颞下颌关节紊乱综合征(TMD)是一种影响颞下颌关节及其周围肌肉和相关结构的临床问题,表现为关节疼痛、咀嚼肌功能障碍等症状。颞下颌关节疼痛常包含咀嚼肌疼痛、颞下颌关节疼痛和头痛等,其中最常见的疼痛为咀嚼肌疼痛,约占颞下颌关节紊乱综合征总人数的45%,咀嚼及疼痛的主要特征为局部疼痛或者牵涉痛、肌肉僵硬以及不明病因的肌肉感觉改变,A型肉毒毒素(BTX-A)作为一种非手术治疗手段,因其能够缓解咀嚼肌过度紧张与疼痛,逐渐受到临床研究的关注。本文综述了BTX-A在治疗TMD中的应用,包括其作用机制、对肌肉疼痛和最大张口度(MMO)的影响,以及其安全性和副作用。Temporomandibular joint disorder syndrome (TMD) is a clinical problem affecting the temporomandibular joint and its surrounding muscles and related structures, which manifests itself as joint pain, masticatory muscle dysfunction, etc. Temporomandibular joint pain often includes masticatory muscle pain, temporomandibular joint pain and headache, among which masticatory muscle pain is the most common pain, accounting for about 45% of the total number of temporomandibular joint disorder syndrome. The main characteristics of mastication and pain are local pain or referred pain, muscle stiffness and muscle sensory changes of unknown etiology. Botulinum toxin type A (BTX-A), as a non-surgical treatment, is gradually gaining attention in clinical studies because of its ability to alleviate the excessive tension and pain of masticatory muscles. This article reviews the application of BTX-A in the treatment of TMD, including its mechanism of action, effects on muscle pain and maximum mouth opening (MMO), as well as its safety and side effects.
目的评价咬合板结合家庭疗法在咀嚼肌肌筋膜疼痛的疗效。方法选取2019年6月至2021年6月于广西医科大学附属口腔医院口腔修复科进行稳定型咬合板结合家庭疗法治疗的咀嚼肌肌筋膜疼痛患者32例,分析治疗3个月后的临床有效率。于治疗前和治疗后3个月行疼痛视觉模拟评分(visual analogue scale,VAS)和T-ScanⅢ数字化咬合评估系统检查,分别评估患者的疼痛程度及咬合功能,咬合功能包括:(牙合)力不对称指数(asymmetry index of occlusal force,AOF)、(牙合)力中心点位置(center of force,COF)、(牙合)接触点数(number of occlusal contacts,NOC)、闭(牙合)时间(occlusal time,OT)。结果(1)治疗后,临床有效率为93.75%;(2)VAS、AOF、COF、OT均较治疗前降低(P<0.05);NOC在治疗前后差异无统计学意义(P>0.05)。结论稳定型咬合板结合家庭疗法治疗咀嚼肌肌筋膜疼痛可有效缓解疼痛和改善咬合功能。
