Kelemen Kata, König János, Váncsa Szilárd, Szabó Bence, Hegyi Péter, Gerber Gábor, Schmidt Péter, Hermann Péter
Department of Prosthodontics, Semmelweis University, Budapest, Hungary.
Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
J Prosthodont Res. 2025 Apr 14;69(2):203-214. doi: 10.2186/jpr.JPR_D_23_00272. Epub 2025 Jan 6.
Arthrogenic temporomandibular disorders (TMDs) that do not respond to conservative treatment necessitate the use of semi-conservative methods, such as arthrocentesis. However, the ranking of intraarticular devices used in arthrocentesis remains controversial. Therefore, a network meta-analysis and systematic review were conducted to compare the different materials used for arthrocentesis.
Databases of Cochrane Library, EMBASE, PubMed, and Web of Science were searched systematically to retrieve randomized controlled trials (RCTs) published in English comparing the efficacy of different intraarticular materials used for arthrocentesis. The mean differences (MD) and 95% confidence interval (CI) were calculated for maximum mouth opening (MMO) and pain perception using Bayesian network meta-analysis.
Among the 7674 studies retrieved, 13 RCTs were included in the quantitative synthesis. Evaluation of the short-term follow-up (1-3 months) outcomes revealed that saline-platelet-rich plasma (saline-PRP) and saline-steroid yielded the greatest improvement in MMO, with MDs of 3.49 (CI: -4.23, 10.81) and 3.36 (CI: -4.70, 10.46), respectively. Saline-PRP exhibited improvement in terms of pain reduction (MD=-2.72 (CI: -5.80, 0.35). Evaluation of the long-term follow-up outcomes revealed that saline-PRP yielded promising results for both outcomes: MD of 1.58 (CI: -6.84, 9.92) and -2.79 (CI: -9.44, 3.60) for MMO and pain reduction, respectively.
Saline-PRP injection led to a clinically noticeable shift in MMO and pain perception in the short term; in contrast, the results of saline-PRP, saline-hyaluronic acid (HA), and saline steroids were statistically insignificant. Saline-HA and saline-steroid effectively increased MMO in the long term, whereas saline-PRP yielded the most distinct reduction in pain.
对于保守治疗无效的关节源性颞下颌关节紊乱病（TMDs），需要采用半保守治疗方法，如关节腔穿刺术。然而，关节腔穿刺术中使用的关节内装置的排名仍存在争议。因此，进行了一项网络荟萃分析和系统评价，以比较用于关节腔穿刺术的不同材料。
系统检索Cochrane图书馆、EMBASE、PubMed和Web of Science数据库，以检索用英文发表的比较用于关节腔穿刺术的不同关节内材料疗效的随机对照试验（RCTs）。使用贝叶斯网络荟萃分析计算最大开口度（MMO）和疼痛感知的平均差（MD）和95%置信区间（CI）。
在检索到的7674项研究中，13项RCTs被纳入定量合成。短期随访（1 - 3个月）结果评估显示，生理盐水-富血小板血浆（saline-PRP）和生理盐水-类固醇在MMO方面改善最大，MD分别为3.49（CI：-4.23，10.81）和3.36（CI：-4.70，10.46）。Saline-PRP在疼痛减轻方面有改善（MD = -2.72（CI：-5.80，0.35）。长期随访结果评估显示，saline-PRP在两个结果方面都产生了有前景的结果：MMO和疼痛减轻的MD分别为1.58（CI：-6.84，9.92）和-2.79（CI：-9.44，3.60）。
Saline-PRP注射在短期内导致MMO和疼痛感知有临床上明显的变化；相比之下，saline-PRP、生理盐水-透明质酸（HA）和生理盐水-类固醇的结果在统计学上不显著。生理盐水-HA和生理盐水-类固醇在长期内有效增加MMO，而saline-PRP在疼痛减轻方面最为明显。
