颞下颌关节紊乱病疼痛患者感觉功能改变的定量比较研究

QUANTITATIVE COMPARATIVE STUDY ON SOMATOSENSORY FUNCTION CHANGES IN TEMPOROMANDIBULAR DISORDERS PAIN PATIENTS

摘要:

目的 定量比较研究颞下颌关节紊乱病中两种典型疼痛的感觉功能改变。方法 采用定量感觉测试技术测试颞下颌关节痛患者与咀嚼肌痛患者（各30名）的疼痛点、对侧点与手部，基于健康对照组数据进行Z值转换，采用两因素方差分析和上调/下调评估系统分析两组患者感觉功能异常差异。 结果 患者疼痛点机械触觉较迟钝，痛觉和温度觉较敏感（P ＜ 0.01）；两组患者比较可见，关节痛组疼痛点多种感觉更敏感，而咀嚼肌痛组对侧与手部多种感觉更敏感（P ＜ 0.05）；98.3%患者疼痛点存在感觉功能异常且两组患者异常类型存在差异，咀嚼肌痛组手部异常比率较高（P ＜ 0.01）。结论 颞下颌关节痛和咀嚼肌痛在感觉功能改变方面存在差异，咀嚼肌痛涉及中枢敏化，临床上需要个性化诊疗。

Abstract:

Objective To compare somatosensory function changes in two typical types of temporomandibular disorders pain quantitatively. Methods Standardized quantitative sensory testing (QST) was performed on the pain sites, contralateral sites and right hands of 30 temporomandibular arthralgia patients and 30 myalgia patients diagnosed by DC/TMD. Z-transformation was performed in two groups based on the data of healthy controls. Differences of somatosensory changes between groups were assessed through two-way ANOVA. Loss/gain scores were computed for the evaluation of individual somatosensory changes of two groups. Results The pain sites of two group patients presented decreased sensitivity to mechanical tactile stimuli and increased sensitivity to mechanical pain stimuli and thermal stimuli compared with non-pain sites(P < 0.01). Pain sites of arthralgia patients showed significantly more sensitive than myalgia patients in multiple parameters, while contralateral sites and hands of myalgia patients presented increased sensitivity to multiple stimuli significantly (P < 0.01). 98.3% of patients somatosensory abnormalities on the pain sites. Arthralgia was mainly mixed hyperalgesia, while myalgia was characterized by mechanical hyperalgesia. Significantly higher distribution frequency of abnormalities in hand could be detected in myalgia patients(P <0.01). Conclusions: There are significant differences in somatosensory function changes between temporomandibular arthralgia and myalgia. Myalgia involves modulation of central system. It indicates a possible need for individualized TMD diagnosis and treatment.