Temporomandibular joint disorders (TMD) refer to a group of heterogeneous pain and dysfunction conditions involving the masticatory system, reducing life quality of the sufferers. Intra-articular injection of hyaluronate for TMD has been used for nearly 2 decades but the clinical effectiveness of the agent has not been summarized in the form of a systematic review.
To assess the effectiveness of intra-articular injection of hyaluronate both alone and in combination with other remedies on temporomandibular joint disorders.
Intensive electronic and handsearches were carried out. The Cochrane Oral Health Group's Trials Register (September 2001), CENTRAL (The Cochrane Library 2001, Issue 3), MEDLINE (1966 to May 2001), PubMed (up to March 2002), EMBASE (1980 to August 2001), SIGLE (1980 to December 2001), CBMdisc (1983 to July 2001, in Chinese) and Chinese Medical Library were searched. All the Chinese professional journals in the oral health field were handsearched and conference proceedings consulted. There was no language restriction.
Randomized or quasi-randomized controlled trials (RCTs), with single or double blind design, testing the effectiveness of hyaluronate for patients with temporomandibular joint disorders.
Data collection and analysis
Two review authors independently extracted data, and three review authors independently assessed the quality of included studies. The first authors of the selected articles were contacted for additional information.
Seven studies were included in the review. Three studies, including 109 patients with temporomandibular disorders, compared hyaluronate with placebo. Long term effects (3 months or longer) are in favour of hyaluronate for the improvement of clinical signs/overall improvement of TMD (RR = 1.71, 95% CI: 1.05, 2.77) from two of the studies (n = 71). However, this conclusion was not stable enough at sensitivity analysis.
Three studies provided data from 124 patients for the comparison of hyaluronate with glucocorticoids (one study also included a placebo group). Hyaluronate had the same short term and long term effects on the improvement of symptoms, clinical signs or overall conditions of the disorders as glucocorticoids.
When comparing the effect of arthroscopy or arthrocentesis with and without hyaluronate, results were inconsistent. Hyaluronate had a potential in improving arthroscopic evaluation scores.
Mild and transient adverse reactions such as discomfort or pain at the injection site were reported in the hyaluronate groups. No quality of life data were reported
There is insufficient, consistent evidence to either support or refute the use of hyaluronate for treating patients with TMD. Further high quality RCTs of hyaluronate need to be conducted before firm conclusions with regard to its effectiveness can be drawn.
進階電子搜尋和手動搜尋資料庫。搜尋了The Oral Health Group's Trials Register (September 2001)、The Cochrane Library CENTRAL database (Issue 3, 2001)、MEDLINE (1966～2001.05)、PubMed (2002.03)、EMBASE (1974～2001.08), SIGLE (1980 – 2001.12), CBMdisc (1983 – 2001.07;中文)和中文醫學圖書資料庫。並手動搜尋所有口腔保健領域的中文專業期刊與相關的研討會議論文集。沒有語言限制。
回顧性文獻篩選取得7篇研究。其中3篇研究含109位顳顎關節障礙症患者，為玻尿酸治療和安慰劑的比較。在2篇研究中，評估長期效果時(3個月或更長時間), 顯示玻尿酸有助於改善顳顎關節障礙症的臨床徵候/全面改善。(RR = 1.71, 95%CI: 1.05, 2.77)(n = 71)。然而，此結論對於敏感度分析而言還不夠穩定。有3篇研究提供124位患者來比較玻尿酸與糖化皮質類固醇的效果。(其中一篇研究甚至包含安慰劑群組)。對於改善症狀、臨床徵候或障礙症的整體狀況，玻尿酸的短期和長期效果都與糖化皮質類固醇相似。當比較有無玻尿酸合併治療的關節內視鏡檢查或關節穿刺時，其結果並不一致。玻尿酸治療能改善關節鏡的評估指標。玻尿酸群組在注射區域會有輕度和短暫不良反應，如不舒服或疼痛。無文獻提供有關生活品質的資料。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。