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目的系统评价透明质酸钠(HS)与激素(CO)治疗颞下颌关节功能紊乱(TMD)的临床疗效及不良反应。方法检索Cochrane图书馆临床对照资料、Medline、Embase、中国生物医学文献数据库、中国循证医学数据库、维普数据库等。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 5.0.14软件进行Meta分析。结果最终纳入研究的文献为5篇。(1)综合指标短期内的症状改善及体征改善差异无统计学意义(P>0.05)。(2)单一临床指标分析改善短期临床表现:下颌运动疼痛症状、最大张口度、关节区压痛、综合效应两组差异无统计学意义(P>0.05)。(3)特殊指标定性分析(高分辨CT评估骨组织改变):两组破坏性及修复性骨改变差异无统计学意义。(4)注射后不良反应疼痛较强烈的进行合并分析:显示两组差异无统计学意义(P>0.05)。结论 HS与CO进行颞下颌关节上腔注射治疗TMD短期内疗效及不良反应无明显差异。HS不良反应轻微且暂时,但疼痛较重的病例CO有一定的效果。
Objective To systematically evaluate the clinical effects and adverse reactions of sodium hyaluronate (HS) and hormone (CO) in the treatment of TMD. Methods Cochrane Library clinical control data retrieval, Medline, Embase, China Biomedical Literature Database, China evidence-based medicine database, VIP database. Two reviewers used the Cochrane Collaboration’s recommended criteria to independently assess the risk of inclusion in the literature and extract data. Meta-analysis was performed using Revman 5.0.14 software. Results The final study included 5 articles. (1) There was no significant difference in short-term improvement of symptoms and signs between comprehensive indexes (P> 0.05). (2) A single clinical index analysis to improve short-term clinical manifestations: mandibular motor pain symptoms, maximum mouth opening, joint area tenderness, the combined effect was no significant difference between the two groups (P> 0.05). (3) Qualitative analysis of special indicators (high-resolution CT assessment of bone tissue changes): two groups of destructive and repair changes in bone no significant difference. (4) After injection, the pain of adverse reactions was more intensively analyzed. There was no significant difference between the two groups (P> 0.05). Conclusion There is no significant difference in short-term curative effect and adverse reaction between HS and CO for TMJ injection. HS mild adverse reactions and temporary, but severe cases of CO have some effect.