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目的:探讨3种不同方法治疗伴有磨牙症TMD的咀嚼肌肌电特征差异,评价3种治疗方法的效果。方法:30例伴有磨牙症的TMD患者被随机分为3组,每组10例。A组进行内毒杆菌毒素A(BTX-A)双侧咬肌肌内注射治疗,B组进行功能训练治疗,C组进行弹性颌垫治疗。对3组研究对象在治疗前、治疗1、3、6个月分别采集双侧咬肌(MM)和颞肌前束(TA)在下颌姿势位(MPP)以及牙尖交错位(ICP)最大紧咬牙时的肌电图(EMG),采用SAS 5.0统计学软件分析比较3组的峰值电位(Amp)之间是否存在统计学差异。结果:横向比较中各个治疗时间段A组患者疼痛视觉模拟评分(VAS)显著低于B组和C组(P<0.05),肌电显示MPP中A组在治疗过程中能显著降低双侧咬肌肌力(P<0.05),ICP时A组在1、3个月时显著降低双侧咬肌肌力(P<0.05),同时双侧颞肌肌力显著增强(P<0.05)。纵向比较中3组在治疗过程中均能明显降低疼痛(P<0.05),但3组时间点不同,A组缓解疼痛时间较长,肌电图显示3组均可显著降低咬肌MPP肌力(P<0.05),A、C组可降低ICP咬肌肌力(P<0.05),A组双侧颞肌肌力可代偿增强(P<0.05),B、C组颞肌肌力治疗前后均无统计学差异(P>0.05)。结论:临床症状与肌电图的结合使用能够对口颌系统行使功能过程中咀嚼肌的表现进行很好地观测,对TMD患者的咀嚼肌生物力学和结构方面有很好地理解。BTX-A肌内注射方法治疗伴有磨牙症的TMD可显著缓解患者疼痛,疗效持续时间较长。BTX-A肌内注射可显著降低咀嚼肌力,使目标肌肉(咬肌)疲劳得到缓解,促进咀嚼肌力平衡重建,较传统方式存在潜在优势。
OBJECTIVE: To explore the difference of EMG characteristics of three different methods in treating TMD with bruxism and to evaluate the efficacy of the three treatment methods. Methods: Thirty patients with TMD with bruxism were randomly divided into three groups, 10 in each. Group A received intramuscular injection of BTX-A bilateral masseter muscle, group B received functional training and group C received elastic maxillary pad treatment. Three groups of subjects were recruited to collect bilateral maxillary masseter muscle (MM) and anterior temporalis musculature (TA) at mandibular position (MPP) and maxillary cusp (ICP) before treatment, Elastic electromyography (EMG) during clenching was performed and SAS 5.0 statistical software was used to compare the peak potential (Amp) between the three groups for statistical differences. Results: The pain visual analogue scale (VAS) in group A was significantly lower than that in group B and group C (P <0.05) at each treatment time in horizontal comparison. Electromyography showed that group A in MPP significantly reduced bilateral bite (P <0.05). In ICP group, the strength of bilateral masseter muscle was significantly decreased (P <0.05) and the strength of bilateral temporal muscle muscle was significantly increased (P <0.05) at 1 month and 3 months in ICP group. In the longitudinal comparison group, pain relief was significantly reduced in all three groups during the course of treatment (P <0.05). However, the pain relief time was longer in group A than in group A, and EMG showed that all three groups could significantly reduce MPP strength (P <0.05). The muscular strength of ICP masseter muscle in group A and C was lower than that in group C (P <0.05) There was no significant difference between before and after (P> 0.05). CONCLUSIONS: The combination of clinical symptoms and EMG can be a good observation of the performance of the masticatory muscles in the exercise of oral mandibular system, and has a good understanding of the biomechanics and structure of masticatory muscles in TMD patients. BTX-A intramuscular injection of TMD with bruxism can significantly relieve pain in patients with longer duration of treatment. BTX-A intramuscular injection can significantly reduce chewing muscle strength, so that the target muscle (masseter muscle) fatigue relief, promote chewing muscle strength balance reconstruction, there are potential advantages over the traditional way.