【摘要】 目的 研究临床以弹响消失位作为调位垫治疗位的可行性，进一步探讨调位位作为调位垫治疗垫的治疗机理。方法 25名接受调位垫治疗的可复性盘前移位患者，以弹响消失位制作调位垫，在关节造影下验证盘/突位置改变，观察临床治疗效果。结果 25名患者中，19人盘-突完全复位，5人复位不全，1人未复位，治疗过程中盘-突复合体运动协调。治疗后关节区舒适，开口型改变，关节弹响减轻。结论 以临床弹响消失位作为调位垫的治疗位是可行的。调位垫通过改变盘-突位置关系，改善盘-突复合体运动的协调性，有利于盘后区的机化和盘后带改建，从而达到治疗目的。
to probe into the practicability of using the jaw position of eliminating tmj clicks as the therapeutic position of repositioning splint
yang desheng, han ke, zhou shumin, et al.
(department of stomatology, general hospital of armed police beijing 100039, china)
【abstract】 objective to evaluate that it was practicable to use the jaw position of eliminating tmj clicks as the therapeutic position of repositioning splint and to probe into the therapeutic mechanism of repositioning splint.methods 25 patients with reducible disc displacement were treated with repositioning splint. the therapeutic jaw position was the position without tmj clicking, then verified by arthrography. the treatment effect was observed.results among 25 cases, 19 discs were completely recaptured, 5 incompletely recaptured, 1 not recaptured. once the splints inserted, the movements of disc-condyle complex were smooth. after treatment finished, the opening types were improved, the clicks were lessened.conclusions it's practicable to use the jaw position of eliminating clicks as the treatment jaw position of repositioning splint. the therapeutic mechanism of repositioning splint may be that it altered the relationship of disc and condyle and improved their movement. that was favorable to fibrize the retrodiscal tissue and to strengthen the posterior band of disc.
【key words】 repositioning splint; arthrography； temporomadibular joint
可复性盘前移位是指正中位时关节盘后带位于髁突横嵴之前，在髁突滑动中可恢复正常位置关系。这是颞下颌关节内紊乱中最常见的类型，弹响是其最常见的症状。调位垫可以改善盘-突位置关系，是一种保守治疗可复性盘前移位的有效方法。临床上常以弹响消失位作为其调位位置。临床定位能否恢复正常的盘-突位置关系，调位后盘-突运动是否协调等，对客观评价调位垫的作用机理与认识可复性盘前移位的临床意义均有帮助。本项研究以可复性盘前移位患者戴用调位垫的临床疗效及对关节造影的动态观察，评价临床确定治疗位的可行性，进一步认识调位垫的治疗机理。
材料和方法
1.研究对象： 北京医科大学口腔医院关节病中心诊断为可复性盘前移位，弹响声能在前伸对刃位内（包括对刃位）消失，愿意配合调位垫治疗者25人。其中男5人，女20人，年龄17～43岁，平均26岁。病程1个月～1年。
2.临床治疗位的确定： 患者大张口，听到弹响声后闭口于对刃位，逐渐后退，同时作开闭口运动，寻找弹响消失、前伸最小位置。待患者熟悉此位后，以蜡记录。
3.x线造影关节运动监测：行关节下腔造影，戴用调位垫，在闭口位观察盘-突位置关系改变情况。判别标准如下：髁突横嵴位于关节盘后带最厚处之前为完全复位；髁突横嵴位于关节盘后带之后为未复位；髁突横嵴位于关节盘后带，但未到达最厚处为复位不全。对于未复位者，以烫软的红色打样膏在造影下记录其盘-突复位时的位，重新制作调位垫。嘱患者作开闭口运动，观察盘-突复合体的运动协调性。本新闻共3页,当前在第1页123
责任编辑：韩晓炜
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