背景:A型血友病,B型和血管性血友病是最常见的出血性疾病。关节自发性出血的趋势增加,导致关节内感染。据信颞下颌关节(TMJ)可以以类似的方式受到影响,这可以进一步导致有限的张口和强直。出血性疾病(BD)与颞下颌关节紊乱病(TMD)发展之间的关系知之甚少。这项系统评价旨在评估与健康对照组相比,遗传性出血性疾病个体中TMD的相关性。
方法:PubMed,搜索了OvidSP和GoogleScholar,以查找从成立到2023年5月1日之间发表的文章。所有的文章都是人口,曝光,应用纳入和排除标准的比较和结果模型(PECO)。参与者(P)是儿童,成人或青少年;暴露(E)是儿童,诊断为血友病或出血性疾病(BD)的成人或青少年;比较(C)是年龄和性别匹配的健康对照,没有血友病或出血性疾病;结果(O)是任何体征或症状的患病率(临床,影像学)提示颞下颌关节紊乱病(TMD)。包括显示TMD患病率的研究以进行定性分析。定量分析中仅包括提供两组(BD和健康对照)中TMD患病率数据的研究。TMD的诊断可以通过临床症状和体征,射线照相标准,颞下颌关节紊乱病诊断标准(DC/TMD),颞下颌关节紊乱病的研究诊断标准(RDC/TMD)或任何其他成像标准(MRI)。我们将排除标准设定为没有对照组的文章,诊断敏感性研究,病例报告、系统综述和叙述性综述。软件ReviewManager版本5.4(CochraneCollaboration)用于进行合并分析。我们测量了结果TMD的两组(BD和健康对照)之间的风险比(RR)。
结果:共纳入7项研究用于数据的定性分析。纳入研究的人群(BD和对照)年龄在2至57岁之间。个别研究中TMD的患病率从2%到77%不等,个别研究中的对照组从2%到14%不等。在纳入的研究中,只有临床症状,4项研究考虑了症状和病史.纳入四项研究进行荟萃分析,四项研究的汇总结果表明,BD组和对照组的TMD患病率无显著差异(p值=.11,RR2.19;95%CI[0.84,5.73]).
结论:本系统综述和荟萃分析显示出血性疾病与TMD患病率增加之间没有关联。
BACKGROUND: Haemophilia A, B and von Willebrand disease are the most common bleeding disorders. There is an increased tendency of spontaneous bleeding into joints resulting in intra-articular infection. It is believed that Temporomandibular Joint (TMJ) can be affected in a similar manner which can further lead to limited mouth opening and ankylosis. The association between bleeding disorders (BD) and development of temporomandibular disorders (TMD) is poorly understood. This systematic
review intends to evaluate the association of TMD in individuals with inherited bleeding disorders as compared to healthy controls.
METHODS: PubMed, Ovid SP and Google Scholar were searched for articles published between the times of inception to 1 May 2023. All the articles were subjected to Population, Exposure, Comparison and Outcome model (PECO) based on which inclusion and exclusion criteria were applied. Participants (P) is children, adults or adolescents; Exposure (E) is children, adults or adolescents with a diagnosis of
Haemophilia or bleeding disorder (BD); Comparator (C) is age and gender-matched healthy controls who do not have Haemophilia or bleeding disorder; Outcome (O) is prevalence of any signs or symptoms (clinical, radiographic) that is suggestive of temporomandibular disorder (TMD). Studies showing the prevalence of TMD are included for qualitative analysis. Only the studies which provided data of the prevalence of TMD in both the groups (BD and healthy controls) were included in the quantitative analysis. TMD diagnosis can be by clinical signs and symptoms, radiographic criteria, Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) or any other imaging criteria (MRI). We have set the exclusion criteria as articles without a control group, diagnostic sensitivity studies, case reports and systematic reviews and narrative reviews. The software
Review Manager version 5.4 (Cochrane Collaboration) was used to perform the pooled analysis. We measured the risk ratio (RR) between the two groups (BD and healthy controls) for the outcome TMD.
RESULTS: A total of seven studies are included for qualitative analysis of data. The age of the population (BD and control) in the included studies ranged between 2 and 57 years. The prevalence of TMD in individual studies varied from 2% to 77%, and controls in the individual studies varied from 2% to 14%. Among the included studies, only clinical signs, symptoms and history were taken into consideration in four studies. Four studies were included for meta-analysis, the pooled result of the four studies suggests there is no significant difference in the prevalence of TMD in BD and control group (p value = .11, RR 2.19; 95% CI [0.84, 5.73]).
CONCLUSIONS: This systematic
review and meta-analysis elicits no association between bleeding disorders and increased prevalence of TMD.