Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, and Department of Orthopedic Surgery of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Department of Sports Medicine, Zhejiang University School of Medicine, Hangzhou, China; The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, and Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, Zhejiang, China.
Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, and Department of Orthopedic Surgery of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Department of Sports Medicine, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, and Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China.
J Evid Based Dent Pract. 2022 Sep;22(3):101720. doi: 10.1016/j.jebdp.2022.101720. Epub 2022 Mar 18.
OBJECTIVE: To compare the efficacy of Intra-articular injections of corticosteroids (CCS), hyaluronic acid (HA), and platelet-rich plasma (PRP) on temporomandibular joint osteoarthritis. METHODS: Studies were identified from PubMed, Embase and Cochrane Central Register of Controlled Trials, ClinicalTrials.gov with date up to January 15, 2022. Randomized controlled trials included were the studies of patients with temporomandibular joint osteoarthritis who had intra-articular treatment with CCS, HA, PRP, placebo and follow-up assessing temporomandibular joint function in target outcome variables. The primary outcome was temporomandibular joint pain. The secondary outcomes were maximal mouth opening (mm), and lateral movement to the affected side (mm). This study is registered with PROSPERO, number CRD42021270914. RESULTS: Nine randomized controlled trials involving 316 patients were included. For primary pain outcome, no significance was detected when CCS, HA and PRP were compared with placebo by both short- (3-6 months) and long-term (>12 months) follow-up. Relatively, the top ranking of which was PRP in the long-term (Mean Difference, -0.23 [95% CI, -2.49 to 2.04]). In addition, these injectables did not significantly outperform placebo by evaluating secondary functional outcomes (maximal mouth opening and lateral movement) with the same follow-up. Subgroup analyses showed that the effect of CCS on subgroups with more than 70% women was statistically less effective compared with placebo (Mean Difference, 1.73 [95% CI, 0.37-3.09]). CONCLUSION: Evidence suggested that intra-articular pharmacological injections of CCS, HA, and PRP had no effect on improving temporomandibular joint pain and functional outcomes compared with placebo injection.
目的：比较关节内注射皮质类固醇（CCS）、透明质酸（HA）和富含血小板的血浆（PRP）治疗颞下颌关节骨关节炎的疗效。
方法：从 PubMed、Embase 和 Cochrane 对照试验中心注册库、ClinicalTrials.gov 中检索截至 2022 年 1 月 15 日的研究。纳入的随机对照试验为接受关节内 CCS、HA、PRP、安慰剂治疗并随访评估目标结局变量下颞下颌关节功能的颞下颌关节骨关节炎患者的研究。主要结局为颞下颌关节疼痛。次要结局为最大张口度（mm）和患侧侧向移动度（mm）。本研究在 PROSPERO 注册，编号 CRD42021270914。
结果：纳入 9 项随机对照试验，共 316 例患者。对于主要疼痛结局，CCS、HA 和 PRP 在短期（3-6 个月）和长期（>12 个月）随访时与安慰剂相比均无显著性差异。相对而言，PRP 在长期随访时的效果最佳（平均差值，-0.23[95%CI，-2.49 至 2.04]）。此外，这些注射剂在评估相同随访时的次要功能结局（最大张口度和侧向移动度）时，也未显著优于安慰剂。亚组分析显示，CCS 对女性比例超过 70%的亚组的疗效明显低于安慰剂（平均差值，1.73[95%CI，0.37-3.09]）。
结论：证据表明，与安慰剂注射相比，关节内皮质类固醇、透明质酸和富含血小板的血浆的药理学注射并不能改善颞下颌关节疼痛和功能结局。
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