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。
Objective To obtain an evidence-based treatment for an adolescent patient with temporomandibular os- teoarthritis. Methods The detailed history of an adolescent patient with temporomandibular osteoarthritis was ana- lysed. 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 temporomandi- bular 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 treat- ment 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 mdividual treatment plan could be established for each patient with temporo- mandibular disorders, and this will provide strong sup- porting 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.
出处
《华西口腔医学杂志》
CAS
CSCD
北大核心
2012年第6期624-627,631,共5页
West China Journal of Stomatology
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
temporomandibular disorders
osteoarthritis
evidence-based treatment
hyaluronate
glucosamine
