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악관절잡음 및 동통을 동반한 정복성 관절원판 변위 환자에 대한 관절강 pumping 효과

Other Titles
 (The) effect of joint space pumping treatment in patients with reducible disc displacement accompanied by TMJ sound a 
Authors
 김현철 
Issue Date
1999
Description
치의학과/석사
Abstract
[한글]

동통을 동반한 정복성 관절원판 변위 환자의 악관절 상관절강내에 Pumping을 시행하여 시행 전후의 악관절잡음 변화를 비교하기 위하여 본 연구를 시행하였다. 연구 대상자는 두개하악장애 치료를 위해 연세대학교 치과병원 구강내과에 내원한 환자 20명(평균 32.1±10.2세)이었으며 대상자들에게 병력조사와 임상검사 및 방사선사진 촬영검사를 시행하여 정복성 관절원판 변위 환자로 진단되었고 이를 다시 관절잡음의 발생시기에 따라 급성군과 만성군의 두 군으로 나누었다. 시술전 악관절잡음을 Sonopak을 이용하여 측정하였으며 악관절강 Pumping 시행 직후, 시행 1주일 후 각각 악관절잡음의 변화를 재측정하였고, 가시적 상사 척도를 이용하여 환자가 주관적으로 느끼고 있는 악관절잡음과 동통에 대한 크기를 Pumping 시행전, 1주일 후에 각각 나누어 측정하였다. Sonopak상 진동 관련 항목으로는 진동 총에너지, 고주파 진동 에너지, 저주파 진동 에너지, 저주파에 대한 고주파에너지의 비율, 최대 진폭, 최대 주파수, 중간 주파수 등 7개의 항목이었다.

1. 치료전 만성군과 급성군에서 유의차는 없었으나 만성군이 진동 총 에너지, 고주파 진동에너지, 저주파 진동에너지, 최대진폭, 최대주파수, 중간주파수가 급성군보다 크게 나타났다.

2. 전체 대상자들의 경우 악관절강 Pumping 직후 진동 총 에너지, 고주파 진동에너지, 저주파 진동에너지, 최대진폭, 최대주파수가 유의성(<0.05) 있게 감소하였고 Pumping 1주일 후에도 고주파 진동에너지, 저주파 진동에너지, 최대주파수, 중간주파수가 유의성(<0.05)있게 감소하여 대체적으로 악관절잡음이 감소함을 나타내었다.

3. Pumping시행 전과 직후 비교에서 급성군은 진동 총 에너지, 고주파 진동에너지, 저주파 진동에너지, 최대진폭, 최대주파수가 유의성(<0.05)있게 감소하였고 만성군은 진동 총 에너지, 고주파 진동에너지, 저주파 진동에너지, 비율, 최대진폭, 최대주파수가 유의성(<0.05)있게 감소하였고, 급성군과 만성군간의 유의차는 없었다.

4. Pumping 시행직후와 1주일 후의 비교에서 급성군은 고주파 진동에너지, 최대진폭, 최대주파수, 중간주파수가 유의성(<0.05) 있게 감소하였고 만성군의 경우 저주파 진동에너지가 유의성(<0.05) 있게 감소하였으나 Pumping시행 1주일 후 시행직후보다 진동 총 에너지, 비율, 최대진폭, 중간주파수가 유의성은 없지만 다시 증가하는 경향을 나타내었다.

5. 악관절 동통과 악관절잡음의 Pumping 시행전, 시행 1주일 후의 가시적 상사척도(VAS)에서 급성, 만성군 모두에서 악관절 동통은 유의성 있게(<0.05) 감소하였으나 급성, 만성간의 유의차는 없었고, 악관절잡음은 급성군에 있어서 Pumping시행 전, 1주일 후 비교시 유의성(<0.05) 있게 감소하였으나 만성군에서는 거의 변화가 없어 악관절잡음 감소는 미미하였고 급성군과 만성군간의 유의차가 있었다.(<0.05)

이상의 결과로 종합하여 볼 때 두개하악장애중 정복성 관절원판변위 환자에서 상관절강 Pumping요법의 시행으로 단순관절잡음(clicking) 및 동통 감소에 효과를 보이므로 임상에서의 활용이 가능하리라 사료된다.

[영문]

Pumping into the upper joint cavity of the TMJ was done on patients who had reducible disc displacement with pain. This article discusses the change in TMJ sounds before and after the Pumping treatment. 20subjects(mean age of 32.1±10.2yr) were selected among those who visited the department of Oral Medicine of Yonsei University for the treatment of craniomandibular dysfunctions. Through a thorough history taking, clinical exam and X-ray taking these subjects were diagnosed as reducible disc displacement Patients, and they were subdivided into two groups as acute and chronic according to the time the TMJ sound was made. Sonopak was used to measure the TMJ sound before, right after and one-week after the Pumping treatment. VAS was used to measure the degree of subjective TMJ complaints(sounds and pain)

before and one-week after the Pumping treatment. Vibration related items included total integral, high integral, low integral, ratio of high integral to low integral, peak amplitude, peak frequency and median frquency.

1. It was not statistically significant between the acute and chronic groups before the treatment. However, total integral, high integral, low integral, peak amplitude, peak frequency, median frequency showed to be greater in the chronic group.

2. In all the subjects, just after the Pumping treatment was done, total integral high and low integral, peak amplitude and peak frequency significantly decreased (p<0.05). Even after one week, low integral, peak frequency and median frequency significantly decreased (p<0.05), and the TMJ sound diminished accordingly.

3. Comparing the two groups(before and right after the Pumping treatment), there was the following difference: in the acute group, high integral, high amplitude, high frequency and median frequency significantly decreased(p<0.05). In the chronic group, total integral, high integral, low integral, ratio, peak amplitude and peak frequency significantly decreased(p 0.05). It was not statistically significant between the acute and chronic group.

4. Comparing the two groups(right after and one week after the Pumping treatment), there was the following difference : in the acute group, high integral, high amplitude, high frequency and median frequency significantly decreased(p<0.05). In the chronic group, low integral significantly decreased(p<0.05). However, although it was not statistically significant, after one week, there was an increase in total integral, ratio, peak amplitude and peak frequency compared to right after the treatment group.

5. In the VAS of before and one week after the Pumping treatment of the TMJ pain and sound, the TMJ pain significantly decreased(p<0.05) in both the acute and chronic group. However, it was not statistically significant between the two groups. There was a statistically significant decrease(p<0.05) in the TMJ sound in the acute group after one week of Pumping treatment, but no change was notable in the chronic group and it was not statistically significant between the two groups.

From the above results, we can conclude that Pumping into the upper joint cavity of patients having reducible disc displacement is effective in reducing clicking and pain. Therefore, it can be applied in diverse clinical fields.
Full Text
https://ymlib.yonsei.ac.kr/catalog/search/book-detail/?cid=CAT000000006280
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Appears in Collections:
2. College of Dentistry (치과대학) > Dept. of Advanced General Dentistry (통합치의학과) > 2. Thesis
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/125996
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