华西口腔医学杂志 ›› 2012, Vol. 30 ›› Issue (6): 624-627.doi: 10.3969/j.issn.1000-1182.2012.06.015

• 临床研究 • 上一篇    下一篇

椅旁循证在颞下颌关节骨关节炎治疗中的应用研究

潘光华1 李春洁2 李双君2 赵洪伟2 陈海燕3   

  1. 1.安顺市人民医院口腔颌面外科, 安顺561000; 2.四川大学华西口腔医学院口腔颌面外科学教研室, 成都610041; 3.四川新斯顿制药有限责任公司, 成都610031
  • 收稿日期:2012-04-20 修回日期:2012-07-20 出版日期:2012-12-01 发布日期:2012-12-01
  • 通讯作者: 赵洪伟,Tel:028-85501428
  • 作者简介:潘光华(1979—),男,贵州人,主治医师,硕士

Application of dental chairside evidence-based medicine for the treatment temporomandibular osteoarthritis

Pan Guanghua1, Li Chunjie2, Li Shuangjun2, Zhao Hongwei2, Chen Haiyan3.   

  1. 1. Dept. of Oral and Maxillofacial Surgery, People’s Hospital of Anshun, Anshun 561000, China; 2. Dept. of Oral and Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu 610041, China; 3. Sichuan Xinsidun Pharmaceutical Co. Ltd., Chengdu 610031, China
  • Received:2012-04-20 Revised:2012-07-20 Online:2012-12-01 Published:2012-12-01

摘要:

目的针对1例青少年颞下颌关节骨关节炎患者,检索当前最佳临床证据,为临床治疗颞下颌关节紊乱病提供依据和参考。方法通过分析1例青少年颞下颌关节骨关节炎患者的病情,提出临床问题,检索Clinical Evidence (至2010年12月)、美国国家指南交换中心(2000—2010年12月)、Cochrane图书馆(2010年第4期)、MEDLINE(OVID, 1950—2010年12月)、中国生物医学文献数据库(1978—2010年12月),获取包含有该患者相应特征的与颞下颌关节紊乱病手术和保守治疗方法相关的临床指南、系统评价及临床随机对照试验,以为该患者寻找个性化的治疗方案。结果纳入文献5篇,包括1篇临床指南、3篇系统评价及1篇临床随机对照试验。当前证据表明:针对青少年颞下颌关节紊乱病患者,应尽量避免手术治疗而选择保守治疗如关节腔内注射等;透明质酸钠是对颞下颌关节紊乱病有明确治疗效果的关节腔内注射药物;下腔注射或上下腔注射效果优于单纯上腔注射;口服氨基葡萄糖治疗颞下颌关节紊乱病的效果优于布洛芬。根据以上证据,结合患者及医院情况,为其制定了关节上下腔内注射透明质酸钠及口服氨基葡萄糖类药物保守治疗。6个月后,患者的临床症状、体征及锥形束CT均有明显改善。结论运用循证医学方法,充分利用临床医学证据,能够为颞下颌关节紊乱病患者提供个性化的治疗方案,为颞下颌关节疾病的临床实践提供有力的支持。关节上下腔透明质酸钠注射结合口服氨基葡萄糖药物治疗颞下颌关节骨关节炎是有效的。

关键词: 颞下颌关节紊乱病, 骨关节炎, 循证治疗, 透明质酸, 氨基葡萄糖

Abstract:

Objective To obtain an evidence-based treatment for an adolescent patient with temporomandibular osteoarthritis. Methods The detailed history of an adolescent patient with temporomandibular osteoarthritis was analysed. Clinical Evidence(to Dec 2010), National Guideline Clearinghouse(2000-Dec 2010), Cochrane Library(Issue 4, 2010), MEDLINE(OVID, 1950-Dec 2010) and China Biology Medicine Database(1978-Dec 2010) were searched to obtain evidence such as clinical guidelines, systematic reviews and randomized controlled trials related to surgery or conservative treatment to temporomandibular osteoarthritis to find a personal treatment strategy for the patient. Results Five articles were finally included, i.e. 1 clinical guideline, 3 systematic reviews and 1 randomized controlled trials. These evidence showed that: Conservative treatment like intra-articular injection instead of surgery should be adopted for adolescent patient; hyaluronate is the drug with sufficient evidence in supporting its use in treating temporomandibular disorders; inferior temporomandibular joint cavity injection or both upper and lower cavity injection has better effect than that of superior cavity injection only; and there was some evidence to support the use of glucosamine to treat temporomandibular disorders. Considering the situation of the case and the clinical evidence, an individual treatment plan of hyaluronate injection into the upper and lower cavity and glucosamine take orally was established. A long-term follow-up of 6 months showed a good treatment outcome. Conclusion Through the evidence-based methods and the use of clinical evidence, an individual treatment plan could be established for each patient with temporomandibular disorders, and this will provide strong supporting to the treatment of temporomandibular disorders.Up to now, it is clear that hyaluronate injection into the upper and lower cavity with glucosamine administration is effective in treating temporomandibular osteoarthritis.

Key words: temporomandibular disorders, osteoarthritis, evidence-based treatment, hyaluronate, glucosamine