J Oral Facial Pain Headache. 2021;35(1):17-29. doi: 10.11607/ofph.2606.
To review randomized clinical trials on arthrocentesis for managing temporomandibular disorders (TMD) and to discuss the clinical implications.
On March 10, 2019, a systematic search of relevant articles published over the last 20 years was performed in PubMed, as well as in Scopus, the authors' personal libraries, and the reference lists of included articles. The focus question was: In patients with TMD (P), does TMJ arthrocentesis (I), compared to any control treatment (C), provide positive outcomes (O)?
RESULTS/CONCLUSION: Thirty papers were included comparing TMJ arthrocentesis to other treatment protocols in patients with disc displacement without reduction and/or closed lock (n = 11), TMJ arthralgia and/or unspecific internal derangements (n = 8), or TMJ osteoarthritis (n = 11). In general, the consistency of the findings was poor because of the heterogenous study designs, and so caution is required when interpreting the meta-analyses. In summary, it can be suggested that TMJ arthrocentesis improves jaw function and reduces pain levels, and the execution of multiple sessions (three to five) is superior to a single session (effect size = 1.82). Comparison studies offer inconsistent findings, with the possible exception of the finding that splints are superior in managing TMJ pain (effect size = 1.36) compared to arthrocentesis, although this conclusion is drawn from very heterogenous studies (I = 94%). The additional use of cortisone is not effective for improving outcomes, while hyaluronic acid or platelet-rich plasma positioning may have additional value according to some studies. The type of intervention, the baseline presence of MRI effusion, and the specific Axis I diagnosis do not seem to be important predictors of effectiveness, suggesting that, as in many pain medicine fields, efforts to identify predictors of treatment outcome should focus more on the patient (eg, age, psychosocial impairment) than the disease.
回顾关节内穿刺术治疗颞下颌关节紊乱病（TMD）的随机临床试验，并讨论其临床意义。
2019 年 3 月 10 日，在 PubMed 以及 Scopus、作者个人图书馆和纳入文章的参考文献中进行了过去 20 年相关文章的系统检索。关注的问题是：在 TMD 患者（P）中，与任何对照治疗（C）相比，TMJ 关节内穿刺术（I）是否提供阳性结果（O）？
结果/结论：比较关节内穿刺术与其他治疗方案治疗未复位和/或闭锁性关节盘前移位（n = 11）、TMJ 关节炎和/或非特异性内部紊乱（n = 8）或 TMJ 骨关节炎（n = 11）患者的 30 篇论文被纳入。总的来说，由于研究设计的异质性，研究结果的一致性较差，因此在解释荟萃分析时需要谨慎。总之，可以认为 TMJ 关节内穿刺术可改善下颌功能并降低疼痛水平，且多次（3-5 次）治疗优于单次治疗（效应量 = 1.82）。对比研究结果不一致，除了夹板在管理 TMJ 疼痛方面优于关节内穿刺术（效应量 = 1.36）这一发现外（这一结论是基于非常异质的研究得出的（I = 94%））。额外使用皮质激素并不能改善治疗效果，而透明质酸或富含血小板的血浆定位可能根据一些研究具有额外的价值。干预类型、基线 MRI 积液的存在以及特定的轴 I 诊断似乎不是疗效的重要预测因素，这表明，与许多疼痛医学领域一样，识别治疗效果预测因素的努力应更多地关注患者（例如年龄、心理社会障碍），而不是疾病本身。
