J Am Dent Assoc. 2018 Nov;149(11):940-952.e2. doi: 10.1016/j.adaj.2018.07.025.
The authors conducted a systematic review and meta-analysis to determine whether arthrocentesis or arthroscopy combined with platelet-rich plasma (PRP) or platelet-rich growth factor (PRGF) injection compared with no injection or saline injection (control group) or hyaluronic acid (HA) injection reduced pain and increased maximum mouth opening (MMO) in patients with temporomandibular joint (TMJ) osteoarthritis (OA).
The authors used the Cochrane Library, Embase, PubMed, Web of Science, Google Scholar databases and hand searched reference lists through May 4, 2018, to identify randomized controlled trials and controlled trials including patients with TMJ OA receiving injections (PRP or PRGF versus other). The authors assessed the risk of bias according to the Cochrane guidelines.
The authors screened 36 abstracts. They included 5 studies (3 randomized controlled trials and 2 controlled trials) with a total of 285 patients with TMJ OA in this review. The authors assessed all 5 studies as being at high risk of bias. The quality of evidence was very low owing to statistical heterogeneity, small sample size, or high risk of bias. Meta-analyses with 2 studies showed a visual analog scale pain improvement from baseline of -2.778 units (0-10 scale, 0 = no pain, 10 = worst pain) favorable to PRP or PRGF compared with findings in control groups (95% confidence interval [CI], -3.504 to -2.052; P < .001) and an improvement of -0.968 favorable to PRP or PRGF compared with findings in HA groups (95% CI, -1.854 to -0.082; P = .032). The authors found no significant increase in MMO in those receiving PRP or PRGF compared with that in the control or HA groups.
Although the results of the included studies showed that arthrocentesis or arthroscopy with PRP or PRGF, saline, or HA injections all reduced pain and increased mouth opening, the evidence was of very low quality. Further studies are needed to confirm these preliminary results showing that PRP or PRGF with arthrocentesis or arthroscopy significantly improved pain but did not increase MMO compared with findings in the control or HA groups.
作者进行了一项系统评价和荟萃分析，以确定关节穿刺术或关节镜检查联合富含血小板的血浆（PRP）或富含血小板的生长因子（PRGF）注射是否比不注射或生理盐水注射（对照组）或透明质酸（HA）注射更能减轻疼痛并增加颞下颌关节（TMJ）骨关节炎（OA）患者的最大张口度（MMO）。
作者使用 Cochrane 图书馆、Embase、PubMed、Web of Science、Google Scholar 数据库和手检参考文献列表，截至 2018 年 5 月 4 日，以确定随机对照试验和包括接受注射治疗的 TMJ OA 患者的对照试验（PRP 或 PRGF 与其他）。作者根据 Cochrane 指南评估偏倚风险。
作者筛选了 36 篇摘要。他们在本次综述中纳入了 5 项研究（3 项随机对照试验和 2 项对照试验），共 285 例 TMJ OA 患者。作者评估 5 项研究均存在高偏倚风险。由于存在统计学异质性、样本量小或偏倚风险高，证据质量极低。两项研究的荟萃分析显示，与对照组相比，PRP 或 PRGF 治疗的视觉模拟评分疼痛改善为基线-2.778 个单位（0-10 个刻度，0 表示无痛，10 表示最痛）（95%置信区间[CI]，-3.504 至-2.052；P<.001），与 HA 组相比，PRP 或 PRGF 治疗的改善为-0.968 个单位（95%CI，-1.854 至-0.082；P=.032）。作者发现，与对照组或 HA 组相比，接受 PRP 或 PRGF 治疗的患者的 MMO 并没有显著增加。
尽管纳入研究的结果表明，关节穿刺术或关节镜检查联合 PRP 或 PRGF、生理盐水或 HA 注射均可减轻疼痛并增加张口度，但证据质量极低。需要进一步的研究来证实这些初步结果，即关节穿刺术或关节镜检查联合 PRP 或 PRGF 显著改善疼痛，但与对照组或 HA 组相比，并不增加 MMO。
