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关节源性颞下颌关节紊乱病的双穿刺关节腔穿刺术:生物玻璃酸钠补充疗法与玻璃酸钠补充疗法的随机对照试验

Double-Puncture Arthrocentesis in Arthrogenous TMJ Disorders: Bioviscosupplementation vs. Viscosupplementation a Randomized Controlled Trial.

作者信息

Ângelo David Faustino, Cardoso Henrique José, Sanz David, Maffia Francesco, Sarkis Marcella, Mota Beatriz, Salvado Francisco

机构信息

Instituto Português da Face, 1500-493 Lisboa, Portugal.

Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, 2430-028 Marinha Grande, Portugal.

出版信息

J Clin Med. 2025 May 27;14(11):3750. doi: 10.3390/jcm14113750.

Abstract

Intra-articular injections of hyaluronic acid (HA) or platelet-rich plasma (PRP) have been used in the treatment of temporomandibular joint (TMJ) arthrocentesis to improve lubricative properties and influence regenerative processes. This study aimed to evaluate the potential clinical benefits of complementary bioviscosupplementation with hyaluronic acid (HA) and platelet-rich plasma (PRP) in patients undergoing double-portal TMJ arthrocentesis. A total of forty-six patients (33 females, 13 males; mean age of 45.83 ± 20.62 years) with arthrogenous temporomandibular disorders, identified through clinical and imaging examinations, were randomized into HA+PRP (23 patients) or HA-alone (23 patients) groups. The primary outcome variable was TMJ arthralgia; the secondary outcome was maximum mouth opening (MMO). All the outcome variables were assessed preoperatively (T0) and at several follow-ups (T1-1 month, T2-3 months, T3-6 months, T4-12 months follow-up). The HA+PRP group presents lower TMJ arthralgia levels than the HA group at every follow-up moment ( < 0.05, r ≈ 0.3). At T3 and T4, the HA+PRP group presented a higher MMO average than the HA group ( = 0.03 and = 0.02; r ≈ 0.3). At T4, the HA group's success rate was lower than the HA+PRP group (65% vs. 96%), and a higher number of postoperative reinterventions were observed (35% vs. 4%). In this study, complementary intra-articular bioviscosupplementation (HA+PRP) following double-portal TMJ arthrocentesis was associated with better clinical outcomes regarding TMJ arthralgia reduction, MMO improvement, and reduced risk of future TMJ reintervention.

摘要

关节腔内注射透明质酸(HA)或富血小板血浆(PRP)已被用于颞下颌关节(TMJ)关节穿刺术的治疗,以改善润滑性能并影响再生过程。本研究旨在评估在接受双切口TMJ关节穿刺术的患者中,透明质酸(HA)和富血小板血浆(PRP)联合生物粘弹性补充疗法的潜在临床益处。通过临床和影像学检查确诊的46例患有关节源性颞下颌关节紊乱病的患者(33例女性,13例男性;平均年龄45.83±20.62岁)被随机分为HA+PRP组(23例患者)和单纯HA组(23例患者)。主要结局变量是TMJ关节疼痛;次要结局是最大开口度(MMO)。所有结局变量均在术前(T0)以及几个随访时间点(T1 - 1个月、T2 - 3个月、T3 - 6个月、T4 - 12个月随访)进行评估。在每个随访时间点,HA+PRP组的TMJ关节疼痛水平均低于HA组(<0.05,r≈0.3)。在T3和T4时,HA+PRP组的MMO平均值高于HA组(=0.03和=0.02;r≈0.3)。在T4时,HA组的成功率低于HA+PRP组(65%对96%),且观察到术后再次干预的次数更多(35%对4%)。在本研究中,双切口TMJ关节穿刺术后进行关节腔内联合生物粘弹性补充疗法(HA+PRP)与在减轻TMJ关节疼痛、改善MMO以及降低未来TMJ再次干预风险方面更好的临床结局相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d28/12155997/caa3036bdbff/jcm-14-03750-g001.jpg

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