Al-Baghdadi M, Durham J, Araujo-Soares V, Robalino S, Errington L, Steele J
Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Newcastle University, UK Institute of Health and Society, Newcastle University, UK
Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Newcastle University, UK Institute of Health and Society, Newcastle University, UK.
J Dent Res. 2014 Jul;93(7 Suppl):37S-51S. doi: 10.1177/0022034514528333. Epub 2014 Mar 21.
Various interventions have been used for the management of patients with temporomandibular joint (TMJ) disc displacement without reduction (DDwoR), but their clinical effectiveness remains unclear. This systematic review investigated the effects of these interventions and is reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic and manual searches up to November 1, 2013, were conducted for English-language, peer-reviewed, publications of randomized clinical trials comparing any form of conservative or surgical interventions for patients with clinical and/or radiologic diagnosis of acute or chronic DDwoR. Two primary outcomes (TMJ pain intensity and maximum mouth opening) and a number of secondary outcomes were examined. Two reviewers performed data extraction and risk of bias assessment. Data collection and analysis were performed according to Cochrane recommendations. Twenty studies involving 1,305 patients were included. Data analysis involved 21 comparisons between a variety of interventions, either between interventions, or between intervention and placebo or no intervention. Meta-analysis on homogenous groups was conducted in 4 comparisons. In most comparisons made, there were no statistically significant differences between interventions relative to primary outcomes at short- or long-term follow-up (p > .05). In a separate analysis, however, the majority of reviewed interventions reported significantly improved primary outcome measures from their baseline levels over time (p < .05). Evidence levels, however, are currently insufficient for definitive conclusions, because the included studies were too heterogeneous and at an unclear to high risk of bias. In view of the comparable therapeutic effects, paucity of high-quality evidence, and the greater risks and costs associated with more complex interventions, patients with symptomatic DDwoR should be initially treated by the simplest and least invasive intervention.
多种干预措施已被用于治疗颞下颌关节（TMJ）不可复性盘前移位（DDwoR）患者，但它们的临床疗效仍不明确。本系统评价调查了这些干预措施的效果，并按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行报告。截至2013年11月1日，我们进行了电子和手工检索，以查找英文、经同行评审的随机临床试验出版物，这些试验比较了针对临床和/或放射学诊断为急性或慢性DDwoR患者的任何形式的保守或手术干预措施。研究了两个主要结局（TMJ疼痛强度和最大开口度）以及一些次要结局。两名评审员进行了数据提取和偏倚风险评估。数据收集和分析按照Cochrane推荐进行。纳入了20项涉及1305例患者的研究。数据分析涉及各种干预措施之间、干预措施与安慰剂或无干预措施之间的21项比较。对4项比较进行了同质组的Meta分析。在大多数比较中，干预措施在短期或长期随访时相对于主要结局在统计学上无显著差异（p>.05）。然而，在一项单独分析中，大多数经审查的干预措施报告随着时间推移其主要结局指标相对于基线水平有显著改善（p<.05）。然而，由于纳入的研究过于异质且偏倚风险不明确至高风险，目前证据水平不足以得出明确结论。鉴于治疗效果相当、高质量证据匮乏以及更复杂干预措施相关的更大风险和成本，有症状的DDwoR患者应首先采用最简单、侵入性最小的干预措施进行治疗。
