关节腔内注射曲安奈德／透明质酸治疗颞下颌关节紊乱病的疗效比较

目的探讨关节腔内注射糖皮质激素曲安奈德、粘弹剂透明质酸钠或二者联合使用治疗颞下颌关节紊乱病的疗效。方法应用半随机同期对照设计对3种治疗方案进行比较：①关节腔内单纯注射曲安奈德3次（8mg／次），②关节腔内单纯注射透明质酸钠（1％，1ml／次）4次，③关节腔内先注射曲安奈德2次再注射透明质酸钠2次。均为关节上腔灌洗后注射药物，每10日注射1次。第1个月、12个月及24个月进行随访，综合症状体征改善情况评定为优、良者计为有效，比较各组有效率。结果每组均纳入188例颞下颌关节紊乱病患者，24个月失访率为6．9％～10．1％。治疗1个月时，曲安奈德组有效率最高达92．0％：治疗12个月、24个月时透明质酸钠组有效率高于曲安奈德组（12个月84．6％vs．54．1％，24个月83．4％vs．40．4％），合并用药组有效率在12个月、24个月分别为90．4％和66．3％。结论关节腔内注射糖皮质激素曲安奈德关治疗颞下颌关节紊乱病短期疗效较好，关节腔内注射透明质酸钠则具有较好的远期效果.

Effects of Intra-articular Injection of Drugs for Temporomandibular Disorders

Objective To compare effects of intra-articular injection of corticosteroid or viscoelastic agent alone or a combination of the two drugs for treatment of temporomandibular joint disorders. Methods A prospective quasirandomized controlled trial was conducted to compare 3 treatment protocols of intra-articular injections in the upper compartment of the joint immediately following arthrocentesis repeatedly every 10 days: ① triamcinolone 8 mg alone for 3 times,② 1% hyaluronate 1 ml alone for 4 times,and ③ triamcinolone 8 mg for 2 times then 1% hyaluronate 1 ml for 2 times. Clinical examinations were done at baseline,1,12,and 24 months after end of the treatments. According to improvement of the symptoms and clinical signs,the effectiveness was graded in 3 classes: excellent,better,no change,or worse. The first two were classified as effective. Effective rates of the treatments and subgroups were compared statistically. Results Five hundred and sixty four patients with temporomandibular disorders were included and randomly allocated to 3 groups with 188 patients in each group. The rate of lost follow up at 24 months was 6.9% to 10.1%. At one month after treatment,the triamcinolone group had a better effective rate at 92.0%. At 12 and 24 months of follow up, effective rates of the hyaluronate group were better than those in the triamcinolone alone group (84.6% vs. 54.1% and 83.4% vs.40.4%). Effective rates of combining triamcinolone and hyaluronate group at 12 and 24 months were 90.4% and 66.3% respectively. Conclusion Intra-articular injection of corticosteroid has better results in a short term and hyaluronate has better results in a long term in the treatment of temporomandibular joint disorders.