Sit Regina Wing-Shan, Reeves Kenneth Dean, Zhong Claire Chenwen, Wong Charlene Hoi Lam, Wang Bo, Chung Vincent Chi-Ho, Wong Samuel Yeung-Shan, Rabago David
The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong, China.
Private Practice, Roeland Park, KS, USA.
Sci Rep. 2021 Jul 19;11(1):14638. doi: 10.1038/s41598-021-94119-2.
Hypertonic dextrose prolotherapy (DPT) has been reported to be effective for temporomandibular disorders (TMDs) in clinical trials but its overall efficacy is uncertain. To conduct a systematic review with meta-analysis of randomized controlled trials (RCTs) to synthesize evidence on the effectiveness of DPT for TMDs. Eleven electronic databases were searched from their inception to October, 2020. The primary outcome of interest was pain intensity. Secondary outcomes included maximum inter-incisal mouth opening (MIO) and disability score. Studies were graded by "Cochrane risk of bias 2" tool; if data could be pooled, a meta-analysis was performed. Ten RCTs (n = 336) with some to high risk of bias were included. In a meta-analysis of 5 RCTs, DPT was significantly superior to placebo injections in reducing TMJ pain at 12 weeks, with moderate effect size and low heterogeneity (Standardized Mean Difference: - 0.76; 95% CI - 1.19 to - 0.32, I = 0%). No statistically significant differences were detected for changes in MIO and functional scores. In this systematic review and meta-analysis, evidence from low to moderate quality studies show that DPT conferred a large positive effect which met criteria for clinical relevance in the treatment of TMJ pain, compared with placebo injections.Protocol registration at PROSPERO: CRD42020214305.
高渗葡萄糖注射疗法（DPT）在临床试验中已被报道对颞下颌关节紊乱症（TMDs）有效，但其总体疗效尚不确定。进行一项随机对照试验（RCTs）的系统评价和荟萃分析，以综合关于DPT治疗TMDs有效性的证据。检索了11个电子数据库，时间跨度从建库至2020年10月。主要关注的结局是疼痛强度。次要结局包括最大切牙间开口度（MIO）和功能障碍评分。采用“Cochrane偏倚风险2”工具对研究进行分级；若数据可合并，则进行荟萃分析。纳入了10项存在一些至高度偏倚风险的RCTs（n = 336）。在对5项RCTs的荟萃分析中，DPT在减轻12周时的颞下颌关节疼痛方面显著优于安慰剂注射，效应量中等且异质性低（标准化均数差：-0.76；95% CI -1.19至-0.32，I² = 0%）。MIO和功能评分的变化未检测到统计学显著差异。在这项系统评价和荟萃分析中，来自低至中等质量研究的证据表明，与安慰剂注射相比，DPT在治疗颞下颌关节疼痛方面具有较大的积极效果，达到了临床相关性标准。在国际前瞻性系统评价注册库（PROSPERO）的方案注册号：CRD42020214305。
