Singh R K, Pal U S, Goyal Pawan, Nischal A, Gurung Tika Ram, Daga Dipti
KG Medical University, Lucknow, India.
J Maxillofac Oral Surg. 2018 Sep;17(3):270-275. doi: 10.1007/s12663-017-1037-4. Epub 2017 Aug 19.
The purpose of the study was to compare the efficacy of arthrocentesis alone and arthrocentesis with duloxetine in patients with TMJ pain.
This study comprised of 20 patients. Patients with TMJ pain as confirmed by RDC/TMD and with pain duration of at least 3 months were included in the study. Patients were randomly divided into two groups, group A in which patients were treated with arthrocentesis alone and group B in which patients were treated with arthrocentesis followed by duloxetine 30 mg twice daily for 12-week therapy. Patients were followed up at regular interval at day 1, day 5, day 7, week 4, week 6 and week 12. Outcome assessment of pain, swelling, maximal mouth opening, painful/pain-free lateral or protrusive jaw movement was done. Hospital anxiety and depression (HAD) scale was used to assess pre- and post-treatment anxiety and depression. Radiologic assessment was done based on OPG and CBCT. Biochemical assessment of IL-6 in lavage fluid between groups A and B was done pre-operatively and postoperatively.
There was significant reduction of pain in both groups, but reduction of pain was more in group B than in group A at week 4, week 6 and week 12. Mouth opening was significantly higher in group B than in group A patients. Reduced painful lateral and protrusive movements were seen in group B than in group A patients. There was no significant difference in hospital anxiety and depression scale among the groups at pre-operative and at 4th week post-operative. Though a significant reduction of IL-6 levels was seen post-operatively, there was no significant difference between the two groups.
Arthrocentesis is an effective procedure for relieving symptoms in patients with temporomandibular disorders. In this study, combination of duloxetine with arthrocentesis gave much better outcome than arthrocentesis alone. Further studies with large sample size required to evaluate the effect of arthrocentesis plain or in combination with duloxetine in providing permanent relief to the patient.
本研究旨在比较单纯关节穿刺术与关节穿刺术联合度洛西汀治疗颞下颌关节疼痛患者的疗效。
本研究纳入20例患者。纳入标准为经RDC/TMD确诊为颞下颌关节疼痛且疼痛持续时间至少3个月的患者。患者被随机分为两组，A组患者仅接受关节穿刺术治疗，B组患者接受关节穿刺术，随后每日两次服用30mg度洛西汀，进行为期12周的治疗。在第1天、第5天、第7天、第4周、第6周和第12周定期对患者进行随访。对疼痛、肿胀、最大开口度、疼痛/无痛的侧向或前伸颌运动进行结果评估。采用医院焦虑抑郁量表（HAD）评估治疗前后的焦虑和抑郁情况。基于全景片（OPG）和锥形束计算机断层扫描（CBCT）进行影像学评估。术前和术后对A组和B组灌洗液中的白细胞介素-6（IL-6）进行生化评估。
两组患者的疼痛均有显著减轻，但在第4周、第6周和第12周时，B组的疼痛减轻程度大于A组。B组患者的开口度明显高于A组患者。B组患者疼痛的侧向和前伸运动减少程度大于A组患者。术前和术后第4周，各组间医院焦虑抑郁量表评分无显著差异。虽然术后IL-6水平显著降低，但两组之间无显著差异。
关节穿刺术是缓解颞下颌关节紊乱症患者症状的有效方法。在本研究中，度洛西汀与关节穿刺术联合使用的效果比单纯关节穿刺术好得多。需要进一步进行大样本研究，以评估单纯关节穿刺术或联合度洛西汀为患者提供永久缓解的效果。
