Temporomandibular joint arthrosis (TMJ) yog ib qho kab mob ntev ntawm cov kab mob musculoskeletal, uas yog kev loj hlob hauv cov xwm txheej thiab nrog los ntawm degeneration ntawm cov ntaub so ntswg synovial thiab kev puas tsuaj ntawm pob txha pob txha.
Cov ntsiab lus dav dav
Cov pob txha ntawm lub puab tsaig tsis muaj zog heev, qhov sib koom ua ke nws tus kheej yog articulated, nyob ntawm qhov sib txuas ntawm lub puab tsaig sab (mandible) thiab pob txha taub hau (nws cov pob txha ntawm lub cev). Lub puab tsaig sab sauv tsis muaj qhov sib koom ua ke, yog ib feem ntawm cov pob txha ntawm lub ntsej muag ntawm pob txha taub hau.
Ib qho sib koom ua ke yog ib qho kev sib txuas ntawm cov pob txha, nyob rau hauv ib lub hnab sib koom ua ke, sab hauv uas muaj cov kua roj lubricating rau qhov chaw ntawm qhov sib koom ua ke (synovial). Yog li ntawd, tham txog arthrosis ntawm lub puab tsaig sab sauv tsis muaj tseeb kiag li.
Vim qhov sib txawv ntawm qhov kev thauj khoom ntawm qhov sib koom ua ke, cov ntaub so ntswg nyob ib puag ncig tau koom nrog cov txheej txheem nrog kev txhim kho dystrophic hauv lawv (cov pob txha, meniscus, pob txha mos, cov leeg thiab ligaments).
Hnub nyoog qis dua 50 xyoo, arthrosis ntawm lub puab tsaig tshwm sim hauv yuav luag 50% ntawm cov pejxeem, tshaj 70 xyoo - hauv 90%. Thaum lub hnub nyoog no, lub peev xwm los tsim cov pob txha rov qab tau txo qis. Thiab qhov ntawd tsuas yog cov neeg sau npe.rooj plaub, vim feem ntau cov neeg laus sim tsis mus ntsib kws kho mob. Cov txheej txheem yog ntau dua rau cov poj niam.
Ib me ntsis ntawm lub cev
Lub maxillofacial los yog, raws li qhia nyob rau hauv lub atlas ntawm lub cev, lub temporomandibular sib koom - kev sib txuas yog "ob-zaj dab neeg" thiab ua khub.
Nruab nrab ntawm cov pob txha muaj ib txheej nyob rau hauv daim ntawv ntawm ib tug interarticular disc. Kev tsim kho yog tuav los ntawm 2 lub voj-zoo li ligaments, thiab thaum lub sijhawm ua haujlwm nws raug tswj los ntawm zom cov nqaij, uas suav tias yog qhov kev cob qhia tshaj plaws hauv lub cev. Kev xaiv lub puab tsaig:
- kab laug sab laug;
- rau-rov qab;
- ntsug kev taw qhia - nce thiab nqis, nrog rau kev sib hloov txav thaum zom.
Txoj kev koom tes kuj koom nrog hauv kev hais lus.
Mechanism ntawm kev loj hlob ntawm pathology
Txoj kev loj hlob ntawm cov txheej txheem pib nrog qhov tseeb tias maj mam, rau ntau yam, pib nyias, thiab tom qab ntawd ploj tag nrho, thawj zaug hauv qee qhov chaw, tom qab ntawd tag nrho, pob txha mos npog lub taub hau ntawm lub puab tsaig. Ntawm no, nws cov fiber ntau network ntawm collagen yog ploj, nws yog hloov los ntawm rog. Cov pob txha mos dries, microcracks tshwm nyob rau hauv nws. Kev sim los ntawm lub cev los them nyiaj rau kev tawg ntawm pob txha mos yog tshwm sim los ntawm kev loj hlob ntawm osteophytes - cov ntsiab lus ntawm cov pob txha, vim tias pob txha mos nws tus kheej tsis muaj peev xwm rov tsim dua tshiab. Cov duab ntawm cov pob qij txha tawg, thiab nws tsis tuaj yeem ua haujlwm tag nrho.
