Tang Y H, Van Bakelen N B, Gareb B, Spijkervet F K L
Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands.
Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands.
J Craniomaxillofac Surg. 2025 Mar;53(3):250-261. doi: 10.1016/j.jcms.2024.12.006. Epub 2024 Dec 12.
This systematic review aimed to evaluate the efficacy of arthrocentesis compared to conservative treatments for symptomatic temporomandibular joint disorders. A systematic search for randomized, prospective and retrospective controlled trials was undertaken in five electronic databases. Various patient outcomes and economic evaluations were analysed for short-term (<6 months), intermediate-term (6 months to 5 years) and long-term (≥5 years) follow-up periods. Primary meta-analyses were performed for randomized controlled trials using random-effects models. Arthrocentesis was superior to conservative treatments regarding pain reduction at short-term (MD 14.5 (95% CI 9.7; 19.4), k= 9 RCTs, n= 545 patients, I= 48%, high quality of evidence) and intermediate-term follow-up (MD 14.2 (95% CI 7.3; 21.1), k=9 RCTs, n= 547 patients, I= 81%, moderate quality of evidence). Furthermore, arthrocentesis was superior to conservative treatment regarding maximum mouth opening improvement at short-term (MD 2.4 mm (95% CI 0.8; 4.1), k= 8 RCTs, n= 472 patients, I= 80%, moderate quality of evidence) and intermediate-term follow-up (MD 2.2 mm (95% CI 0.5; 3.9), k= 8 RCTs, n= 468 patients, I= 75%, moderate quality of evidence). Trial sequential analysis supported the conclusions of all primary meta-analyses. Results were clinically relevant for pain improvement, but not for maximum mouth opening improvement. Results at long-term follow-up and for other study outcomes were either lacking or too heterogenous for meta-analysis, highlighting the need for more standardized, high-quality research.
本系统评价旨在评估关节穿刺术与保守治疗相比对症状性颞下颌关节紊乱症的疗效。在五个电子数据库中进行了系统检索，以查找随机、前瞻性和回顾性对照试验。对短期（<6个月）、中期（6个月至5年）和长期（≥5年）随访期的各种患者结局和经济评估进行了分析。使用随机效应模型对随机对照试验进行了主要的荟萃分析。在短期随访（MD 14.5（95%CI 9.7；19.4），k = 9项随机对照试验，n = 545例患者，I = 48%，高质量证据）和中期随访（MD 14.2（95%CI 7.3；21.1），k = 9项随机对照试验，n = 547例患者，I = 81%，中等质量证据）时，关节穿刺术在减轻疼痛方面优于保守治疗。此外，在短期随访（MD 2.4 mm（95%CI 0.8；4.1），k = 8项随机对照试验，n = 472例患者，I = 80%，中等质量证据）和中期随访（MD 2.2 mm（95%CI 0.5；3.9），k = 8项随机对照试验，n = 468例患者，I = 75%，中等质量证据）时，关节穿刺术在改善最大开口度方面优于保守治疗。试验序贯分析支持了所有主要荟萃分析的结论。结果在疼痛改善方面具有临床相关性，但在最大开口度改善方面不具有临床相关性。长期随访结果和其他研究结局要么缺乏，要么异质性太大而无法进行荟萃分析，这突出表明需要更多标准化、高质量的研究。
