目的

探讨关节灌洗和透明质酸钠治疗不同病程的颞下颌关节（TMJ）不可复性关节盘前移位的临床效果。

方法

选择2006 年10 月至2009 年3 月TMJ 不可复性关节盘前移位126 例（138 侧关节）进行关节灌洗和透明质酸腔内注射治疗，按发病病程分为三组：6 个月以内组36 例；6 ～12 个月组42 例；12 个月以上组48 例。 随访12 ～36 个月（平均26 个月），并对三种方法的疗效进行比较。

结果

三组总有效率为88.9%（112/126）。 其中6 个月以内组术后张口度平均增加（8.2±3.4）mm，健侧侧向运动增加（4.8±1.4）mm，91.7%（33/36）患者疼痛明显缓解，有效率为94.4%（34/36）。 6 ～12 个月组张口度平均增加（8.0±3.2）mm，健侧侧向运动增加（4.4±1.5）mm，90.5%（38/42）患者疼痛明显缓解，有效率为92.9%（38/42）。12 个月以上组术后张口度平均增加（7.1±4.1）mm，健侧侧向运动增加（3.5±2.4）mm，81.3%（39/48）患者疼痛明显缓解，有效率为83.3%（40/48）。 三组比较，张口度、侧向运动改善、疼痛缓解及有效率，6 个月以内组和6 ～12 个月组均优于12 个月以上组（P ＜0.05），而6 个月以内组和6 ～12 个月组差异无统计学意义（P ＞0.05）。

结论

关节灌洗术和透明质酸钠治疗不可复性关节盘前移位是有效的治疗方法，发病在12 个月以内治疗效果明显优于12 个月以上。 因此，早期治疗有助于提高疗效。

Objective

To compare clinical effects of arthrocentesis and sodium hyaluronate in treatment of TMD disc displacement without reduction of different stages.

Methods

126 cases （138 joints） with TMD disc displacement without reduction underwent arthrocentesis and sodium hyaluronate injection.These cases were distributed to three groups according to course of diseases： less than 6 months； 6 to 12 months； and over 12 months.The follow-up period was 12 to 36 months （average 26 months）.The clinical effects of each group were compared.

Results

The total success rate of three groups was 88.9%（112/126）.In less 6 months group， postoperative MIO（maximum interincisal opening） increased （8.2±3.4）mm and lateral excursions increased （4.8± 1.4）mm in average.91.7%（33/36） out of all patients who complaining pain as main symptom released.The success rate was 94.4%（34/36）.In the group 6 ～12 months， postoperative MIO increased （8.0±3.2）mm and lateral excursions increased （4.4±1.5）mm.90.5%（38/42） of patients who had pain felt the symptoms reduced.The success rate was 92.9%（38/42）.In the group over 12 months， postoperative MIO increased （7.1±4.1）mm and lateral excursions increased （3.5±2.4）mm in average.81.3%（39/48） of patients had pain released.The success rate was 83.3%（40/48）.Comparing with MIO， lateral excursions， pain release and success rate， the group less 6 months and the group 6 ～12 months were better than that of the group over 12 months （P ＜0.05）， however no significant differences were found between the group less 6 months and the group 6 ～12 months （P ＞0.05）.

Conclusions

Arthrocentesis and sodium hyaluronate injection are the effective procedures in treatment of TMD disc displacement without reduction.However，the clinical effects were better in cases treated within 12 months than those over 12 months.Earlier treatment is better.