Etiology ntawm qhov tshwm sim
Qhov laj thawj tuaj yeem yog hauv zos thiab dav. Cov kev hloov hauv zos suav nrog kev hloov pauv hauv kev sib koom ua ke nws tus kheej:
- muaj kev thauj khoom tsis sib xwssib koom;
- deformation ntawm cov hniav;
- poob thiab lwj ntawm cov hniav;
- malocclusion;
- teeth gaps;
- kev ua haujlwm ntawm lub puab tsaig;
- tsis txaus ntseeg hauv cov qauv ntawm lub puab tsaig;
- lub puab tsaig raug mob thiab kev phais;
- tsis raug sau lossis prosthesis;
- kev hloov pauv.
Common ua:
- laus;
- climax hauv cov poj niam (kev cuam tshuam cov pob txha metabolism);
- genetic predisposition;
- tus cwj pwm phem tom thiab tom rau tes;
- bruxism;
- malnutrition;
- hypodynamia;
- mob caj dab ntawm lwm cov pob qij txha;
- cov txheej txheem rheumatic;
- endocrinopathy (thyroid thiab ntshav qab zib);
- nyob hauv tus kws kho hniav lub rooj zaum ntev nrog koj lub qhov ncauj qhib;
- kab mob (SARS, mob khaub thuas);
- Tus cwj pwm ntawm zom zaub mov.
YKev faib tawm ntawm pathology
Lub puab tsaig arthrosis muaj 4 theem hauv nws txoj kev loj hlob:
- Pathological mobility ntawm ligaments, qhov chaw sib koom ua ke pib nqaim, tsis sib xws thiab tsis sib xws. Pob txha mos degrades me ntsis. Lub sijhawm zoo tshaj plaws rau kev kho mob.
- theem nce qib. Kev txav mus los ntawm kev sib koom ua ke txo qis, qhov mob tshwm sim. Cov txheej txheem condylar ntawm mandible ossifies (ossification).
- Late stage. Cov pob txha mos raug puas tsuaj tag, muaj osteophytes, kev puas tsuaj thiab txo cov txheej txheem condylar. Qhov kev ncua deb ntawm cov pob txha ntawm cov pob qij txha yog nce, sclerosis ntawm qhov chaw ntawm lub pob qij txha.
- Launched theem. Ankylosis (fibrous fusion ntawm kev sib koom tes).
Raws li kev hloov pauv ntawm x-ray, arthrosis ntawm lub puab tsaig tuaj yeem deforming thiab sclerosing. Hauv thawj kis, qhov sib koom ua ke yog nthuav dav, articular fossa yog ua raws, muaj kev loj hlob ntawm cov pob qij txha, lub puab tsaig qis yog sharply deformed. Hauv qhov thib ob, qhov chaw sib koom ua ke yog nqaim thiab muaj pob txha sclerosis.
Los ntawm keeb kwm arthrosis muab faib ua thawj thiab theem nrab. Thawj tshwm sim nyob rau hauv cov neeg laus, nws yog polyarticular, tsis muaj yav tas los pathology, nws yog feem ntau tsis paub. Secondary tshwm sim tawm tsam keeb kwm ntawm pathologies uas twb muaj lawm: raug mob, o, thiab lwm yam.
Symptomatic manifestations
Lub puab tsaig arthrosis ib txwm nthuav dav zuj zus. Feem ntau cov tsos mob thawj zaug degenerative tsis pom los ntawm tus neeg mob. Ntawm lawv yog thaum sawv ntxov nruj ntawm kev sib koom ua ke, crunching thiab nias. Txog hnub lawv ploj lawm.
Ntxiv mus, mob koom nrog thaum zom, hais lus, thiab tom qab so. Cov tsos mob ntawm arthrosis ntawm lub puab tsaig pob qij txha ua rau lawv tus kheej hnov thaum yav tsaus ntuj los yog ib qho kev hloov ntawm huab cua. Mob txo qhov amplitude ntawm kev sib koom tes oscillations, nws txoj haujlwm yog txwv.
