关节穿刺术与保守疗法治疗 TMJ 紊乱的比较：系统评价和荟萃分析。
Arthrocentesis vs conservative therapy for the management of TMJ disorders: A systematic review and meta-analysis.
机构信息
Department of Stomatology, affiliated Hospital of Shaoxing University, 999 Zhongxing South Road, Shaoxing, Zhejiang 312000, China.
Department of Stomatology, affiliated Hospital of Shaoxing University, 999 Zhongxing South Road, Shaoxing, Zhejiang 312000, China.
出版信息
J Stomatol Oral Maxillofac Surg. 2023 Feb;124(1S):101283. doi: 10.1016/j.jormas.2022.09.004. Epub 2022 Sep 7.
OBJECTIVE
Arthrocentesis is being widely used as an invasive treatment modality for managing temporomandibular joint (TMJ) disorders. The current review aimed to assess if arthrocentesis as the first line of therapy leads to better outcomes as compared to conservative management of TMJ disorders.
METHODS
PubMed, Scopus, Embase, Web of Science, and CENTRAL were searched up to 20th June 2022 for randomized controlled trials comparing TMJ arthrocentesis vs conservative management as first-line therapy for TMJ disorders.
RESULTS
Eight trials were included. Our analysis indicated significantly reduced pain scores in patients undergoing TMJ arthrocentesis as compared to conservative therapy at 1 month (MD: -0.82 95% CI: -1.43, -0.20 I=56% p = 0.01) and 6 months (MD: -1.38 95% CI: -2.45, -0.32 I=86% p = 0.01), but not at 3 months of follow-up (MD: -0.66 95% CI: -1.68, 0.37 I=82% p = 0.21). The results were not stable on sensitivity analysis. There was no difference in MMO between the TMJ arthrocentesis and conservative therapy groups at 1 month (MD: -0.06 95% CI: -3.67, 3.54 I=88% p = 0.97), 3 months (MD: -0.35 95% CI: -3.95, 3.25 I=89% p = 0.85) and 6 months (MD: 0.00 95% CI: -3.34, 3.34 I=86% p = 0.10).
CONCLUSION
Analysis of a small number of trials with high inter-study heterogeneity indicates that first line TMJ arthrocentesis may result in a significant but small improvement in pain scores but without any additional improvement in MMO as compared to conservative therapies. Current evidence does not provide strong support for the use of TMJ arthrocentesis as the first line of therapy for TMDs.
目的
关节穿刺术作为一种有创治疗方法，被广泛用于治疗颞下颌关节（TMJ）紊乱。本综述旨在评估关节穿刺术作为一线治疗方法与 TMJ 紊乱的保守治疗相比是否能带来更好的结果。
方法
我们在 PubMed、Scopus、Embase、Web of Science 和 CENTRAL 上检索了截至 2022 年 6 月 20 日的随机对照试验，比较了 TMJ 关节穿刺术与保守治疗作为 TMJ 紊乱一线治疗的效果。
结果
共纳入 8 项试验。我们的分析表明，与保守治疗相比，TMJ 关节穿刺术在 1 个月（MD：-0.82，95%CI：-1.43，-0.20，I²=56%，p=0.01）和 6 个月（MD：-1.38，95%CI：-2.45，-0.32，I²=86%，p=0.01）时疼痛评分显著降低，但在 3 个月时（MD：-0.66，95%CI：-1.68，0.37，I²=82%，p=0.21）没有差异。敏感性分析结果不稳定。在 1 个月（MD：-0.06，95%CI：-3.67，3.54，I²=88%，p=0.97）、3 个月（MD：-0.35，95%CI：-3.95，3.25，I²=89%，p=0.85）和 6 个月（MD：0.00，95%CI：-3.34，3.34，I²=86%，p=0.10）时，TMJ 关节穿刺术与保守治疗组之间的最大开口度（MMO）没有差异。
结论
对具有高度异质性的少数试验进行分析表明，一线 TMJ 关节穿刺术可能会导致疼痛评分的显著但较小的改善，但与保守治疗相比，在 MMO 方面没有任何额外的改善。目前的证据并不能为 TMJ 关节穿刺术作为 TMDs 的一线治疗提供强有力的支持。
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