顎関節症に対する運動療法の短期的効果

• Published in: Journal of the Japanese Society for the Temporomandibular Joint Vol. 28; no. 2; pp. 126 - 134
• Main Authors: 山口 賀大, 佐久間 重光, 遠渡 将輝, 坂口 晃平, 田口 慧, KOBAYASHI Rina, 足立 充, 伊藤 裕, TAGUCHI Nozomu, 日比 英晴
• Format: Journal Article
• Language: Japanese
• Published: 一般社団法人 日本顎関節学会 2016; The Japanese Society for Temporomandibular Joint
• Subjects: closed lock; short-term effectiveness; temporomandibular disorders; therapeutic exercise; 短期的効果; 運動療法; 非復位性関節円板前方転位; 顎関節症
• ISSN: 0915-3004; 1884-4308
• DOI: 10.11246/gakukansetsu.28.126

Therapeutic exercise increases range of motion, decreases pain, and shortens the duration of symptoms. However, few studies have assessed the effectiveness of therapeutic exercise by using quantitative methods. In this study, we prescribed a range of temporomandibular joint motion exercises involving both passive exercises performed by a dentist and self-traction therapy performed by the patient, and evaluated the short-term effectiveness of the treatment in patients with temporomandibular joint anterior disc displacement without reduction.We enrolled 45 patients who had moderate or severe TMJ function. We asked them to perform therapeutic exercises and evaluated their clinical symptoms (maximum opening distance, pain at rest, pain on motion, pain on mastication, and degree of difficulty in performing activities of daily living) at the first visit and at the first follow-up visit approximately 2 weeks later.The results demonstrated statistically significant improvements in maximum opening distance, pain on motion, pain on mastication and degree of difficulty in performing activities of daily living (p<0.001). The positive outcomes were considered the result of improvements in range of joint motion and expansion of the joint cavity, resulting in smoother movement of the condylar translation. The results of this study suggest that our therapeutic exercise program is a potentially beneficial conservative treatment for the short-term reduction of symptoms accompanying temporomandibular joint anterior disc displacement without reduction. 運動療法は，施術直後より関節可動域を増大し，疼痛を早期に軽減させ病悩期間を短縮するものの，その効果について定量的な評価を行った研究は少ない。本研究では，術者が行う顎関節可動化療法と患者が行う自己牽引療法を1つの運動療法プログラムとして捉え，非復位性関節円板前方転位症例に実施した際の短期的治療効果を検討した。顎関節機能に中等度以上の障害が認められた45例を対象として運動療法を施行し，初診時とその約2週間後の初回再来時における臨床症状（最大開口域，安静時痛，開閉口時痛，咀嚼時痛および日常生活支障度）について評価した。その結果，最大開口域，開閉口時痛，咀嚼時痛および日常生活支障度において有意な改善を認めた（p＜0.001）。これら症状の改善は，運動療法により関節可動域が改善され，関節腔が拡大されることで下顎頭の動きが改善したものと考える。したがって，本運動療法プログラムは，非復位性関節円板前方転位に伴う諸症状を短期間に軽減させる有効な保存療法になる可能性が示唆された。