Published
2026-03-17
Section
Articles
How to Cite
颞下颌关节紊乱病治疗策略的相关进展
罗 金波
重庆医科大学附属第一医院
张 劲松
重庆医科大学附属第一医院
DOI: https://doi.org/10.59429/zxyy.v3i1.13235
Keywords: 颞下颌关节紊乱病;治疗;综述
Abstract
颞下颌关节紊乱病(TMD)系口腔颌面部常见疾病,临床多表现为颌面部疼痛、下颌运动功能异常、关节弹 响或杂音等。其临床症状呈现多样性,发病率较高,显著影响患者的生活质量。TMD 的病因复杂,涉及人的生理、 心理及环境等多种因素,发病机制尚不清楚,因此其治疗存在一定的难度。随着医学研究的不断深入,多种治疗方 法用于 TMD 的治疗,且有一定的疗效,但疗效不一,治疗方法的多样性和复杂性也给临床诊疗带来了一定的困难。 因此,本文旨在系统梳理 TMD 当前主流的临床治疗策略,以期为临床实践提供参考依据。
References
[1] 傅开元,雷杰. 颞下颌关节紊乱病的分类、诊断及治疗进展[J]. 口腔医学,2024, 44(01): 6-10.
[2] Valesan LF, Da-Cas CD, Réus JC, et al. Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis[J]. Clin Oral Investig, 2021, 25(2): 441-453.
[3] 马绪臣,张震康. 颞下颌关节紊乱病双轴诊断的临床意义和规范治疗的必要性[J]. 中华口腔医学杂志,2005(05): 6-8.
[4] Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications[J]. J Oral Facial Pain Headache, 2014, 28(1): 6-27.
[5] 傅开元. 2014 年新版国际颞下颌关节紊乱病分类及诊断标准解读[J]. 中华口腔医学杂志,2017, 52(6): 374-376.
[6] Kaya K, Dulgeroglu D, Unsal-Delialioglu S, et al. Diagnostic value of ultrasonography in the evaluation of the temporomandibular joint anterior disc displacement[J]. J Craniomaxillofac Surg, 2010, 38(5): 391-395.
[7] Lin SL, Wu SL, Ko SY, et al. Temporal relationship between dysthymia and temporomandibular disorder: a population based matched case-control study in Taiwan[J]. BMC Oral Health, 2017, 17: 50.
[8] 刘知音,蔡鹏,唐正龙等. 颞下颌关节紊乱患者焦虑和心理压力与应对方式的相关性研究[J]. 贵州医科大学学报,2020, 45(3): 321-325.
[9] 吴玲,李慧敏,陈中会等. 颞下颌关节紊乱病患者轴Ⅱ测评临床调查研究[J]. 中华口腔医学杂志,2022, 57(1): 76-84.
[10] De Barros Pascoal AL, De Freitas R, Da Silva LFG, et al. Effectiveness of Counseling on Chronic Pain Management in Patients with Temporomandibular Disorders[J]. J Oral Facial Pain Headache, 2020, 34(1): 77-82.
[11] 张宁,张敏,崔北芸等. Nd:Yag 激光和咀嚼肌神经封闭治疗颞下颌关节痛的临床观察[J]. 临床和实验医学杂志,2018, 17(4): 431-433.
[12] Kulkar S, Thambar S, Arora H. Evaluating the effectiveness of nonsteroidal anti-inflammatory drug(s) for relief of pain associated with temporomandibular joint disorders: A systematic review[J]. Clin Exp Dent Res, 2020, 6(1): 134-146.
[13] Derwich M, Mitus-Kenig M, Pawlowska E. Orally Administered NSAIDs-General Characteristics and Usage in the Treatment of Temporomandibular Joint Osteoarthritis-A Narrative Review[J]. Pharmaceuticals (Basel), 2021, 14(3): 219.
[14] Ouanounou A, Haas DA. Pharmacotherapy for the elderly dental patient[J]. J Can Dent Assoc, 2015, 80: f18.
[15] Andre A, Kang J, Dym H. Pharmacologic Treatment for Temporomandibular and Temporomandibular Joint Disorders[J]. Oral Maxillofac Surg Clin North Am, 2022, 34(1): 49-59.
[16] 徐丽丽,蔡斌,方仲毅等. 个体化综合物理疗法治疗颞下颌关节紊乱病的疗效观察[J]. 中华物理医学与康复杂志,2014, 36(5): 329-332.
[17] Asquini G, Rushton A, Pitance L, et al. The effectiveness of manual therapy applied to craniomandibular structures in the treatment of temporomandibular disorders: protocol for a systematic review[J]. Syst Rev, 2021, 10: 70.
[18] 杨阳,张卫卫,尹家林等. 手法联合超短波治疗颞颌关节紊乱患者的疗效观察[J]. 中华物理医学与康复杂志,2021, 43(5): 427-429.
[19] Tanhan A, Ozer AY, Polat MG. Efficacy of different combinations of physiotherapy techniques compared to exercise and patient education in temporomandibular disorders: A randomized controlled study[J]. Cranio, 2021, 39(5): 391-399.
