中国组织工程研究

中国组织工程研究 ›› 2022, Vol. 26 ›› Issue (20): 3225-3229.doi: 10.12307/2022.625

• 口腔组织构建 oral tissue construction • 上一篇    下一篇

活血化瘀汤与跌打万花油热敷结合咬合板改善颞下颌关节紊乱患者的软组织张力

冯 兵1，潘晶晶1，杨 斌1，许剑恒1，刘德裕2，史静琴1，宋振华1   

  1. 中南大学湘雅医学院附属海口医院，1康复医学科，2口腔颌面外科，海南省海口市   570208
  • 收稿日期:2021-04-14 修回日期:2021-04-16 接受日期:2021-06-09 出版日期:2022-07-18 发布日期:2022-01-19
  • 通讯作者: 宋振华，硕士，主任医师，中南大学湘雅医学院附属海口医院康复医学科，海南省海口市 570208
  • 作者简介:冯兵，男，1983年生，安徽省金寨县人，汉族，主管技师，主要从事肌骨及内脏康复方面的研究。
  • 基金资助:
    海南省卫生健康行业科研项目(20A200155) ，课题名称：肌内效贴在治疗颞下颌关节紊乱病中的临床研究，项目负责人：冯兵

Huoxue Huayu Decoction and Dieda Wanhua Oil hot compress combined with occlusal splint improve soft tissue tension in patients with temporomandibular joint disorders

Feng Bing1, Pan Jingjing1, Yang Bin1, Xu Jianheng1, Liu Deyu2, Shi Jingqin1, Song Zhenhua1   

  1. 1Department of Rehabilitation Medicine, 2Department of Oral and Maxillofacial Surgery, Affiliated Haikou Hospital of Central South University Xiangya School of Medicine, Haikou 570208, Hainan Province, China
  • Received:2021-04-14 Revised:2021-04-16 Accepted:2021-06-09 Online:2022-07-18 Published:2022-01-19
  • Contact: Song Zhenhua, Master, Chief physician, Department of Rehabilitation Medicine, Affiliated Haikou Hospital of Central South University Xiangya School of Medicine, Haikou 570208, Hainan Province, China
  • About author:Feng Bing, Technologist-in-charge, Department of Rehabilitation Medicine, Affiliated Haikou Hospital of Central South University Xiangya School of Medicine, Haikou 570208, Hainan Province, China
  • Supported by:
    the Scientific Research and Development Project of Hainan Health Committee, No. 20A200155 (to FB)

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摘要：

文题释义：
颞下颌关节紊乱：是临床上常见的口腔疾病，在所有的颞下颌关节疾病中其发病率最高，主要临床症状为下颌运动障碍、颞下颌关节运动有弹响以及关节区域疼痛等，其发病原因较多，一般认为关节解剖因素、关节负荷过重、免疫因素、社会心理因素是造成此疾病的主要因素。
活血化瘀汤：来自王清任编写的《医林改错》，此方中红花、桃仁、川穹、赤芍能够活血行气，川穹能够下行气海，上至颠顶，是血中气药；加入大枣能够调和脾胃；加入老葱白为厥阴经，归少阳，其能够通络止痛、辛香开窍；蜈蚣全蝎能够通络止痛、祛风解痉；白芷能够至痛疏风；应用黄酒煎服能够加强活血功效；全方能够开窍止痛、祛风通络、活血行气。

