加圧関節洗浄療法における顎関節内圧の測定

Abstract

To investigate the effect of distension and removal of adhesion in the upper joint space after lavage under sufficient hydraulic pressure during arthrocentesis, we measured changes in intra-articular pressure in the joint space and performed arthroscopic examinations during the procedure.Eight patients (8 joints) with closed lock of the temporomandibular joint who underwent arthrocentesis and arthroscopic examination were studied. Adhesion was observed in 5 joints on arthroscopic examination before irrigation; the remaining 3 joints had no adhesion. Changes in intra-articular pressure during irrigation under high pressure (40KPa) were measured in these 8 joints. In 5 joints with adhesion, arthroscopic examination was repeated to confirm whether the adhesion was removed after irrigation.Immediately after application of pressure, the intra-articular pressure in the joints without adhesion was 9.1-14.7 KPa, and that in the joints with adhesion was 10.0-13.3 KPa. After applying pressure to the joints without adhesion, 30 seconds were required until a stable pressure was reached, whereas 2 to 5minutes were required in joints with adhesion. In all 5 joints with adhesion, removal of the adhesion was observed on arthroscopic examination after the intra-articular pressure decreased to a stable level.These results indicate that lavage under sufficient hydraulic pressure, which is a 2-to 5-minute procedure, can widen a narrowed joint space and remove adhesion.