Department of Dentistry (Oral & Maxillofacial Surgery), All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India.
ESIC Dental College & Hospital, Rohini, New Delhi, India.
J Craniomaxillofac Surg. 2022 Nov;50(11):825-830. doi: 10.1016/j.jcms.2022.10.002. Epub 2022 Oct 27.
The present study aimed to compare the efficacies of intra-articular injections of platelet-rich plasma (PRP) and hyaluronic acid (HA) following single needle arthrocentesis in patients with TMJ internal derangement. This double-blinded randomised controlled trial involved the enrolment of patients diagnosed with unilateral TMD, falling into either Wilkes' stages II or III. In Group A, single needle arthrocentesis was performed using Ringer's lactate serving as a control group; in Group B, intra-articular injection of 1 ml hyaluronic acid injection was given following arthrocentesis; and in Group C, autologous intraarticular injections of 1 ml of PRP was given after arthrocentesis, twice in two weeks' interval. The primary outcome variables were maximum mouth opening and pain, while TMJ clicking sounds formed the secondary outcome variable. All the outcome variables were assessed preoperatively (T0) and postoperatively after the second dose of injection at one month (T1), three months (T2), and six months (T3). The alpha level was set to p < 0.05. Ninety patients (N = 90) comprised the final sample size of the study with thirty patients(n = 30) in each treatment group. A statistically significant decrease in the management in mean pain scores was noted between T0 [mean scores were 7.30 ± 1.05 (Group A), 7.63 ± 1.12 (Group B), and 7.56 ± 1.04(Group C)] and T3 [mean scores were 2.66 ± 0.88 (Group A), 2.4 ± 0.72 (Group B), and 1.66 ± 0.66 (Group C)] time intervals between Group A and C(p < 0.001). Significant improvement was noted in preoperative maximum mouth opening (MMO) of Group A, B, and C which was 22.83 ± 3.58, 22.17 ± 4.07, and 21.37 ± 3.69, respectively to 28.90 ± 2.72, 32.17 ± 3.97, and 34.10 ± 3.80 mm, respectively at six months postoperatively (p < 0.001). A significant decrease in joint sounds was evident for all three groups(p = 0.003 for Group A, p < 0.001 for Group B, and p < 0.001 for Group C) across the time intervals. Moreover, Group C showed a significant decrease in the prevalence of joint sound compared to the other two groups at all-time intervals postoperatively when equated to baseline (p = 0.02 at T1, p = 0.009 at T2, and p = 0.002 at T3). Within the limitations of the present study, it can be concluded that intra-articular PRP may be preferable over HA whenever appropriate, following single needle arthrocentesis in the treatment of TMJ internal derangement.
本研究旨在比较单次关节内穿刺后关节内注射富血小板血浆(PRP)和透明质酸(HA)治疗 TMJ 内部紊乱的疗效。这是一项双盲随机对照试验,纳入了单侧 TMD 诊断为 Wilkes' Ⅱ期或Ⅲ期的患者。A 组行单次关节内穿刺,以林格氏乳酸盐作为对照组;B 组在关节内穿刺后给予 1ml 透明质酸注射;C 组在关节内穿刺后给予 1ml 自体关节内注射 PRP,间隔两周两次。主要结局变量为最大张口度和疼痛,TMJ 弹响为次要结局变量。所有结局变量均在术前(T0)和术后第二次注射后一个月(T1)、三个月(T2)和六个月(T3)进行评估。α 水平设为 p < 0.05。90 例患者(N = 90)为研究的最终样本量,每组 30 例(n = 30)。A 组、B 组和 C 组的平均疼痛评分在 T0[平均评分分别为 7.30 ± 1.05(A 组)、7.63 ± 1.12(B 组)和 7.56 ± 1.04(C 组)]和 T3[平均评分分别为 2.66 ± 0.88(A 组)、2.4 ± 0.72(B 组)和 1.66 ± 0.66(C 组)]时间间隔之间有统计学显著降低(p < 0.001)。A、B 和 C 组术前最大张口度(MMO)分别为 22.83 ± 3.58、22.17 ± 4.07 和 21.37 ± 3.69,术后 6 个月分别为 28.90 ± 2.72、32.17 ± 3.97 和 34.10 ± 3.80(p < 0.001),有显著改善。三组关节音均明显减少(A 组 p = 0.003,B 组 p < 0.001,C 组 p < 0.001)。与基线相比,C 组在所有术后时间间隔的关节音发生率均明显低于其他两组(T1 时 p = 0.02,T2 时 p = 0.009,T3 时 p = 0.002)。在本研究的限制范围内,可以得出结论,在单次关节内穿刺后,关节内 PRP 可能优于 HA,用于治疗 TMJ 内部紊乱。