關節內注射透明質酸鈉治療顳下頜關節紊亂病效果的系統評價_《中國循證醫學雜志》

作者：

史宗道 ¹ , 郭春嵐 ² , 陳娥 ¹

1. 四川大學華西口腔醫院,成都,6100412. 中國醫學科學院北京協和醫院口腔科,北京,100032;

關鍵詞：

透明質酸鈉顳下頜關節紊亂病系統評價

視頻：

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摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　評價關節內注射透明質酸鈉治療顳下頜關節紊亂病的效果.
方法　檢索多種數據庫,手檢15種中國口腔醫學雜志,納入應用隨機或半隨機對照試驗設計的有關關節內注射透明質酸鈉治療顳下頜關節紊亂病的文獻摘要及全文,嘗試追尋未發表文獻.資料提取、評價、薈萃分析方法參照Cochrane指導原則進行.
結果　通過廣泛文獻檢索,共發現關節內注射透明質酸鈉治療顳下頜關節紊亂病隨機對照試驗文獻12篇,半隨機對照試驗2篇,治療類風濕顳下頜關節炎隨機對照試驗1篇,其中10篇符合納入標準.除了71例僅有定性資料描述,余490例有定量資料描述,可進行Meta-分析.277例應用透明質酸鈉,113例應用安慰劑或無治療,100例應用糖皮質激素關節內注射.與安慰劑組相比較,透明質酸鈉對減輕短期及長期癥狀,改善疼痛未達到統計學顯著水平,但可顯著減輕短期及長期臨床體征,顯著增加張口度.敏感分析發現,與安慰劑相比對臨床體征可短期改善的結論不穩定.透明質酸鈉不良反應多為輕微一過性.
結論　關節內注射透明質酸鈉可能改善短期及長期顳下頜關節紊亂病臨床體征,不良反應輕微一過性,但需要更多設計良好的隨機對照試驗證實其治療效果.

引用本文： 史宗道,郭春嵐,陳娥. 關節內注射透明質酸鈉治療顳下頜關節紊亂病效果的系統評價. 中國循證醫學雜志, 2004, 04(6): 368-376. doi: 復制