Cov tsos mob hauv qab no ntawm osteoarthritis ntawm lub puab tsaig tshwm:
- ntsej muag asymmetry;
- thaum qhib lub qhov ncauj, txoj hauj lwm ntawm lub puab tsaig hloov pauv sai - nws txav mus rau sab kom lub qhov ncauj qhib; sab sab ua loog;
- mob tshwm sim ntawm tus nplaig, pob ntseg thiab pob qhov muag, nraub qaum ntawm lub taub hau.
Nrog kev tsis txaus siab ntawm qhov chaw no, cov neeg mob tig mus rau cov kws kho mob sib txawv, tab sis vim li cas tsuas yog mob arthrosis xwb. Qhov mob tsis tu ncua thiab mob. Tus neeg mob zom ntawm ib sab.
Cov tsos mob ntawm arthrosis ntawm lub puab tsaig qis tshwm ntawm palpationcrepitus thiab crunch. Lub qhov ncauj tsis qhib dav, tej zaum yuav muaj cov tsos mob ntawm parotitis thiab otitis media. Chewing nqaij raug mob thaum soj ntsuam. X-ray qhia tau hais tias muaj kev hloov pauv hauv arthrosis ntawm lub puab tsaig qis: qhov siab ntawm lub taub hau mandible raug txo qis, cov duab hloov mus rau lub club-shaped lossis taw tes, muaj osteophytes.
Kev kuaj mob arthrosis ntawm lub puab tsaig sib koom
Tsis muaj teeb meem ntau rau tus kws kho mob. Kev tsis txaus siab thiab lub tsev kho mob ua lub hauv paus. Ntawm kev ntsuam xyuas, lub ntsej muag yog asymmetrical thiab txo qhov siab, lub mandible hloov mus rau ib sab.
Lub qhov ncauj tsis qhib zoo, qhov kev ncua deb ntawm cov incisors tsawg dua li qub, nws tuaj yeem txo mus rau 5 hli. Muaj cov leeg nqaij spasm ntawm qhov cuam tshuam.
Arthrosis ntawm lub puab tsaig sab sauv feem ntau nrog cov hniav tsis tiav lossis ib nrab. Cov txheej txheem tseem ceeb ntawm kev kuaj mob yog qhov tseeb thiab cov ntaub ntawv. Yog li no, CT lossis MRI tau sau tseg.
Ntawm x-ray, cov pob txha pob txha pob txha pom tau meej, tab sis nws yuav tsis pom cov kab mob sib kis. Lub ntsiab hloov ntawm x-ray: lub taub hau yog thickened thiab deformed, pob txha spikes, nqaim ntawm qhov chaw sib koom ua ke. Cov qib hloov ntawm theem 4 yog qhia saum toj no.
Kev phom sij ntawm lub puab tsaig yog dab tsi?
Nyob rau qhov kuaj pom ntxov vim tsis muaj tsos mob. Thiab yog li ntawd, kev kho mob thaum ntxov, thaum nws tuaj yeem kho tau tus kab mob yooj yim. Osteoarthritis feem ntau pom los ntawm lub caij nyoog thaum kho hniav.
Thaum kawg, arthrosis ntawm lub puab tsaig tsis tsuas yog ua rau lub neej zoo vim yog lub puab tsaig tsis muaj zog, tab sis kuj ua rau muaj kev tsis taus. Nyuaj noj thiab hais lus. Mob taub hau yog inflammatory exhaustingcharacter.
Kab mob feem ntau kis mus rau cov kabmob uas nyob sib ze. Cov ntshav siab nce siab, tshuaj loog tsis pab, qhov muag tsis pom kev thiab hnov lus tsis zoo, migraines tshwm sim. Kev mob thiab o tuaj yeem ua rau pinching ntawm trigeminal thiab lub ntsej muag paj hlwb, o ntawm periosteum.
Kev kho mob
Kev kho lub puab tsaig arthrosis muaj cov hom phiaj:
- tshem tawm qhov o thiab mob;
- tswj cov metabolism;
- restoration ntawm pob txha mos;
- kev txhim kho ntawm lub cev - rau tag nrho cov hom phiaj no tsis yog-steroidal tshuaj tiv thaiv kab mob - NSAIDs tau siv tas li;
- blockades;
- vasodilating;
- muscle relaxants kom qhib lub puab tsaig zoo dua;
- anxiolytics;
- tshuaj tiv thaiv kev nyuaj siab;
- opiates;
- GCS (glucocorticosteroids);
- adjuvants;
- Vitamin thiab minerals.
