Oren Daniel, Dror Amiel A, Khalil Tharwat Haj, Zoabi Adeeb, Zigron Asaf, Kablan Fares, Srouji Samer
Department of Oral and Maxillofacial Surgery, Galilee College of Dental Sciences, Galilee Medical Center, Nahariya, Israel; The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel; The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
J Craniomaxillofac Surg. 2022 Apr;50(4):336-342. doi: 10.1016/j.jcms.2022.03.002. Epub 2022 Mar 9.
The aim of this study is to compare the effectiveness of intra-articular and three-point sub-synovial steroid injections. In this retrospective Cohort study an OSCA lysis and lavage, intra-articular and threepoint sub-synovial steroid injections were performed and the maximal interincisinal opening (MIO), pain using 10- point visual analog scale (VAS) and quality of life (QOL) were measured one week before the procedure and 1, 3, 6, 12 months, and 2 and 3years after surgery. Sixty-five patients suffering from internal derangement refractory to conservative treatment charts were reviewed. successfully lowered pain (p value = 0.0012), and improved mouth opening (p value = 0.023), and quality of life (QoL) (p value = 0.003) for up to 6 months after surgery. OSCA with intra-articular CS injections effectively lowered pain (p value = 0.0025), and improved mouth opening (p value = 0.03) and QoL (p value = 0.004) for 12 months. In comparison, OSCA with sub-synovial steroid injections was significantly effective in lowering pain (p value = 0.000002), improving mouth opening (p value = 0.000004), and QoL (p value p = 0.000006) for the duration of the 36-month follow-up period within the limitations of the study it seems that the OSCA technique with site-specific, sub-synovial CS injections should be the preferred treatment approach when the priority is long-term success concerning pain relief, increased mouth opening and improved quality of life in Wilkes II-IV patients.
本研究的目的是比较关节内注射和三点滑膜下类固醇注射的效果。在这项回顾性队列研究中,进行了开放性关节盘松解和灌洗、关节内注射和三点滑膜下类固醇注射,并在手术前一周以及术后1个月、3个月、6个月、12个月、2年和3年测量了最大切牙间开口度(MIO)、使用10分视觉模拟量表(VAS)评估的疼痛程度以及生活质量(QOL)。对65例经保守治疗无效的内部紊乱患者的病历进行了回顾。[具体治疗方式]在术后长达6个月的时间里成功减轻了疼痛(p值 = 0.0012),改善了开口度(p值 = 0.023)和生活质量(QoL)(p值 = 0.003)。关节内注射皮质类固醇的开放性关节盘松解术在12个月内有效减轻了疼痛(p值 = 0.0025),改善了开口度(p值 = 0.03)和生活质量(QoL)(p值 = 0.004)。相比之下,在36个月的随访期内,滑膜下类固醇注射的开放性关节盘松解术在减轻疼痛(p值 = 0.000002)、改善开口度(p值 = 0.000004)和生活质量(p值 = 0.000006)方面具有显著效果。在本研究的局限性范围内,对于Wilkes II-IV期患者,当优先考虑长期成功缓解疼痛、增加开口度和改善生活质量时,采用特定部位滑膜下皮质类固醇注射的开放性关节盘松解术似乎是首选的治疗方法。