结果: 试验组纳入20例患者, 其中男性3例, 女性17例, 平均年龄(34.40±8.41)岁; 对照组纳入15例患者, 其中男性1例, 女性14例, 平均年龄(32.20±12.00)岁, 两组患者一般资料差异无统计学意义(P＞0.05)。两组患者治疗前的张口度、疼痛值及下颌功能受限程度差异均无统计学意义(P＞0.05), 治疗后上述指标较治疗前均有所改善(P＜0.05), 但试验组患者治疗后的张口度显著大于对照组(P＜0.05), 下颌功能受限程度显著低于对照组(P＜0.05)。CBCT二维图像显示两组患者治疗后的髁突骨质均较治疗前光滑, 图像融合分析显示试验组10例(50.0%)患者和对照组5例(33.3%)患者的髁突出现修复改建区域, 两者之间差异无统计学意义(P＞0.05)。除1例试验组患者外, 两组其余患者的髁突均有部分区域吸收。结论: 关节腔冲洗联合液态CGF注射在短期内可以改善单侧TMJOA患者的临床症状和体征, 且在增加张口度和改善下颌功能方面优于HA对照组。两组患者的CBCT融合图像均显示部分病例有髁突骨质修复改建的表现, 但其与治疗方案的相关性仍需要扩大样本量进一步研究。

关键词: 颞下颌关节, 骨关节炎, 浓缩生长因子, 透明质酸, 关节腔注射

Abstract:

Objective: To observe the clinical effect of arthrocentesis combined with liquid phase concentrated growth factor (CGF) injection in the treatment of unilateral temporomandibular joint osteoarthritis (TMJOA), in order to provide a new treatment option for TMJOA patients. Methods: In this non-randomized controlled study, patients diagnosed with unilateral TMJOA who visited the center for temporomandibular joint disorder and orofacial pain of Peking University School and Hospital of Stomatology from June 2021 to January 2023 were selected as research objects. The patients were divided into experimental group and control group, which were selected by patients themselves. The experimental group received arthrocentesis combined with liquid phase CGF injection and the control group received arthrocentesis combined with HA injection. Both groups were treated 3 times, once every two weeks. The clinical effect was evaluated by the maximum mouth opening, pain value and the degree of mandibular function limitation 6 months after treatment. The change of condylar bone was evaluated by cone beam CT (CBCT) image fusion technology before and after treatment. Results: A total of 20 patients were included in the experimental group, including 3 males and 17 females, with an average age of (34.40±8.41) years. A total of 15 patients were included in the control group, including 1 male and 14 females, with an average age of (32.20±12.00) years. There was no statistical difference in general information between the two groups (P > 0.05). There were no statistical differences in the mouth opening, pain value and the degree of jaw function limitation between the two groups before treatment (P > 0.05), and all of them improved 6 months after treatment compared with before treatment (P < 0.05). However, the mouth opening of experimental group was significantly higher than that of control group 6 months after treatment (P < 0.05), and the degree of jaw function limitation was significantly lower than that of control group (P < 0.05). CBCT 2D images showed that the condylar bone of both groups was smoother after treatment than before treatment, and image fusion results showed that 10 patients (50.0%) in the experimental group and 5 patients (33.3%) in the control group had reparative remodeling area of condylar bone, and there was no statistical difference between them (P > 0.05). Except for one CGF patient, the other patients in both groups had some absorption areas of condylar bone. Conclusion: The arthrocentesis combined with liquid phase CGF injection can improve the clinical symptoms and signs of unilateral TMJOA patients in short term, and is better than HA in increasing mouth opening and improving jaw function. CBCT fusion images of both patient groups show some cases of condylar bone reparative remodeling and its relevance to treatment plans still requires further study.

Key words: Temporomandibular joint, Osteoarthritis, Concentrated growth factor, Hyaluronic acid, Intra-articular injection

中图分类号: 

  • R782.6

表1

治疗前后患者MMO的变化"

Items Experimental group Control group t P
Before treatment/mm, ${\bar x}$±s 31.20±4.72 30.06±4.70 0.704 0.486
After treatment/mm, ${\bar x}$±s 41.85±5.86 36.00±6.21 2.849 0.007
Mean change/mm, ${\bar x}$±s 10.65±5.53 5.93±7.11 2.211 0.034
t －8.616 －3.234
P ＜0.001 0.006

表2

治疗前后患者VAS值的变化"

Items Experimental group Control group t P
Before treatment, ${\bar x}$±s 62.25±22.39 57.33±16.24 0.719 0.477
After treatment, ${\bar x}$±s 11.50±10.89 17.33±9.42 －1.659 0.107
Mean change, ${\bar x}$±s －50.75±26.72 －40.00±19.91 －1.308 0.200
t 8.495 7.781
P ＜0.001 ＜0.001

表3

治疗前后患者JFLS平均分值的变化"

Items Experimental group Control group t P
Before treatment, ${\bar x}$±s 2.66±0.88 2.42±0.71 0.883 0.384
After treatment, ${\bar x}$±s 0.44±0.37 0.72±0.27 －2.477 0.019
Mean change, ${\bar x}$±s －2.23±1.00 －1.70±0.54 －2.108 0.043
t 9.913 11.118
P ＜0.001 ＜0.001

图1

1例患者关节腔注射CGF后髁突骨质修复改建图像示例"

图2

1例患者关节腔注射CGF后髁突骨质局部吸收图像示例"

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