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.
Citation：
HUANG Hongping,WU Xiuli. Effects of Intra-articular Injection of Drugs for Temporomandibular Disorders. Chinese Journal of Evidence-Based Medicine, 2009, 09(12): 1292-1295. doi: 10.7507/1672-2531.20090236
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Copyright © the editorial department of Chinese Journal of Evidence-Based Medicine of West China Medical Publisher. All rights reserved
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李晓东, 史宗道, 田卫东. 透明质酸钠关节腔内注射治疗颞下颌关节紊乱病的疗效分析. 华西口腔医学杂志, 2004, 22(2): 135-137.
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史宗道, 杨峰, 张静仪, 等. 透明质酸钠治疗颞颌关节退行性关节病临床随机对照研究. 中国修复重建外科杂志, 2002, 16(1): 11-15.
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史宗道, 郭春岚, 陈娥. 关节内注射透明质酸钠治疗颞下颌关节紊乱病效果的系统评价. 中国循证医学杂志, 2004, 4(6): 368-376.
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Bjørnland T, Gjaerum AA, Møystad A. Osteoarthritis of the temporomandibular joint: an evaluation of the effects and complications of corticosteroid injection compared with injection with sodium hyaluronate. J Oral Rehabil, 2007, 34(8): 583-589.
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Møystad A, Mork-Knutsen BB, Bjørnland T. Injection of sodium hyaluronate compared to a corticosteroid in the treatment of patients with temporomandibular joint osteoarthritis: a CT evaluation. Oral Surg,Oral Med, Oral Pathol, and Oral Radiol Endod, 2008, 105(2): e53-60.
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- 1. 马绪臣. 主编. 颞下颌关节病的基础与临床. 第1版. 北京: 人民卫生出版社, 2000, 102-116.
- 2. Nitzan DW, Dolwick MF, Martinez GA. Temporomandibular joint arthrocentesis: A simplified treatment for severe limited mouth opening. J oral Maxilllofac Surg, 1991, 49(11): 1163-1167.
- 3. 胡波, 王大章. 醋酸强的松龙关节腔内注射对颞下颌关节影响的初步研究. 口腔医学纵横, 1995, 11(2): 86-88.
- 4. 傅开元, 马绪臣, 张震康. 颞下颌关节紊乱病关节腔内注射糖皮质激素后关节液病理分析. 中华口腔医学杂志, 1999, 34(1): 55-57.
- 5. 李晓东, 史宗道, 田卫东. 透明质酸钠关节腔内注射治疗颞下颌关节紊乱病的疗效分析. 华西口腔医学杂志, 2004, 22(2): 135-137.
- 6. 史宗道, 杨峰, 何志秀, 等. 透明质酸钠与强的松龙治疗兔实验性颞颌关节骨关节炎的研究. 中国修复重建杂志, 2002, 16(1): 5-10.
- 7. 史宗道, 杨峰, 张静仪, 等. 透明质酸钠治疗颞颌关节退行性关节病临床随机对照研究. 中国修复重建外科杂志, 2002, 16(1): 11-15.
- 8. 史宗道, 郭春岚, 陈娥. 关节内注射透明质酸钠治疗颞下颌关节紊乱病效果的系统评价. 中国循证医学杂志, 2004, 4(6): 368-376.
- 9. Bjørnland T, Gjaerum AA, Møystad A. Osteoarthritis of the temporomandibular joint: an evaluation of the effects and complications of corticosteroid injection compared with injection with sodium hyaluronate. J Oral Rehabil, 2007, 34(8): 583-589.
- 10. Møystad A, Mork-Knutsen BB, Bjørnland T. Injection of sodium hyaluronate compared to a corticosteroid in the treatment of patients with temporomandibular joint osteoarthritis: a CT evaluation. Oral Surg,Oral Med, Oral Pathol, and Oral Radiol Endod, 2008, 105(2): e53-60.