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1. ［1］Rugh JD, Solberg WK. Oral health status in the United States: temporomandibular disorders[J]. J Dent Edu., 1985;49(6) :398-405.
2. ［2］Solberg WK, Woo MW, Houston JB. Prevalence of mandibular dysfunction in young adults[J]. JADA,1979; 98(1): 25-34.
3. ［3］Wanman A, Agerberg G. Mandibular dysfunction in adolescent[J]. Acta Odont Scand, 1986; 44(1): 45-73.
4. ［4］Xu YH, Yi XZ, Luo ZH. An epidemiologic study of temporomandibular joint dysfunction in young people [J ]. Chin J Stomatol, 1989 (3) ;24,249-252.
5. 徐櫻華,易新竹,羅宗賚,任平惠.顳下頜關節紊亂綜合征在青年學生中的流行病學調查[J].中華口腔醫學雜志1989;24(3):249-52.
6. ［5］Stegenga B, de Bont LGM, Boering G. Osteoarthrosis as the cause of craniomandibular pain and dysfuction, A unifying concept[J]. J Oral Maxillofac Surg, 1989;47(3) :249-256.
7. ［6］Stegenga B, de Bont LGM, van der Kuijl B, Boering G. Classification of temporomandibular joint osteoarthrosis and internal derangement. Part I: Diagnostic significance of clinical and radiographic symptoms and signs[J]. J Cranio-mandibul Pract, 1992;10(2) :96-106.
8. ［7］Toller PA. Use and misuse of intra-articular corticosteroids in treatment of temporomandibular joint pain. Proceedings of the Royal Society of Medicine[J], 1977; 70(7) :461-463.
9. ［8］Kopp S, Wenneberg B. Effects of occlusal treatment and intraarticular injections on temporomandibular joint pain and dysfunction. Acta Odontolog Scandinavica, 1981 ;39(2) :87-96.
10. ［9］Zhang XN, Zhang ZK. Effect of intra-articular injection of prednisolone in treating organic destrucion of the TMJ disturbance syndrome[J]. Chin J Stomatol,1985 ;20(2) :93-95.
11. 張熙恩,張震康.關節下腔注射醋酸強的松龍治療顳下頜關節紊亂綜合征器質性破壞期的近期療效觀察[J].中華口腔醫學雜志,1985;20(2):93-95.
12. ［10］Wenneberg B, Kopp S, Grondahl HG. Long-term effect of intra-articular injections of a glucocorticosteroid into the TMJ:a clinical and radiographic 8-year follow-up[J]. J Craniomandibul Disord: Facial & Oral Pain,1991; 5(1) :11-18.
13. ［11］Kikiewicz D. Effect of hydrocortisone on experimental necrosis of cartilage of the temporomandibular joint in guinea pigs [ J ]. Annales Academiae Medicae Stetinensis in Polish,1985; 31:185-196.
14. ［12］Gu ZY, Cai ZQ, Wu QL. The effects ofprednisolone on rabbit temporomandibular joints[J]. J Oral Maxillofac Surg,1993:3(4) :218-220.
15. 谷志遠,曹志強,吳求亮,.醋酸強的松龍對兔顳下頜關節的影響[J].口腔頜面外科雜志,1993;3(4):218-220.
16. ［13］Hu B, Wang DH, Preliminary study on effects ofintraarticular injection of prednisolone on temporomandibular joint [ J ]. J Comprehensive Stomatol, 1995; 11 ( 2 ): 86-88.
17. 胡波,王大章.醋酸強的松龍關節內注射對顳下頜關節影響的初步研究[J]口腔醫學縱橫雜志,1995;11(2):86-88.
18. ［14］Shi ZD, Yang F, He ZX, Shi B, Yang MZ. Comparative study on effects of sodium hyaluronate and prednisolone injecions on experimental temporomandibular joint osteoarthritis of rabbits[J]. Chin J Reparat and Reconstruct Surg, 2002; 16(1) :5-10.
19. 史宗道,楊峰,何志秀,史冰,楊名仲透明質酸鈉與強的松龍治療兔實驗性顳頜關節骨關節炎的對照研究[J].中國修復重建外科雜志,2002;16(1):5-10.
20. ［15］Chandler GN,Wright V.Deleterious effect ofintra-articular hydrocorrisone[J]Lancet,1958;2(7048):661-663.
21. ［16］Fu K,Ma X,Zheng Z.Pathologic study on synovialfluid after intra-articular corticosteroid therapy in temporomandibular jomt disorders[J].Chin J Stomatol 1999;34(1):55-57.
22. 傅開元,馬緒臣,張震康,孫開華,魏明潔.顳下頜關節紊亂病關節腔注射糖皮質激素后關節液病理分析[J]中華口腔醫學雜志,1999;34(1):55-57.
23. ［17］Abatangelo G, Botri P, Bue D. Intrarticular sodium hyaluronate injections in the Pond-Nuki experimental model of osteoarthritis in dogs [ J ]. Clin Orthop Relat Res, 1989;241:286-99.
24. ［18］Galateo D, Schiavinato A, Lini E, Guidolin D. Intrarticular sodium hyaluronate injections in the Pond-Nuki experimental model of osteoarthritis in dogs[J]. Clin J Orthop, 1989 ;241:286-299.
25. ［19］Kitoh Y, Katsuramaki T, Tanaka H. Effect ofSL-1010 (sodium hyaluronate with high molecular weight) on experimental osteoarthritis induced by intra-articularly applied papain in rabbits[J]. Nippon Yakurigaku Zasshi,1992 ;100( 1 ) :67-76.
26. ［20］Neo H, IsmimaruJI, Kurita K, Goss AN. The effect ofhyaluronic acid on experimental temporomandibular joint osteoarthrosis in the sheep[J]. J Oral Maxillofac Surg, 1997; 55(10):1 114-1 119.
27. ［21］Zhang SZ; Wu YH. The effect of sodium hyaluronate on the rabbit osteoarthrosis[J]. Shanghai J Stomatol, 2003; 12 (3):187-190.
28. 張世周,吳益華.透明質酸鈉對兔顳下頜關節骨病的作用[J].上海口腔醫學,2003;12(3):187-190.
29. ［22］Rydel NW, Butler J, Balazs EA. Hyaluronic acid in synovial fluid VI. Effect of intra-articular injection of hyaluronic acid on the clinical symptoms of arthritis in track horses[J]. Acta Veterinaria Scandinavica, 1970(2) ;11:139-155.
30. ［23］Peyron JG, Balazs EA. Preliminary clinical assessment of Nahyaluronate injection into human arthritic joints [ J ]. Pathologieet Biologie, 1974 ;22 (8) :731.
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《中國循證醫學雜志》

關節內注射透明質酸鈉治療顳下頜關節紊亂病效果的系統評價

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《中國循證醫學雜志》

關節內注射透明質酸鈉治療顳下頜關節紊亂病效果的系統評價

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