Thaum muaj mob ntawm periosteum, tshuaj tua kab mob raug muab.
Chondroprotectors yog siv los kho cov pob txha mos. Ntawm lawv yog chondroitin, hyaluronic acid, glucosamine sulfate. Cov tshuaj hauv qab no yog nrov tshaj plaws: "Teraflex", "Chondroxide", "Don", "Moveks", "Elbona", "Alflutop" thiab lwm yam.
Chondroprotectors siv tau ntev li 6 lub hlis. Tau kawg, lawv yuav tsis rov qab pob txha mos, tab sis lawv yuav txhawb nqa cov pob txha thiab pob txha mos.
Zoo siv lawv tawm ntawm qhov hnyav. Txhua yam kev kho mob tau zoo heev nyob rau hauv thawj theem ntawm tus kab mob. Tom qab ntawd, cov txheej txheem yuav hloov tsis tau.
Lub puab tsaig arthrosiskho nrog vasodilators. Kev kho mob yog nqa tawm tsis tsuas yog nrog tshuaj, tab sis kuj nrog kev txhaj tshuaj thiab sab hauv kev sib koom ua ke.
Intra-articular txhaj tshuaj tuaj yeem raug sau rau qhov mob hnyav, feem ntau yog corticosteroids. Nrog rau qhov raug mob hauv zos, tsis muaj kev phiv ntawm lub plab, tab sis rov ua haujlwm ntawm GCS tuaj yeem ua rau tuag ntawm tes thiab ua rau pob txha mos degeneration. Tom qab ntawd lawv tuaj yeem hloov nrog hyaluronic acid - nws tseem yuav txo qhov mob, tab sis tsis ua rau cov pob txha hloov pauv.
Nrog kev tswj hwm qhov ncauj ntawm GCS, tus kws kho mob tau sau tshuaj ntxiv kom txo qis acidity - Omeprazole, thiab lwm yam. GCS kuj tseem siv rau hauv kev kho lub cev rau iontophoresis. Tsis tas li ntawd, ib yam khoom uas muaj lub npe complex polyvinylpyrrolidonepolymer yog txhaj rau hauv qhov sib koom ua ke, uas hloov cov pob txha pob txha puas lawm.
Kev kho mob ntawm lub puab tsaig sab qis tuaj yeem siv tsis tau tsuas yog dav, tab sis kuj tseem kho hauv zos nrog tshuaj pleev thiab gels. Kev kho Opioid yog siv los txo qhov mob - "Fentanyl", "Promedol", "Tramadol", "Codeine", thiab lwm yam. Cov tshuaj analgesics yuav tsis pab ntawm no.
Kev kho mob arthrosis ntawm lub puab tsaig yuav tsum tsuas yog ua los ntawm kws kho mob. Cov txiaj ntsig ntawm kev kho mob tsuas yog hnov txog qhov nyuaj ntawm kev kho thiab kev kho cov chav kawm.
Kev cuam tshuam ntawm chav kawm yuav ua rau txhua tus tsos mob rov qab los. Ntxiv nrog rau cov tshuaj, kev kho mob yog ntxiv los ntawm kev kho lub cev, zaws, kev tawm dag zog, noj zaub mov, orthopedics thiab, yog tias tsim nyog, phais.
Kho cov tsos mob ntawm arthrosis ntawm lub puab tsaig tiag tiag yuav siv sij hawm ntev, tab sis raug pom zoo los ntawm kev pom zoo. Thaum muaj kev hloov pauv hauv lub xeev kev txhim kho,Kev kho mob kev noj qab haus huv pib.
Physiotherapy
txheej txheem muaj ntau yam:
- kho mob ultrasound;
- magnetotherapy;
- poov tshuaj iodide electrophoresis;
- UFO;
- galvanotherapy;
- paraffin thiab ozokeritotherapy;
- infrared irradiation;
- laser kho;
- daim ntawv thov kev kho mob cov kua tsib rhuab sib xyaw nrog dimexide.
