하악과두의 수조작적 부하검사법에 의한 악관절음 평가에 관한 연구

Abstract

[한글]

본 연구는 정상군 26명(52개의 악관절)과 환자군 77명(154개의 악관절)을 대상으로 하였으며 환자군을 다시 임상적 진단분류법에 따라 단순악관절동통군(92개의 악관절), 복원성 관절원판변위군(48개의 악관절), 골관절염군(14개의 악관절)으로 분류하여 촉진법과 전자진동술에 의해 하악의 기능운동 중에 나타날 수 있는 악관절음을 하악과두의 부하검사법과 비부하검사법을 사용하여 비교평가하였다.

1. 촉진법에서 하악과두의 비부하검사법과 부하검사법 모두에서 악관절음 개구말기(각각 52%, 53.04%) 및 폐구말기(각각 82.76%, 76.6%)에 발생하였으며, 개구 및 폐구시 하악과두의 비부하검사법에서는 연성의 성질(각각 63.64%, 85.71%)을, 부하검사법의 경우에서는 악관절음이 경서의 성질(각각 64.68%, 48.15%)을 띠었으며, 악관절음의 양상은 부하검사법의 경우 비부하검사법의 경우에서보다 개구시는 염발음(27.03%) 폐구시는 단순관절음(72.32%)의 발생빈도가 더 높게 나타났다.

2. 전자진동술에 의한 악관절 진동의 발생시기는 하악과두의 비부하검사법과 부하검사법 모두에서 개구말기(각각 59.52%, 57.14%) 및 폐구 말기(각각 54.78%, 61.04%)에 발생하였다.

3. 전자진동술에서의 개구 및 폐구시 진동의 총에너지, 고주파 에너지, 최대진폭, 최대주파수는 모든 군에서 부하검사법의 경우 더 높은 측정치를 보였으며,(p 0.05) 저주파에 대한 고주파의 비율은 모든 군에서 부하검사법의 경우 더 낮은 측정치를 보였다.(p 0.05)

중간주파수는 부하검사법의 경우 정상군과 단순악관절동통군에서는 더 낮은 측정치를, 복원성 관절원판변위군과 골관절염군에서는 더 높은 측정치를 보였다.(p 0.05)

이상의 결과들을 종합해보면 촉진법과 전자진동술 모두에서 하악과두의 부하검사법은 비부하검사법에 비해 하악의 기능운동 중에 관찰되지 않는 악관절음을 측정할 수 있으므로, 좀 더 정확하게 악관절음을 평가할 수 있는 유용한 방법임을 알 수 있었다.

[영문]

Temporomandibular joint sounds are the most common sign and symptom of TMDs and one of signs of intracapsular disease of th TMJ. Subjects were composed of the clinical normal group(52 TMJs) and TMD patient groups(154 TMJs) who were diagnosed by clinical and radiographic examination and then were classified into 3 groups, which were simple arthralgia group(92 TMJs), disc displacement with reduction group(48 TMJs) and osteoarthritis group(14 TMJs). In this study, TMJ sounds in all subject groups were examined using by the manipulative joint loading test and by

the joint non-loading test, which was recorded respectively by the clinical palpation and the electrovibratography.

The results were as follows;

1. In the clinical palpation, temporomandibular joint sounds occurred in late mouth opening(52%, 53.04% respectively) and late closing(82.76%, 76.6% respectively) by both joint loading and joint non-loading test. On evaluating the nature of TMJ sounds, it had a tendency to have soft TMJ sounds(63.64%, 85.71% respectively) in the joint non-loading test and hard TMJ sounds(64.68%, 48.15% respectively) in the joint loading test during mouth opening and closing. In the pattern of TMJ sounds, the closing clicking(72.32%) and opening crepitus(27.03%) were more frequently in the joint loading test than in the joint non-loading test.

2. The occurrence of joint vibrations in the EVG was late at mouth opening(59.52%, 57.14% respectively) and closing(54.78%, 61.04% respectively) in both joint loading and non-loading test.

3. Total integral, high integral, peak amplitude, and peak frequency of all subject groups at both mouth opening and closing were higher in the joint loading test than in the joint non-loading test.(p 0.05) The ratio( 300Hz/ 300Hz) of all subject groups at both mouth opening and closing were lower in the joint loading test than in the joint non-loading test.(p 0.05) The median frequency of normal subjects and simple arthralgia group at both mouth opening and closing were higher in the joint loading test than in the joint non-loading test and that of disc displacement group and osteoarthritis group were lower in the joint loading test than in the joint non-loading test.(p 0.05)

The above results suggest that the manipulative joint loading test may measure temporomandibular joint sounds which are not detected during the examination by the joint non-loading test. Therefore we concluded that the method is useful means of evaluating TMJ sounds more exactly.