[20] Yildiz SK, Özkan FÜ, Aktaş I, et al. The effectiveness of ultrasound treatment for the management of knee osteoarthritis: a randomized, placebo-controlled, double-blind study[J]. Turk J Med Sci, 2015, 45(6): 1187-1191.
[21] Abbasi F, Moaddabi A, Beithardan G, et al. Com-paring the effects of low-level laser therapy with ibuprofen in improving myofascial pain dysfunction syndrome[J]. Dent Hypotheses, 2021, 12(4): 124-127.
[22] Li W, Wu J. Treatment of temporomandibular joint disorders by ultrashort wave and extracorporeal shock wave: a comparative study[J]. Med Sci Monit, 2020, 26: e923461.
[23] 陈一楠,周薇娜,于林凤等. 经皮神经电刺激治疗颞下颌关节疼痛的研究[J]. 口腔医学研究,2018, 34(03): 254-257.
[24] 王乾佑,管同康,赵雯霞等. 针灸治疗颞下颌关节紊乱病的相关机制探讨[J]. 中国医药科学,2023, 13(19): 37-40+69.
[25] 何丽慧,黄惠榕,吴翠娟等. 经筋推拿治疗颞下颌关节紊乱病临床疗效和安全性的 Meta 分析[J]. 医学信息,2023, 36(11): 60-66.
[26] Zhang SH, He KX, Lin CJ, et al. Efficacy of occlusal splints in the treatment of temporomandibular disorders: a systematic review of randomized controlled trials[J]. Acta Odontol Scand, 2020, 78(8): 580-589.
[27] 郭隽,曹菁,李程等. 颞下颌关节紊乱病患者经再定位咬合板治疗前后的影像学分析[J]. 天津医药,2021, 49(7): 735-741.
[28] Yap AU, Tan MWY, Foo JKY, et al. Noninvasive interventions for temporomandibular disorders: A scoping review of systematic reviews from 2017 to 2022[J]. Quintessence Int, 2023, 54(9): 772-787.
[29] 雷杰,傅开元. ?垫治疗颞下颌关节可复性盘前移位的机制及对临床治疗的启示[J]. 中国实用口腔科杂志,2017, 10(6): 321-325.
[30] Tatli U, Benlidayi ME, Ekren O, et al. Comparison of the effectiveness of three different treatment methods for temporomandibular joint disc displacement without reduction[J]. Int J Oral Maxillofac Surg, 2017, 46(5): 603-609.
[31] Derwich M, Mitus-Kenig M, Pawlowska E. Mech-anisms of action and efficacy of hyaluronic acid, corticosteroids and platelet-rich plasma in the treatment of temporomandibular joint osteoarthritis: A systematic review[J]. Int J Mol Sci, 2021, 22(14): 7405.
[32] Zarate MA, Frusso RD, Reeves KD, et al. DextroseProlotherapy Versus Lidocaine Injection for Temporomandibular Dysfunction: A Pragmatic Randomized Controlled Trial[J]. J Altern Complement Med, 2020, 26(11): 1064-1073.
[33] Neville C, Venables V, Aslet M, et al. An objective assessment of botulinum toxin type A injection in the treatment of post-facial palsy synkinesis and hyperkinesis using the synkinesis assessment questionnaire[J]. J Plast Reconstr Aesthet Surg, 2017, 70(11): 1624-1628.
[34] Klein AW. The Therapeutic potential of botulinum toxin[J]. Dermatol Surg, 2004, 30(3): 452-455.
[35] 陈奕帆,汤良晨,陈敏儿等. A 型肉毒素治疗肌源性颞下颌关节紊乱病的研究进展[J]. 口腔疾病防治,2024, 32(06): 470-477.
[36] Freund B, Schwartz M, Symington JM. The use of botulinum toxin for the treatment of temporomandibular disorders: preliminary findings[J]. J Oral Maxillofac Surg, 1999, 57(8): 916-920.
[37] Rezazadeh F, Esnaashari N, Azad A, et al. The effects of botulinum toxin A injection on the lateral pterygoid muscle in patients with a painful temporomandibular joint click: a randomized clinical trial study[J]. BMC Oral Health, 2022, 22(1): 217.
[38] Ayala JC, Rizzatti-Barbosa CM, Custodio W. Influence of botulinum toxin A in pain perception and condyle-fossa relationship after the management of temporomandibular dysfunction: a randomized controlled clinical trial[J]. Oral Maxillofac Surg, 2024, 28(1): 269-277.
[39] Pingel J, Nielsen MS, Lauridsen T, et al. Injection of high dose botulinum-toxin A leads to impaired skeletal muscle function and damage of the fibrilar and non-fibrilar structures[J]. Sci Rep, 2017, 7: 14746.
[40] Villa S, Raoul G, Machuron F, et al. Improvement in quality of life after botulinum toxin injection for temporomandibular disorder[J]. J Stomatol Oral Maxillofac Surg, 2019, 120(1): 2-6.