CAJ | 학술논문

目的评价关节内注射透明质酸钠治疗颞下颌关节紊乱病的效果.方法检索多种数据库,手检15种中国口腔医学杂志,纳入应用随机或半随机对照试验设计的有关关节内注射透明质酸钠治疗颞下颌关节紊乱病的文献摘要及全文,尝试追寻未发表文献.资料提取、评价、荟萃分析方法参照Cochrane指导原则进行.结果通过广泛文献检索,共发现关节内注射透明质酸钠治疗颞下颌关节紊乱病随机对照试验文献12篇,半随机对照试验2篇,治疗类风湿颞下颌关节炎随机对照试验1篇,其中10篇符合纳入标准.除了71例仅有定性资料描述,余490例有定量资料描述,可进行Meta-分析.277例应用透明质酸钠,113例应用安慰剂或无治疗,100例应用糖皮质激素关节内注射.与安慰剂组相比较,透明质酸钠对减轻短期及长期症状,改善疼痛未达到统计学显著水平,但可显著减轻短期及长期临床体征,显著增加张口度.敏感分析发现,与安慰剂相比对临床体征可短期改善的结论不稳定.透明质酸钠不良反应多为轻微一过性.结论关节内注射透明质酸钠可能改善短期及长期颞下颌关节紊乱病临床体征,不良反应轻微一过性,但需要更多设计良好的随机对照试验证实其治疗效果.
목적평개관절내주사투명질산납치료섭하합관절문란병적효과.방법검색다충수거고,수검15충중국구강의학잡지,납입응용수궤혹반수궤대조시험설계적유관관절내주사투명질산납치료섭하합관절문란병적문헌적요급전문,상시추심미발표문헌.자료제취、평개、회췌분석방법삼조Cochrane지도원칙진행.결과통과엄범문헌검색,공발현관절내주사투명질산납치료섭하합관절문란병수궤대조시험문헌12편,반수궤대조시험2편,치료류풍습섭하합관절염수궤대조시험1편,기중10편부합납입표준.제료71례부유정성자료묘술,여490례유정량자료묘술,가진행Meta-분석.277례응용투명질산납,113례응용안위제혹무치료,100례응용당피질격소관절내주사.여안위제조상비교,투명질산납대감경단기급장기증상,개선동통미체도통계학현저수평,단가현저감경단기급장기림상체정,현저증가장구도.민감분석발현,여안위제상비대림상체정가단기개선적결론불은정.투명질산납불량반응다위경미일과성.결론관절내주사투명질산납가능개선단기급장기섭하합관절문란병림상체정,불량반응경미일과성,단수요경다설계량호적수궤대조시험증실기치료효과.
Objective To assess the effectiveness of intraarticular injection of hyaluronate (HA) on temporomandibular disorders (TMD). Methods Searching various databases available, handsearching 15 Chinese dental journals to find articles, abstracts and unpublished literature with randomized or quasi-randomized design on the effects of intraarticular injection of HA on TMD. Data extraction, appraisal, and the methods for Meta-analysis were conducted based on the Cochrane guidelines. Results 12 R CTs and 2 CCT on TMD and 1 R CT on rheumatoid arthritis involving temporomandibular joints (TMJ) were located, 10 of them fulfilled inclusion criteria in which 561 patients were reported. Except 71 cases with only qualitative data, 490 cases could be calculated in Meta-analysis:277 on HA, 113 on placebo or non-treatment (PL) and 100 on corticosteroids (CO). In comparison with PL, HA injection showed no statistically significant effect on short and long term improvement of symptoms, and short term improvement of VAS as well. But it presented significant better effects than PL in short and long term improvement of clinical signs, especially mouth opening. When sensitivity analysis was conducted for improvement of short term signs, the conclusion was not stable. Comparison of the effect between HA and CO showed the same efficacy levels.Adverse reactions of HA were mild and transient. Conclusions HA may improve short and long term clinical signs of TMD and have only mild and transient adverse reactions. However, more RCTs are needed to confirm its therapeutic effect.