尽管关节穿刺术是治疗有症状患者的颞下颌关节紊乱病(TMD)的公认安全治疗方式,透明质酸(HA)注射的益处仍然不确定。这项研究的目的是评估关节内HA注射辅助关节穿刺术是否比其他药物更有效地改善TMD相关症状。此外,在一组患者中,采用SF-36®问卷评估了HA注射对TMD患者生活质量的影响.Medline的电子搜索,Scopus和Cochrane数据库已执行至2020年3月。使用了以下搜索词:“关节穿刺术”,\"透明质酸\",“关节内注射”,\“生物补充”,“颞下颌关节紊乱病”。包括前瞻性和回顾性研究,这些研究报道了与其他关节内药物相比,HA注射液在治疗颞下颌关节紊乱病方面的应用。系统或叙述性评价和临床前研究被排除。此外,我们进行了一项回顾性临床研究,以评估HA注射关节穿刺术前后的生活质量变化.在系统审查中,最初的搜索产生了1327篇文章。筛选标题后,摘要,和全文,选择了29项研究(26项随机研究,2个对照临床试验,1份回顾性报告)。在临床研究中,包括12名患者。关节内注射HA和其他药物以及关节穿刺术似乎对改善TMD和疼痛的功能症状有益。该病例系列还支持HA注射的功效,表明这些患者的生活质量得到了改善。然而,从文献综述来看,无法确定可预测地改善颞下颌疾病的疼痛和/或功能症状的最佳药物或方案,由于病因不同,治疗方式的多样性和相互矛盾的结果。总之,文献中没有一致认为,与其他治疗方式相比,HA注射显示出更好的结果.根据目前临床研究的结果,在TMD患者的临床症状和生活质量方面,有/没有关节穿刺术的HA注射似乎是有益的。
Although arthrocentesis is an accepted safe treatment modality for the management of temporomandibular disorders (TMD) in symptomatic patients, the benefit of hyaluronic acid (HA) injections remains uncertain. The aim of this study was to evaluate whether intra-articular HA injections adjunctive to arthrocentesis can be more effective than other medications for the improvement of TMD associated symptoms. Additionally, the impact of HA injections on quality of life of TMD patients was assessed with SF-36® questionnaire in a cohort of patients. An electronic search of Medline, Scopus and Cochrane databases was performed up to March 2020. The following search terms were used: \"arthrocentesis\", \"hyaluronic acid\", \"intra-articular injections\", \"visco-supplementation\", \"temporomandibular disorders\". Prospective and retrospective studies that reported the application of HA injections compared to other intra-articular drugs for the treatment of temporomandibular disorders were included. Systematic or narrative reviews and pre-clinical studies were excluded. Additionally, a retrospective clinical study was performed for evaluation of changes in quality of life before and after arthrocentesis with HA injections. In the systematic review, the initial search yielded 1327 articles. After screening of the titles, abstracts, and full texts, 29 studies were selected (26 randomized studies, 2 controlled clinical trials, 1 retrospective report). In the clinical study, 12 patients were included. Intra-articular injections of HA and other medications together with arthrocentesis seemed to be beneficial for improvement of functional symptoms of TMD and pain. The
case series also supported the efficacy of HA injections showing an improvement of quality of life of these patients. However, from literature review, it was impossible to identify an optimum drug or a protocol for predictably improving the pain and/or functional symptoms of temporomandibular problems, due to different etiologies, diversity of treatment modalities and conflicting results. In conclusion, there is no consensus in the literature that HA injections shows better results in comparison with other treatment modalities. According to the results of the present clinical study, HA injections with/without arthrocentesis seems to be beneficial in terms of clinical symptoms and quality of life of the TMD patients.