• 1. 四川大學(xué)華西口腔醫(yī)院,成都,6100412. 中國(guó)醫(yī)學(xué)科學(xué)院北京協(xié)和醫(yī)院口腔科,北京,100032;

目的 　評(píng)價(jià)關(guān)節(jié)內(nèi)注射透明質(zhì)酸鈉治療顳下頜關(guān)節(jié)紊亂病的效果.
方法 　檢索多種數(shù)據(jù)庫(kù),手檢15種中國(guó)口腔醫(yī)學(xué)雜志,納入應(yīng)用隨機(jī)或半隨機(jī)對(duì)照試驗(yàn)設(shè)計(jì)的有關(guān)關(guān)節(jié)內(nèi)注射透明質(zhì)酸鈉治療顳下頜關(guān)節(jié)紊亂病的文獻(xiàn)摘要及全文,嘗試追尋未發(fā)表文獻(xiàn).資料提取、評(píng)價(jià)、薈萃分析方法參照Cochrane指導(dǎo)原則進(jìn)行.
結(jié)果 　通過(guò)廣泛文獻(xiàn)檢索,共發(fā)現(xiàn)關(guān)節(jié)內(nèi)注射透明質(zhì)酸鈉治療顳下頜關(guān)節(jié)紊亂病隨機(jī)對(duì)照試驗(yàn)文獻(xiàn)12篇,半隨機(jī)對(duì)照試驗(yàn)2篇,治療類風(fēng)濕顳下頜關(guān)節(jié)炎隨機(jī)對(duì)照試驗(yàn)1篇,其中10篇符合納入標(biāo)準(zhǔn).除了71例僅有定性資料描述,余490例有定量資料描述,可進(jìn)行Meta-分析.277例應(yīng)用透明質(zhì)酸鈉,113例應(yīng)用安慰劑或無(wú)治療,100例應(yīng)用糖皮質(zhì)激素關(guān)節(jié)內(nèi)注射.與安慰劑組相比較,透明質(zhì)酸鈉對(duì)減輕短期及長(zhǎng)期癥狀,改善疼痛未達(dá)到統(tǒng)計(jì)學(xué)顯著水平,但可顯著減輕短期及長(zhǎng)期臨床體征,顯著增加張口度.敏感分析發(fā)現(xiàn),與安慰劑相比對(duì)臨床體征可短期改善的結(jié)論不穩(wěn)定.透明質(zhì)酸鈉不良反應(yīng)多為輕微一過(guò)性.
結(jié)論 　關(guān)節(jié)內(nèi)注射透明質(zhì)酸鈉可能改善短期及長(zhǎng)期顳下頜關(guān)節(jié)紊亂病臨床體征,不良反應(yīng)輕微一過(guò)性,但需要更多設(shè)計(jì)良好的隨機(jī)對(duì)照試驗(yàn)證實(shí)其治療效果.

引用本文： 史宗道,郭春嵐,陳娥. 關(guān)節(jié)內(nèi)注射透明質(zhì)酸鈉治療顳下頜關(guān)節(jié)紊亂病效果的系統(tǒng)評(píng)價(jià). 中國(guó)循證醫(yī)學(xué)雜志, 2004, 04(6): 368-376. doi: 復(fù)制

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  12. 12. ［10］Wenneberg B, Kopp S, Grondahl HG. Long-term effect of intra-articular injections of a glucocorticosteroid into the TMJ:a clinical and radiographic 8-year follow-up[J]. J Craniomandibul Disord: Facial & Oral Pain,1991; 5(1) :11-18.
  13. 13. ［11］Kikiewicz D. Effect of hydrocortisone on experimental necrosis of cartilage of the temporomandibular joint in guinea pigs [ J ]. Annales Academiae Medicae Stetinensis in Polish,1985; 31:185-196.
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