摘要
目的通过总结颞下颌关节腔内注射透明质酸钠的临床随机对照试验,评价其治疗颞下颌关节结构紊乱的有效性与安全性。方法明确探究透明质酸钠治疗颞下颌关节结构紊乱的有效性与安全性的研究问题后,电子检索Medline、Cochrane图书馆临床随机对照试验库、荷兰医学文摘、欧洲灰色文献数据库和中国生物医学文献数据库,检索时间截至2010年10月3日;同时手工检索19种中文口腔医学杂志。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 5.0.23软件进行统计分析,采用GRADE标准评价Meta分析的质量。结果最终纳入研究的文献为10篇,偏倚风险评价显示均为中等偏倚风险。与阴性对照相比较,透明质酸钠能明显改善患者短期及长期的最大张口度(P<0.05),并在短期内明显改善临床总体评价(P<0.05),但长期效果不明显(P>0.05),对短期和长期关节内疼痛缓解情况无显著效果(P>0.05);同糖皮质激素相比,透明质酸钠在短期临床总体评价和注射后不良反应方面均优于后者(P<0.05),但在缓解关节区疼痛和改善最大张口度方面两者并无显著差异(P>0.05)。结论透明质酸钠在治疗颞下颌关节结构紊乱时有一定的疗效和安全性,但还需要更多高质量的临床随机对照试验支持。
Objective To assess the efficacy and safety of hyaluronate sodium（HS） for internal derangement of temporomandibular joint by means of systematic review on relevant randomized controlled trials.Methods After identifing the study question of the efficacy and safety of HS for internal derangement of temporomandibular joint,Medline, Cochrane Controlled Trials Register,EMBASE,OPEN SIGLE and CBM were searched electronically till October 3rd 2010.Hand-searching covering 19 dental journals in Chinese were also performed.Risk of bias assessment,with Cochrane Collaboration＇s tool,and data extraction of included studies were conducted by two reviewers in duplicate.Meta analysis was done with Revman 5.0.23 and the quality of evidence was evaluated by GRADE.Results 10 ran-domized controlled trials met the eligibility criteria and were included.All these studies had unclear risk of bias.When compared with negative control,HS showed a significant advantage on maximal mouth opening in short and long term（P0.05）,and clinical overall assessment in short term（P0.05）,but its effect on pain control and long term effect on clinical overall assessment had no extra benefit（P0.05）.Additionally,when compared with glucocorticoids,the participants who received HS injection would get a better clinical overall assessment in short term and less adverse drug reactions（P0.05）,but presented a similar temporomandibular joint pain relief and maximal mouth opening（P0.05）.Conclusion To a certain extent,HS had good efficacy and better safety than controls when treating internal derangement of temporomandibular joint.However,as the quality of some included studies were limited,more randomized controlled trials are needed to rein-force the conclusion.
出处
《华西口腔医学杂志》
CAS
CSCD
北大核心
2011年第5期488-493,共6页
West China Journal of Stomatology
基金
全国"大学生创新性实验计划"基金资助项目(10106-1001)
关键词
透明质酸纳
颞下颌关节紊乱
颞下颌关节盘
META分析
系统评价
hyaluronate sodium
temporomandibular joint dysfunction syndrome
temporomandibular joint disk
Meta analysis
systematic evaluation
