Temporomandibular eklem internal düzensizliklerinin tedavisinde sodyum hyalüronat enjeksiyonu ile birlikte yapılan artrosentez uygulaması ve konservatif tedavinin etkinliklerinin kıyaslanması
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Dosyalar
Tarih
2007
Yazarlar
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Yayıncı
Selçuk Üniversitesi Sağlık Bilimleri Enstitüsü
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Günümüzde TME düzensizliklerinin tedavisinde cerrahinin rolü hakkındaki görüş ayrılığı devam etmektedir. Bir çok çalışma TME ağrı ve disfonksiyonunun tedavisinde cerrahinin etkinliğini desteklemektedir. Son dönemde sinoviyal sıvı örnekleri ile yapılan, biyokimyasal ve moleküler temele dayanan çalışmalar TME düzensizliğin sadece mekanik bir problem olmadığını, kompleks enflamatuar bir proses olduğunu, artrosentez ve artroskopik lavaj ile başarı ile tedavi edildiğini göstermektedir. Literatürde artrosentez RODYD tedavisinde etkili minimal invaziv bir cerrahi prosedür olarak tanımlanmaktadır fakat artrosentezin RDYD olan hastaların tedavisinde kullanımı ve etkinliği konusunda yeterli bilgi yoktur.Cerrahinin TME düzensizliklerinin tedavisindeki rolünü önemsizmiş gibi gösteren bazı yayınlarda, hastaların büyük çoğunluğunun cerrahi olmaksızın başarı ile tedavi edildiği ve bundan dolayı yumuşak diyet, çene egzersizleri, non-steroidal analjezik ilaç uygulaması ve kapanış yükseltici aparey uygulaması gibi konservatif tedavi yöntemleri denenmeden herhangi bir girişimsel yöntemin uygulanmaması gerektiği iddia edilmektedir. Bu çalışmanın amacı, konservatif tedavi ve sodyum hyaluronat enjeksiyonu ile birlikte uygulanan artrosentezin RODYD ve RDYD olan hastalardaki etkinliklerinin değerlendirilmesi ve artrosentezin RDYD olan hastalarda etkili olup olmadığı ve ilk aşama tedavi olarak uygulanıp uygulanamayacağının belirlenmesidir.Bu çalışmaya RDYD veya RODYD teşhisi konan 79 hastanın 100 eklemi dahil edilmiştir. Hastalar rastgele iki gruba ayrılmış ve ilk gruba sodyum hyaluronat enjeksiyonu ile birlikte artrosentez uygulanmış, ikinci gruba ise yumuşak diyet, eklem egzersizi, fizik tedavi ve sıcak uygulaması, medikal tedavi ve splint tedavisini içeren konservatif tedavi uygulanmıştır. Hastaların takip periyodu minimum 12 maksimum 24 aydır. 1,3,6,9,12,18,24'üncü aylarda yapılan kontrollerde kas muayenesi, TME palpasyon skorları , maksimum ağız açıklığı, lateral ve protrüziv hareket değerleri ölçülüp formlara kaydedilmiş ayrıca 9 adet ağrı ile ilgili soru, hastanın tedaviden memnuniyeti ve eklem sesinde iyileşme ile ilgili GAÖ değerleri kayıt edilmiştir.Hastalardan toplanan verilerin tedavi gruplarında ve hastalık alt gruplarında kıyaslanması ve istatistiki analizleri yapılmıştır. RODYD olan hasta grubunda artrosentezin başarı oranı %88.34, konservatif tedavinin başarı oranı %66.66 olarak bulunmuştur. RDYD hasta grubunda artrosentezin başarı oranı 73.07, konservatif tedavinin başarı oranı 72.41 olarak bulunmuştur. Bu çalışmanın sonuçları artrosentez ve konservatif tedavinin her ikisininde RODYD ve RDYD hasta gruplarının tedavisinde etkin olduğu görülmüştür. Veri analizlerimize göre RODYD olan hastlarda arrosentez tedavisi konservatif tedaviye göre belirgin şekilde daha etkindir. RDYD olan hastalarda ise artrosentezin konservatif tedaviye göre biraz daha etkin olduğu tespit edilmiştir. Bu sonuçlara göre artrosentez sadece RODYD hasta gruplarında ilk aşamada uygulanan bir cerrahi yöntem olmayıp aynı zamanda RDYD olan hastalarda da birinci basamak uygulanabilecek , konservatif tedaviye alternatif bir tedavi yöntemidir.