Kev sib xyaw ntawm cov tshuaj thiab kev kho lub cev yuav tsum tau ua txhua rau lub hlis txhawm rau ua kom cov nyhuv ua haujlwm ntev.
Kev tawm dag zog
Lawv feem ntau tsuas yog xav tau kev kho mob xwb. Nws yog so, twisting thiab ncab. Thaum ua tsis tu ncua, mandible ce txo lub puab tsaig contraction.
Nws yog qhia rau cov neeg mob uas muaj malocclusion, hniav thiab lub puab tsaig. Lub essence ntawm txoj kev yog los tsim ib tug uniform load ntawm tag nrho cov puab tsaig pob qij txha. Kev kho hniav kaus mom, braces, palatal phaj, crowns thiab prostheses yog siv nyob rau hauv kev kho mob. Qee lub sij hawm tus neeg mob hnav ib txoj hlua khi rau 2-10 hnub, uas txo cov leeg laxity.
Kev ua haujlwm
Nws tsuas yog ua tau thaum lwm txoj hauv kev tsis muaj txiaj ntsig. Indication - mob mus tas li. Qhov tseem ceeb ntawm kev ua haujlwm yog kev tshem tawm ntawm kev sib koom ua ke lossis pob txha mos, tshem tawm lossis hloov pauv ntawm lub taub hau ntawm mandible, kev teeb tsa ntawm kev hloov pauv. Txoj kev tom kawg yog qhov ua tau zoo tshaj plaws vim tias nws hloov tag nrho cov pob qij txha puas. Kev xaiv kho mob yog tus kws kho mob.
Special Diet
Nws yog ib qho tsim nyog yuav tsum tau siv cov khoom noj tsis txaus thiab frayed, tsawg kawg rau lub sijhawm kho. Khoom noj khoom haus thiab ntxhib, tshuaj yej, kas fes, sorrel, spinach, smoked nqaij yuav tsum raug cais tawm. Cov tais diav uas muaj collagen thiab elastin - jelly, hash, jelly.
kev kho neeg zoo
Kev kho mob ntawm lub puab tsaig ntawm lub puab tsaig nrog cov tshuaj pej xeem yuav tsum tsuas yog ntxiv rau qhov tseem ceeb. Muaj ntau yam zaub mov txawv, ob qho tib si yooj yim thiab complex. Feem ntau siv cua sov nrog ntsev los yog xuab zeb. Lawv raug siv thaum cua sov los txo qhov mob ntawm qhov chaw raug mob rau 1.5-2 teev kom txog thaum txias tag.
Lwm daim ntawv qhia yog smear tag nrho lub puab tsaig thiab qab pob ntseg nrog qe dawb hmo ntuj.
Kuj siv:
- celandine kua txiv nrog zib mu - instilled nyob rau hauv lub qhov ntswg;
- tshuaj ntsuab compresses - horseradish, burdock, elecampane, St. John's wort, txiv qaub balm, celandine, calendula, eucalyptus, plantain;
- xav kom noj txiv apple cider vinegar rau ib hlis 3 zaug hauv ib hnub ua ntej noj mov, nws tshem tawm ntsev ntawm lub cev;
- kev sib xyaw ntawm cranberries, zib ntab thiab qej.
ntsuas kev tiv thaiv
Cov xwm txheej yuav tsum yooj yim, tab sis zoo heev:
- tsis suav nrog lub cev tsis ua haujlwm thiab kev ntxhov siab;
- kev tshem tus cwj pwm phem tsis yog haus cawv thiab haus luam yeeb xwb, tab sis kuj yog tus cwj pwm ntawm tom rau tes, xaum thiab cwj mem;
- niam noob;
- zom cov pos hniav rau teev;
- sib tham ntev hauv xov tooj;
- yuav yawn;
- nrhiav hu nkauj.
Koj yuav tsum mus ntsib kws kho hniav tsis tu ncuathiab tswj qhov ncauj huv si.