背景：咬合治疗是对颞下颌关节紊乱的一种保守治疗方法，具有较久的治疗历史，但是其疗效也具有不少争议，患者病情极易复发。传统中医药治疗颞下颌关节紊乱取得了良好的疗效，并逐渐得到大家的关注。
目的：探讨活血化瘀汤与跌打万花油热敷结合咬合板对颞下颌关节紊乱患者的治疗作用以及对患者患侧软组织张力的影响。
方法：选择2017年1月至2019年10月在中南大学湘雅医学院附属海口医院进行治疗的60例颞下颌关节紊乱患者，随机分为2组，每组30例。对照组患者上颌佩戴稳定性咬合板进行治疗，观察组患者在对照组的基础上结合活血化瘀汤和跌打万花油热敷进行治疗。对比两组患者的临床疗效、开口度、颞下颌关节紊乱指数(Fricton指数)、关节压痛以及软组织张力。
结果与结论：①经过活血化瘀汤、跌打万花油以及咬合板治疗后，观察组患者的治疗总有效率为97%，高于单独应用咬合板的对照组患者(73%)(P < 0.05)；②治疗后观察组开口度在3.0-3.9 cm的患者明显增多，且优于单独应用咬合板的对照组(P < 0.05)；③经过治疗后两组患者的各项Fricton指数均有所下降(P < 0.05)，且观察组患者的各项Fricton指数均低于对照组(P < 0.05)；④治疗后两组患者的压痛目测类比评分均有降低(P < 0.05)，且观察组患者的压痛目测类比评分低于对照组(P < 0.05)；⑤治疗后两组患者的软组织张力均有所升高，且观察组患者的软组织张力高于对照组(P < 0.05)；⑥提示应用活血化瘀汤与跌打万花油热敷结合咬合板治疗颞下颌关节紊乱效果显著，能够增大患者的开口度，降低Fricton指数，从而改善患者的患侧软组织张力。

https://orcid.org/0000-0002-5065-9482(冯兵) 

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

关键词: 活血化瘀汤, 跌打万花油, 咬合板, 颞下颌关节紊乱, 软组织张力

Abstract: BACKGROUND: Occlusal therapy, with a long history, is a conservative treatment for temporomandibular joint disorders. However, its efficacy is still controversial. Patients undergoing occlusal therapy are prone to relapse. Traditional Chinese Medicine has achieved good results in the treatment of temporomandibular joint disorders, which has been gradually concerned.
OBJECTIVE: To investigate the therapeutic effect of Huoxue Huayu Decoction and Dieda Wanhua Oil hot compress combined with occlusal splint in patients with temporomandibular joint disorders and the effect on the soft tissue tension of the affected side. 
METHODS: Sixty patients with temporomandibular joint disorders who were treated at the Affiliated Haikou Hospital of Central South University Xiangya School of Medicine from January 2017 to October 2019 were recruited and randomly divided into two groups (n=30 per group): an observation group and a control group. Patients in the control group were treated with an occlusal splint on their upper jaw, while patients in the observation group were treated with Huoxue Huayu Decoction and Dieda Wanhua Oil hot compress based on the use of occlusal splints. The clinical efficacy, degree of mouth opening, temporomandibular joint disorder index (Fricton index), joint tenderness and soft tissue tension were compared between the two groups. 
RESULTS AND CONCLUSION: After the treatment of Huoxue Huayu Decoction, Dieda Wanhua Oil, and occlusal splint therapy, the total effective rate of the observation group was 97%, which was higher than that of the control group (73%; P < 0.05). Compared with the control group, there was a significant increase in the number of patients with the mouth opening of 3.0-3.9 cm (P < 0.05). The Fricton index values were decreased in both groups (P < 0.05), and the Fricton index values in the observation group were lower than those in the control group (P < 0.05). The Visual Analog Scale scores were reduced in both group after treatment (P < 0.05), and the score of tenderness in the observation group was lower than that in the control group (P < 0.05). The soft tissue tension of patients was increased in the two groups, and the soft tissue tension in the observation group was higher than that in the control group (P < 0.05). All these findings indicate that the application of Huoxue Huayu Decoction and Dieda Wanhua Oil hot compress combined with occlusal splint has remarkable effects on temporomandibular joint disorders, which can increase the decrease of mouth opening and reduce the Fricton index, thereby improving the patient’s soft tissue tension on the affected side.

Key words: Huoxue Huayu Decoction, Dieda Wanhua Oil, occlusal splint, temporomandibular joint disorder, soft tissue tension

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