関節痛を伴う顎関節症患者は前方頭位を示すか？セファログラムによる検討

Do Temporomandibular Disorder Patients with Joint Pain Exhibit Forward Head Posture? A Cephalometric Study.

抄録

目的:

顎関節症の有無にかかわらず、頭部および頸部の姿勢を評価し、痛み、症状の重さ、および姿勢の間の相関を評価する。

PURPOSE: To evaluate head and cervical posture in individuals with or without temporomandibular disorders (TMDs) and to assess the correlations between pain, severity of symptoms, and posture.

方法:

合計384名の患者（男性129名、女性255名）を対象とした。Fonseca Anamnestic Index (FAI) を用いて、顎関節症の重症度、有病率、および顎関節痛の有無を評価した。患者を顎関節症なし群，顎関節痛なし群，顎関節痛あり群の3群に分けた．さらに，顎関節痛のある患者を軽度顎関節症群と中等度・重度顎関節症群に分けた．頭部と頸部の姿勢を特徴付けるために、セファログラムで9つのパラメータを追跡した。

METHODS: A total of 384 patients (129 males and 255 females) was included. The Fonseca Anamnestic Index (FAI) was used to assess the severity and prevalence of TMD and the presence of temporomandibular joint (TMJ) pain. Patients were divided into three groups: the TMD-free group, TMD without TMJ pain group, and TMD with TMJ pain group. Subsequently, the patients with TMJ pain were further divided into mild TMD and moderate/severe TMD groups. Nine parameters were traced on cephalograms to characterize the head and cervical posture.

結果:

顎関節痛を有する顎関節症患者は、顎関節痛のない患者や顎関節症のない人に比べて、頭部前方姿勢（FHP）の増加を認めた。顎関節痛のない顎関節症患者と顎関節症でない患者との間に有意な差は認められなかった。顎関節痛を有する顎関節症患者では、中等度・重度の顎関節症患者は軽度の顎関節症患者に比べ、FHPが増加した。関節痛を有する顎関節症患者は、交絡変数調整後、関節痛のない患者よりもCVT/RL (=3.099), OPT/RL (=2.117), NSL/C2' (=4.646) が大きかった（< 0.05）．

RESULTS: TMD patients with TMJ pain showed increased forward head posture (FHP) than patients without TMJ pain and TMD-free subjects. No significant difference was observed between the TMD patients without TMJ pain and TMD-free subjects. In the TMD patients with the TMJ pain group, the moderate/severe TMD patients demonstrated increased FHP compared to mild TMD patients. TMD patients with joint pain had greater CVT/RL ( = 3.099), OPT/RL ( = 2.117), and NSL/C2' ( = 4.646) than the patients without joint pain after adjusting for confounding variables ( < 0.05).

結論:

顎関節痛を有する顎関節症患者は，他の群に比べFHPが増加し，男性患者では顎関節症の重症度が増すにつれてFHPがより有意となり，FHPが顎関節痛の発生に重要な役割を果たす可能性が示唆された．顎関節症の臨床評価では、患者の頭部と頸部の異常な姿勢を考慮する必要がある。

CONCLUSION: TMD patients with TMJ pain showed increased FHP compared to other groups, and FHP became more significant as TMD severity increased in male patients, indicating the FHP might play an important role in the development of TMJ pain. In the clinical assessment of TMD, the patients' abnormal head and cervical posture might be considered.