Bjørnland T, Gjaerum A A, Møystad A
Department of Oral Surgery and Oral Medicine, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway.
J Oral Rehabil. 2007 Aug;34(8):583-9. doi: 10.1111/j.1365-2842.2007.01759.x.
The purpose of this study was to compare the efficacy and the complications of intra-articular temporomandibular joint (TMJ) injections in 40 patients with osteoarthritis of the TMJ. The subjects were randomly divided into two groups, and the patients received either two intra-articular injections with sodium hyaluronate or two intra-articular injections with corticosteroids, 14 days apart. The effect of the treatment was evaluated 14 days, 1 and 6 months after the initial injection and was based on the following measurements: pain intensity, pain localization, joint sounds, mandibular function and complications. Both groups of patients had less pain intensity at the 6-month follow-up, and there was significantly less pain intensity in the group of patients receiving sodium hyaluronate compared with corticosteroids (P = 0.001). A decrease in crepitation was seen in both groups. In the 20 subjects receiving sodium hyaluronate both the mandibular vertical opening and protrusion increased significantly (P < 0.000). Lateral movement from the affected side increased both in subjects injected with sodium hyaluronate (P = 0.024), and those injected with corticosteroids (P = 0.042). In conclusion, this study confirms that injections in the TMJ with sodium hyaluronate or corticosteroids may reduce pain and improve function in patients with osteoarthritis. The injections were more effective in patients with only TMJ pain compared with patients suffering from both TMJ and myofascial pain. Injection with sodium hyaluronate was significantly more effective in decreasing pain intensity than corticosteroids. Temporary pain after injections may be observed.
本研究旨在比较40例颞下颌关节骨关节炎患者关节腔内注射治疗的疗效及并发症。将受试者随机分为两组，患者分别接受间隔14天的两次关节腔内注射透明质酸钠或两次关节腔内注射皮质类固醇。在首次注射后14天、1个月和6个月对治疗效果进行评估，评估基于以下指标：疼痛强度、疼痛部位、关节弹响、下颌功能及并发症。两组患者在6个月随访时疼痛强度均降低，与接受皮质类固醇治疗的患者相比，接受透明质酸钠治疗的患者疼痛强度显著更低（P = 0.001）。两组患者的摩擦音均减少。在接受透明质酸钠治疗的20名受试者中，下颌垂直开口度和前伸均显著增加（P < 0.000）。接受透明质酸钠注射的受试者患侧侧方运动增加（P = 0.024），接受皮质类固醇注射的受试者患侧侧方运动也增加（P = 0.042）。总之，本研究证实，颞下颌关节注射透明质酸钠或皮质类固醇可减轻颞下颌关节骨关节炎患者的疼痛并改善功能。与同时患有颞下颌关节疼痛和肌筋膜疼痛的患者相比，注射治疗对仅患有颞下颌关节疼痛的患者更有效。注射透明质酸钠在减轻疼痛强度方面比皮质类固醇显著更有效。注射后可能会观察到短暂疼痛。
