推拿手法缓解颞下颌关节紊乱张口受限疗效评估.docVIP

推拿手法缓解颞下颌关节紊乱张口受限疗效评估 　　[摘要]目的 观察推拿手法对风寒湿痹型颞下颌关节紊乱患者张口受限的疗效。方法 自门诊选取60例颞下颌关节紊乱患者，随机分为两组。A组31例采用推拿手法治疗，方法为施推法和拇指点按法于阿是穴、耳禾?、颊车、上关和下关穴，以拿法施于外关合谷穴。B组29例以超短波理疗。3次/周，2周为1个疗程。疗程结束后对患者张口受限情况进行评定。结果 AB两组张口受限程度均减轻，治疗前后差异有统计学意义（P0.05）。结论 两种治疗手段疗效相似，均可减轻患者张口受限症状，促进患者功能康复。 　　[关键词] 颞下颌关节紊乱综合征；推拿手法；超短波理疗； 张口受限 　　[中图分类号] R782.63 [文献标识码] A [文章编号] 1674-0742（2014）08（b）-0042-03 　　[Abstract] Objective To investigate the mouth opening improvement and safety of tuina manipulation on patients with temporomandibular disorders （TMD） Methods A total of 60 cases with early stage TMD were selected. All patients were randomized into two groups. Group A （31 cases） employed pushing technique on Ashi point， Erheliao SJ-22， Xiaguan ST-7， Shangguan GB-3， Jiache ST-6 for 5 minutes. Pinching technique was applied on Hegu LI-4 for 1 minute. Group B （29 cases） employed ultrashort wave therapy on local site for 10 minutes. For both groups， the treatment was conducted Three times per week for 2 weeks. The maximum mouth opening were measured prior treatment and after one session treatment. Result In both groups， mouth opening was improved significantly （P0.05）. In group A the maximum mouth opening was increased from 28.6±6.7mm to 29.9±7.6. Group B maximum mouth opening increased from 28.8±5.6 to 30.6±6.5. There was no significant difference between group A and B （P 0.05）. Conclusion Tuina and ultrashort wave therapy are both effective intervention method for limitation of mouth opening for TMD. 　　[key words] Temporomandibular disorders； Tuina manipulation； Ultrashort wave therapy； Limitation of mouth opening 　　颞下颌关节紊乱（temporomandibular disorders， TMD）是指累及咀嚼肌和颞下颌关节，以颞下颌关节和相关肌肉在开闭口运动中出现疼痛、弹响和开闭口运动障碍为主要症状的临床疾病的总称[1]。TMD多见于青壮年及女性发病机制尚不十分清楚，目前多认为是精神心理、解剖、免疫和关节负重等多因素共同作用的结果。当前治疗TMD的原则为首选可逆性的非手术的保守治疗，而保守治疗又可分为病因治疗和对症治疗两大类。推拿手法和超短波照射是常见的对症治疗方法，但现有文献研究推拿手法用于TMD治疗存在纳入分型不明确、缺少对照和评价指标不客观等问题[2]。为了科学评价推拿手法的疗效，该研究2011年9月―2012年9月采用随机对照实验设计来比较推拿手法和超短波理疗对改善患者张口受限症状的治疗效果，现报道如下。 　　1 资料与方法 　　1.1一般资料 　　60例患者均为中国中医科