富血小板血浆与透明质酸联合应用可减轻颞下颌关节骨关节炎关节穿刺术患者的疼痛。

Combined Platelet-Rich Plasma and Hyaluronic Acid can Reduce Pain in Patients Undergoing Arthrocentesis for Temporomandibular Joint Osteoarthritis.

机构信息

Resident, Oral and Maxillofacial Surgery Department, Student Research Committee, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.

Dentist, Research Assistant, Dental Research Center, Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad, Iran.

出版信息

J Oral Maxillofac Surg. 2022 Sep;80(9):1474-1485. doi: 10.1016/j.joms.2022.05.002. Epub 2022 May 16.

DOI:10.1016/j.joms.2022.05.002

PMID:35679902

Abstract

PURPOSE

The benefit of adjuvant medications, such as platelet-rich plasma (PRP) and hyaluronic acid (HA), following arthrocentesis remains controversial. The purpose of this study was to evaluate the efficacy of PRP and HA injection following arthrocentesis in subjects with symptomatic temporomandibular joint osteoarthritis (TMJ-OA).

METHODS AND MATERIALS

The authors implemented a prospective randomized single-blinded pilot clinical study. Healthy adults diagnosed with TMJ-OA who were treated with nonsurgical treatments initially, but failed to respond, participated in this study. Subjects were randomly allocated to HA, PRP, or combined HA+PRP groups following arthrocentesis. The primary outcome variable was the change in pain at 1 and 6 months postoperatively, using the Visual Analogue Scale (VAS). The secondary outcome variables were the changes in maximum mouth opening (MMO), lateral and protrusive mandibular movements, and pathologic TMJ sounds at 1 and 6 months postoperatively. Descriptive and bivariate statistics were computed. The significance level was set at P value < .05, using SPSS 19.

RESULTS

A total of 30 consecutive patients (15 males and 15 females) with a mean age of 29.63 ± 8.34 years were followed for 6 months in this study. The mean reduction in pain at 6 months was 4.1 ± 0.9, 4.1 ± 1.1, and 5.1 ± 1.0 for HA, PRP, and HA/PRP, respectively (P < .05). In all 3 treatment groups, mean VAS parameters had significantly reduced after treatment and these postoperative values were significantly lower in the PRP+HA group (P < .001). The mean increase of MMO after 6 months was 8.0 ± 2.8, 8.0 ± 3.0, and 10.1 ± 3.3 for HA, PRP, and HA/PRP, respectively (P < .05). MMO, lateral, and protrusive mandibular movements significantly improved after treatment in all 3 groups (P < .001). TMJ noises were significantly reduced in all treatment groups (P < .001), but the PRP+HA group exhibited a greater reduction.

CONCLUSION

Combined HA and PRP injection following arthrocentesis is more effective than HA or PRP alone in the management of TMJ-OA.

摘要

目的

关节穿刺术后辅助药物（如富血小板血浆（PRP）和透明质酸（HA））的益处仍存在争议。本研究的目的是评估关节穿刺术后 PRP 和 HA 注射治疗症状性颞下颌关节骨关节炎（TMJ-OA）患者的疗效。

方法与材料

作者实施了一项前瞻性随机单盲试点临床研究。最初接受非手术治疗但未缓解的 TMJ-OA 健康成年人参加了这项研究。关节穿刺术后，受试者随机分配到 HA、PRP 或 HA+PRP 联合组。主要结局变量是术后 1 个月和 6 个月时使用视觉模拟评分（VAS）评估的疼痛变化。次要结局变量是术后 1 个月和 6 个月时最大张口度（MMO）、下颌侧向和前伸运动以及病理性 TMJ 声音的变化。采用描述性和双变量统计分析。使用 SPSS 19 计算显著性水平为 P 值<.05。

结果

本研究共纳入 30 例连续患者（15 例男性和 15 例女性），平均年龄 29.63±8.34 岁，随访 6 个月。HA、PRP 和 HA/PRP 组术后 6 个月疼痛平均缓解分别为 4.1±0.9、4.1±1.1 和 5.1±1.0（P<.05）。在所有 3 种治疗组中，治疗后 VAS 平均参数均显著降低，PRP+HA 组术后值显著降低（P<.001）。术后 6 个月 MMO 的平均增加分别为 HA 组 8.0±2.8、PRP 组 8.0±3.0 和 HA/PRP 组 10.1±3.3（P<.05）。所有 3 组治疗后 MMO、侧向和前伸下颌运动均显著改善（P<.001）。所有治疗组 TMJ 噪声均显著降低（P<.001），但 PRP+HA 组降低更明显。