目的探讨颞下颌关节上腔灌洗术联合咬合板对颞下颌关节不可复性盘前移位(anteriordisc displacement without reduction,ADDWoR)老年患者的疗效。方法选取2023年1月至2023年12月白求恩国际和平医院收治的ADDWoR患者80例,均行颞下颌关节上腔灌洗术联合咬合板治疗,比较患者治疗前后最大张口度、面部疼痛、关节盘形态及关节渗液变化、下颌功能及生活质量,分析患者治疗后疗效。结果患者治疗后3、6个月最大张口度均高于治疗前,且患者治疗后6个月最大张口度高于治疗后3个月(P<0.05);患者治疗后3、6个月张口和咀嚼疼痛视觉模拟量表评分均低于治疗前,且患者治疗后6个月张口和咀嚼疼痛视觉模拟量表评分均低于治疗后3个月(P<0.05);治疗后6个月变形关节盘占比高于治疗前(98.75%vs91.25%,P<0.05),关节渗液检出率低于治疗前(2.50%vs 37.50%,P<0.01);患者治疗后6个月下颌功能限制评估量表评分、口腔健康影响程度量表各项及总评分低于治疗前(P<0.05,P<0.01);80例患者治愈8例,显效52例,有效17例,无效3例,治疗总有效率为96.25%。结论颞下颌关节上腔灌洗术联合咬合板能有效改善ADDWoR老年患者最大张口度、面部疼痛、关节盘形态及关节渗液,提高患者下颌功能及生活质量,疗效良好。
Rock joints always have a smaller strength,and it plays an important influence on the overall strength of rock mass.The mechanical behavior of rock joints is mainly governed by the surface topography,normal stress,and failure degree.In this study,a series of direct shear tests for four different rough rock joints under five normal stresses was carried out.The shear and normal stiffnesses were first determined,and the shear shrinkage effect was represented by a shear-normal coupling coefficient.Assuming that the strength of the joint is composed of frictional and cohesive parts,the evolutions of cohesion,friction angle with joint roughness coefficient(JRC),and plastic shear displacement are obtained.The dilatancy behavior is described by the dilation angle,which is considered a function of JRC,plastic shear displacement,and normal stress.A cohesive-frictional elastoplastic constitutive model is hence proposed.The theoretical curves under constant normal stress conditions of the proposed model are in good agreement with the experimental results.The shear behaviors under constant normal stiffness and constant normal displacement conditions can be predicted using the new constitutive model.