Nowadays the divergence about the role of surgery in the treatment of TMJ disorders continues. Many studies supports the efficacy of surgery in management of TMJ pain and dysfunction. Recent biochemical and moleculer based studies with joint sinovium samples shows us that TMJ disorders is not only a mechanic problem, it is also a complex inflamatory process and can successfully be treated with arthrocentesis and arthroscopic lavage. In literature arthrocentesis defined as an effective and minimally invasive surgical procedure , in treatment of non reducing disc displacements, but there is not enough data about the use and effectiveness of this treatment modalities in disc dislocation with reduction.However the reports which emphasizes the role of surgery in the treatment of TMJ disorders unimportant, suggests that most of the patients can be treated succesfully without surgery and therefore all conservative measures such as soft diet, jaw exercises, non-steroidal analgesic agent, and bite-rising appliences should be tried before any interventional procedures are considered.The aim of our study is to evaluate the efficacy of conservative treatment and arthrocentesis with sodium hyaluronate injection in the treatment of disc displacement with reduction and without reduction. And determine whether arthrocentesis is effective in disc displacement with reduction and can be applied as a first line procedure or not. In this research 100 joints of 79 patients with a diagnose of disc displacement with reduction or disc displacement without reduction were included the study material. Patients were randomly divided in to two groups, arthrocentesis with sodium hyaluronate injection applied the first patient group and the second group was treated with conservative treatment modalities such as soft diet, jaw exercise, physical theraphy, heat application, medical treatment and splint theraphy. Patients follow up period was minimum 12 maximum 24 months. At 1,3,6,9,12,18,24th months control periods muscle examination, TMJ palpations scores, maximal mouth opening, lateral and protrusive jaw movement values measured and recorded in forms. VAS scores about; 9 different question about patients pain , patients satisfaction from the treatment and reduction in joint noise were also recorded. Datas collected from patients were compared and statistical analysis were performed between treatment groups and sickness subgroups. In disc displacement without reduction sickness groups, the success rate of arthrocentesis was found %83.34 and the success rate of conservative treatment was found %66.66. In disc displacement with reduction sickness groups, the success rate of arthrocentesis found was %73.07 and the success rate of conservative treatment was found %72.41.Results of this study shows us that arthrocentesis and conservative treatment are effective treatments in both reducing and nonreducing disc displacements. According to our data analysis in disc displacement without reduction arthrocentesis is significantly more effective than conservative treatment. The efficacy of arthrocentesis in treatment of disc displacement with reduction was found somewhat higher than conservative treatment. These results suggests that arthrocentesis not only can be used as a first line procedure in disc displacement without reduction, this treatment can also be used in disc displacement with reduction as a first step treatment at early stages of this disease as an alternative to conservative treatment.
Nowadays the divergence about the role of surgery in the treatment of TMJ disorders continues. Many studies supports the efficacy of surgery in management of TMJ pain and dysfunction. Recent biochemical and moleculer based studies with joint sinovium samples shows us that TMJ disorders is not only a mechanic problem, it is also a complex inflamatory process and can successfully be treated with arthrocentesis and arthroscopic lavage. In literature arthrocentesis defined as an effective and minimally invasive surgical procedure , in treatment of non reducing disc displacements, but there is not enough data about the use and effectiveness of this treatment modalities in disc dislocation with reduction.However the reports which emphasizes the role of surgery in the treatment of TMJ disorders unimportant, suggests that most of the patients can be treated succesfully without surgery and therefore all conservative measures such as soft diet, jaw exercises, non-steroidal analgesic agent, and bite-rising appliences should be tried before any interventional procedures are considered.The aim of our study is to evaluate the efficacy of conservative treatment and arthrocentesis with sodium hyaluronate injection in the treatment of disc displacement with reduction and without reduction. And determine whether arthrocentesis is effective in disc displacement with reduction and can be applied as a first line procedure or not. In this research 100 joints of 79 patients with a diagnose of disc displacement with reduction or disc displacement without reduction were included the study material. Patients were randomly divided in to two groups, arthrocentesis with sodium hyaluronate injection applied the first patient group and the second group was treated with conservative treatment modalities such as soft diet, jaw exercise, physical theraphy, heat application, medical treatment and splint theraphy. Patients follow up period was minimum 12 maximum 24 months. At 1,3,6,9,12,18,24th months control periods muscle examination, TMJ palpations scores, maximal mouth opening, lateral and protrusive jaw movement values measured and recorded in forms. VAS scores about; 9 different question about patients pain , patients satisfaction from the treatment and reduction in joint noise were also recorded. Datas collected from patients were compared and statistical analysis were performed between treatment groups and sickness subgroups. In disc displacement without reduction sickness groups, the success rate of arthrocentesis was found %83.34 and the success rate of conservative treatment was found %66.66. In disc displacement with reduction sickness groups, the success rate of arthrocentesis found was %73.07 and the success rate of conservative treatment was found %72.41.Results of this study shows us that arthrocentesis and conservative treatment are effective treatments in both reducing and nonreducing disc displacements. According to our data analysis in disc displacement without reduction arthrocentesis is significantly more effective than conservative treatment. The efficacy of arthrocentesis in treatment of disc displacement with reduction was found somewhat higher than conservative treatment. These results suggests that arthrocentesis not only can be used as a first line procedure in disc displacement without reduction, this treatment can also be used in disc displacement with reduction as a first step treatment at early stages of this disease as an alternative to conservative treatment.
Açıklama
Anahtar Kelimeler
emporomandibular eklem, Temporomandibular joint
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Küçük, K. (2007). Temporomandibular eklem internal düzensizliklerinin tedavisinde sodyum hyalüronat enjeksiyonu ile birlikte yapılan artrosentez uygulaması ve konservatif tedavinin etkinliklerinin kıyaslanması. Selçuk Üniversitesi, Yayımlanmış doktora tezi, Konya.
