Guo Chunlan, Shi Zongdao, Revington Peter
Dentistry Department, Peking Union Medical College Hospital, 41# Da Mucang Hutong, Xicheng District, Beijing, China, 100032.
Cochrane Database Syst Rev. 2009 Oct 7(4):CD004973. doi: 10.1002/14651858.CD004973.pub2.
Temporomandibular joint disorders are important oral health problems, reducing the quality of life of sufferers. It has been estimated that approximately 20% to 30% of the adult population will experience temporomandibular joint dysfunction. Arthrocentesis and lavage has been used to treat temporomandibular joint disorders for about 10 years, but the clinical effectiveness of the therapy has not been summarized in the form of a systematic review.
To assess the effectiveness and complications of arthrocentesis and lavage for the treatment of temporomandibular joint disorders compared with controlled interventions.
The Cochrane Oral Health Group's Trials Register (to August 2009), CENTRAL (The Cochrane Library 2009, Issue 3), MEDLINE (1950 to August 2009), EMBASE (1980 to August 2009), OpenSIGLE (to August 2009), CBMdisc (1981 to 2007 (in Chinese)) and Chinese Medical Library were searched. All the Chinese professional journals in the oral health field were handsearched and conference proceedings consulted. There was no language restriction.
All randomised controlled trials (RCTs) (including quasi-randomised clinical trials) aiming to test the therapeutic effects of arthrocentesis and lavage for treating temporomandibular joint disorders.
Two review authors independently extracted data, and three review authors independently assessed the risk of bias of included trials. The first authors of the selected articles were contacted for additional information.
Two trials, at unclear to high risk of bias, were included in the review. The two trials, including 81 patients with temporomandibular joint disorders, compared arthrocentesis with arthroscopy. No statistically significant difference was found between the interventions in terms of pain. However, a statistically significant difference in favour of arthroscopy was found in maximum incisal opening (MIO) (weighted mean difference of -5.28 (95% confidence interval (CI) -7.10 to -3.46)).Mild and transient adverse reactions such as discomfort or pain at the injection site were reported in both groups. No data about quality of life were reported.
AUTHORS' CONCLUSIONS: There is insufficient, consistent evidence to either support or refute the use of arthrocentesis and lavage for treating patients with temporomandibular joint disorders. Further high quality RCTs of arthrocentesis need to be conducted before firm conclusions with regard to its effectiveness can be drawn.
颞下颌关节紊乱是重要的口腔健康问题，会降低患者的生活质量。据估计，约20%至30%的成年人口会经历颞下颌关节功能障碍。关节穿刺冲洗术用于治疗颞下颌关节紊乱已有约10年，但该疗法的临床疗效尚未以系统评价的形式进行总结。
评估与对照干预措施相比，关节穿刺冲洗术治疗颞下颌关节紊乱的有效性和并发症。
检索了Cochrane口腔健康组试验注册库（至2009年8月）、CENTRAL（Cochrane图书馆2009年第3期）、MEDLINE（1950年至2009年8月）、EMBASE（1980年至2009年8月）、OpenSIGLE（至2009年8月）、CBMdisc（1981年至2007年（中文））和中国医学图书馆。手工检索了口腔健康领域的所有中文专业期刊，并查阅了会议论文集。无语言限制。
所有旨在测试关节穿刺冲洗术治疗颞下颌关节紊乱疗效的随机对照试验（RCT）（包括半随机临床试验）。
两名综述作者独立提取数据，三名综述作者独立评估纳入试验的偏倚风险。与所选文章的第一作者联系以获取更多信息。
本综述纳入了两项偏倚风险不明确至高风险的试验。这两项试验共纳入81例颞下颌关节紊乱患者，比较了关节穿刺术与关节镜检查。在疼痛方面，两种干预措施之间未发现统计学上的显著差异。然而，在最大切牙开口度（MIO）方面发现了有利于关节镜检查的统计学显著差异（加权平均差为-5.28（95%置信区间（CI）-7.10至-3.46））。两组均报告了轻微且短暂的不良反应，如注射部位的不适或疼痛。未报告有关生活质量的数据。
目前尚无充分、一致的证据支持或反驳使用关节穿刺冲洗术治疗颞下颌关节紊乱患者。在就其有效性得出确切结论之前，需要进行进一步高质量的关节穿刺术随机对照试验。
