Professor and Clinical Director, Oral and Maxillofacial Surgery, TMJ Consultancy Services, Bhopal, Madhya Pradesh, India; Director Research, DAMER India.
J Oral Maxillofac Surg. 2023 Oct;81(10):1204-1214. doi: 10.1016/j.joms.2023.07.140. Epub 2023 Jul 29.
Arthrocentesis is a minimally invasive procedure with reported efficacy when used for lysis and lavage of the joint for symptomatic internal derangement, irrespective of the technique utilized.
The purpose of the study was to determine if the single puncture arthrocentesis (SPA) is superior to double puncture arthrocentesis (DPA) with respect to pain reduction and improved maximal mouth opening (MMO) for subjects with acute disc displacement without reduction.
A single-blinded randomized prospective clinical trial was conducted at the tertiary referral center for temporomandibular joint disorders. All subjects were diagnosed with acute onset disc displacement without reduction based on history and magnetic resonance imaging findings. Subjects were randomized to SPA or DPA.
PREDICTOR VARIABLE(S): The primary predictor variable was arthrocentesis technique (SPA vs DPA).
MAIN OUTCOME VARIABLE(S): The primary outcome variables were pain and MMO, measured at 4 weeks. The duration for the procedure was recorded at the time of the surgery.
Age, sex, and the side affected were recorded.
Data were analyzed using analysis of variance to compare the primary outcome variables. Levene's, post hoc, and Bonferroni-Holm tests were used for intergroup comparisons with a P value of <0.05 being significant.
Forty subjects completed the study. The mean age for the SPA and DPA groups was 28.3 (±3.9) and 29.1 (±4.1), respectively (P = .52). The sex distribution was 60 and 55% female in the SPA and DPA groups, respectively. The mean pain reduction in the SPA and DPA groups was from 8.30 (±0.86) to 0.90 (±0.78) and from 8.00 (±0.79) to 0.95 (±0.82), respectively (P < .0001). There was no difference in pain reduction between the groups (P = .05). The mean increase in MMO was 34.6 (±2.34) and 33.4 (±2.35) in the SPA and DPA groups, respectively (P < .0001). The difference between the groups was not significant (P = .12). The procedural time in the SPA and DPA groups was 14.15 ± 1.72 and 17.55 ± 1.66, respectively (P < .0001).
SPA and DPA arthrocentesis appear to be equally efficacious for pain reduction and increasing MMO. SPA can be completed in less time than DPA and should be considered as a viable alternative to the conventional DPA technique.
关节穿刺术是一种微创程序，当用于治疗有症状的内部紊乱时，无论采用何种技术，其松解和灌洗关节均具有疗效。
本研究的目的是确定单次穿刺关节穿刺术（SPA）是否优于双次穿刺关节穿刺术（DPA），以减轻疼痛和改善急性盘移位无复位患者的最大张口度（MMO）。
在颞下颌关节紊乱的三级转诊中心进行了一项单盲随机前瞻性临床试验。所有患者均根据病史和磁共振成像结果诊断为急性盘移位无复位。患者被随机分为 SPA 或 DPA 组。
主要预测变量是关节穿刺术技术（SPA 与 DPA）。
主要结局变量是在 4 周时测量的疼痛和 MMO。手术时记录了手术时间。
记录了年龄、性别和受影响的侧别。
使用方差分析比较主要结局变量。采用 Levene 检验、事后检验和 Bonferroni-Holm 检验进行组间比较，P 值<0.05 为差异有统计学意义。
40 名患者完成了研究。SPA 和 DPA 组的平均年龄分别为 28.3（±3.9）和 29.1（±4.1）（P=0.52）。SPA 和 DPA 组的性别分布分别为 60%和 55%女性。SPA 和 DPA 组的疼痛缓解平均值分别从 8.30（±0.86）降至 0.90（±0.78）和从 8.00（±0.79）降至 0.95（±0.82）（P<0.0001）。两组之间的疼痛缓解无差异（P=0.05）。SPA 和 DPA 组 MMO 的平均增加量分别为 34.6（±2.34）和 33.4（±2.35）（P<0.0001）。两组之间的差异无统计学意义（P=0.12）。SPA 和 DPA 组的手术时间分别为 14.15±1.72 和 17.55±1.66（P<0.0001）。
SPA 和 DPA 关节穿刺术在减轻疼痛和增加 MMO 方面似乎同样有效。SPA 可以在更短的时间内完成，而不是 DPA，因此应被视为传统 DPA 技术的可行替代方案。
