透明质酸钠与激素治疗颞下颌关节功能紊乱系统评价

摘要

Objective Compare the efficacy and the complications of intraarticular TMJ injections of hyalu-ronate(HS)and glucocorticoids(CO).Methods Data sources Cochrane Library CENTRAL/CCTR data base,EMbase,Medline,PubMed,Chinese literature databases such as CNKI and Chinese Evidence Based Medicine.We selected 5 randomised controlled studies.Two independent reviewers undertook data extrac-tion.Risk of bias assessment with Cochrane Collaborations tool,Meta analysis was done with Revman 5.0.14.Results Short term effect comparison on improvement symptoms of TMD and Short term effect on improvement of clinical signs;There was no statistically significant difference between the groups (P>0.05).Evaluation of the treatment effects by single clinical variables such as Relief of TMJ pain when mandibular movment,maximum Mouth opening,TMJ tenderness.no statistically significant difference between the two groups (P >0.05).Adverse reactions;Mild and transient adverse reactions at the injec-tion site were reported in the HS groups than CO group.There was no statistically significant difference between the groups in terms of high pain intensity in short term (P >0.05).Conclusion There was no statistically significant difference between the two drugs in short term on improvement TMD,even no much more different on adverse reactions.HS may suffer from only mild and transient adverse reactions;while CO had efficiency on the painful condition.However,more RCTs are needed to confirm its therapeu-tic effect.%目的系统评价透明质酸钠（HS）与激素（CO）治疗颞下颌关节功能紊乱（TMD）的临床疗效及不良反应。方法检索Cochrane图书馆临床对照资料、Medline、Embase、中国生物医学文献数据库、中国循证医学数据库、维普数据库等。2位评价者独立使用Cochrane协作网推荐的标准对纳入文献进行偏倚风险评价并提取数据。运用 Revman 5．0．14软件进行 Meta分析。结果最终纳入研究的文献为5篇。（1）综合指标短期内的症状改善及体征改善差异无统计学意义（P ＞0．05）。（2）单一临床指标分析改善短期临床表现：下颌运动疼痛症状、最大张口度、关节区压痛、综合效应两组差异无统计学意义（P ＞0．05）。（3）特殊指标定性分析（高分辨CT评估骨组织改变）：两组破坏性及修复性骨改变差异无统计学意义。（4）注射后不良反应疼痛较强烈的进行合并分析：显示两组差异无统计学意义（P ＞0．05）。结论 HS与CO进行颞下颌关节上腔注射治疗TMD短期内疗效及不良反应无明显差异。HS不良反应轻微且暂时，但疼痛较重的病例CO有一定的效果。