School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Department of Nosocomial Infection, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
BMC Oral Health. 2024 Sep 18;24(1):1108. doi: 10.1186/s12903-024-04858-7.
Clinical studies have demonstrated the effectiveness of arthrocentesis in managing temporomandibular joint disorders (TMDs). However, there is a lack of consensus among these studies regarding the selection of injectables. Furthermore, an increasing number of drugs have been tested for TMDs in recent years, complicating the decision-making process for clinicians. This study conducted a network meta-analysis of randomized controlled trials (RCTs) to compare the clinical efficacy of different arthrocentesis treatment regimens.
We conducted a comprehensive search of Embase, PubMed, Cochrane Library, and Web of Science to gather articles on RCTs pertaining to the management of TMDs using arthrocentesis. This search spanned from inception of these databases up to July 29, 2024. We then performed a network meta-analysis using Stata 17.0 software. The outcome indicators used were VAS scores and changes in unassisted maximum opening. To determine the efficacy of each regimen, we employed surface-under the cumulative ranking curve (SUCRA) ranking.
Forty RCTs were included, encompassing 1904 temporomandibular joints (TMJs) cases. Treatment options encompass platelet-rich plasma (PRP), hyaluronic acid (HA), corticosteroids (CS), bone marrow concentrate (BMAC), injectable platelet-rich fibrin (i-PRF), concentrated growth factor (CGF), Tenoxicam (TX), microfragmented adipose tissue (FAT), and their combination regimens. The SUCRA ranking revealed that the most effective treatment options at 1-, 3-, and 6-months post-arthrocentesis were HA + PRP, i-PRF, and BMAC, respectively.
HA + PRP, i-PRF and BMAC may represent the optimal arthrocentesis agents for the management of TMDs symptoms and restoration of TMJ function in the short, medium, and long term, respectively.
https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD42024563975.
临床研究已经证实关节内穿刺术在治疗颞下颌关节紊乱（TMD）方面的有效性。然而，这些研究在注射剂的选择上缺乏共识。此外，近年来越来越多的药物被用于 TMD 的测试，这使得临床医生的决策过程变得复杂。本研究对随机对照试验（RCT）进行了网络荟萃分析，以比较不同关节内穿刺治疗方案的临床疗效。
我们全面检索了 Embase、PubMed、Cochrane Library 和 Web of Science，以收集关于使用关节内穿刺术治疗 TMD 的 RCT 文章。检索时间跨度为这些数据库的创建时间至 2024 年 7 月 29 日。然后，我们使用 Stata 17.0 软件进行了网络荟萃分析。使用视觉模拟评分（VAS）评分和未经辅助的最大开口变化作为疗效的评估指标。为了确定每种方案的疗效，我们采用了累积排序曲线下面积（SUCRA）排名。
共纳入 40 项 RCT，包含 1904 个颞下颌关节（TMJ）病例。治疗方案包括富血小板血浆（PRP）、透明质酸（HA）、皮质类固醇（CS）、骨髓浓缩物（BMAC）、注射富血小板纤维蛋白（i-PRF）、浓缩生长因子（CGF）、Tenoxicam（TX）、微碎脂肪组织（FAT）以及它们的联合方案。SUCRA 排名显示，关节内穿刺后 1、3 和 6 个月时最有效的治疗方案分别为 HA+PRP、i-PRF 和 BMAC。
HA+PRP、i-PRF 和 BMAC 可能分别代表 TMD 症状管理和 TMJ 功能恢复的最佳关节内穿刺剂，短期、中期和长期疗效最佳。
https://www.crd.york.ac.uk/PROSPERO/，标识符 CRD42024563975。
