颞下颌关节紊乱病治疗的Cochrane系统评价证据  

Evidence of Cochrane Systematic Reviews on the Treatment of Temporomandibular Disorders

作　　者：张晓歌[1] 杨帆[2] 吴泰相[3] 史宗道[4] 易新竹[1] 

机构地区：[1]四川大学口腔疾病研究国家重点实验室,成都610041 [2]四川大学华西医院,成都610041 [3]四川大学华西医院中国循证医学中心,成都610041 [4]四川大学华西口腔医院,成都610041

出　　处：《中国循证医学杂志》2008年第12期1130-1132,共3页Chinese Journal of Evidence-based Medicine

摘　　要：目的评价颞下颌关节紊乱病(TMD)治疗的Cochrane系统评价证据及纳入治疗TMD系统评价的临床随机对照试验(RCT)的方法学质量。方法文献检索Cochrane Library(2008年第3期)中有关TMD治疗的系统评价,并对系统评价纳入RCT的方法学质量进行评价。结果共检索到3篇系统评价:分别为透明质酸钠、咬合调整、稳定咬合板治疗TMD的疗效评价,共纳入25个RCT。按Cochrane协作网推荐的质量评价方法,纳入的RCT中仅2篇为B级,其余23篇研究均为C级。结论目前缺少足够强度的证据来支持透明质酸钠、稳定咬合板、咬合调整治疗TMD的疗效。其他治疗手段的疗效如关节镜等尚需通过进一步完成的系统评价来评估。TMD治疗的系统评价所纳入RCT的方法学质量普遍较低,部分研究存在随机方法描述不清、无隐蔽分组、无样本量计算及无意向治疗分析等缺陷。建议推行临床试验透明化,实施临床试验注册制度,按照CONSORT声明严格规范RCT的报告,以便于总结预防和治疗TMD的临床证据,提高TMD临床治疗水平。Objective To assess the evidence of Cochrane systematic reviews on the treatment of temporomandibular disorders （TMD） as well as the methodological quality of all randomized controlled trials （RCTs） of the included systematic reviews. Methods The Cochrane Library （Issue 3, 2008） was searched for systematic reviews on the treatment of temporomandibular disorders. The risk of bias was assessed independently by two authors. Results Three systematic reviews involving 25 RCTs were included. The methods of 23 studies were rated as of lower quality with high risk of various biases. Only 2 studies were of high quality. Conclusion There is insufficient or inconsistent evidence to support the use of hyaluronate, occlusal adjustment, and stabilization splint therapy for the treatment of TMD. The overall quality of RCTs about the treatment of TMD is generally low. Analysis of the included trials showed that some trials had no clear description of randomization methods, allocation concealment, sample size calculation, and intention-to-treat analysis. To improve the quality of the reporting of RCTs, clinical trial registration and the revised Consolidated Standards of Reporting Trials （CONSORT） statement should be introduced into the trial design and strictly followed.

关 键 词：颞下颌关节紊乱病 系统评价 随机对照试验 方法学 

分 类 号：R782.6[医药卫生—口腔医学]