手法复位联合咬合板治疗颞下颌关节盘不可复性前移位疼痛与最大张口度的Meta分析  

A meta-analysis of pain and maximum mouth opening of manipulative reduction combined with splint in the treatment of temporomandibular joint anterior disc displacement with out reduction

作　　者：郝紫微 张洁[2] 蒋昕钰 李莎 吴毅英 HAO Zi-wei;ZHANG Jie;JIANG Xin-yu;LI Sha;WU Yi-ying(Department of The First Clinical Medical College of Fujian University of Traditional Chinese Medicine,Fuzhou 350122,China;Department of People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine,Fuzhou 350004,China;Department of The Acupuncture College of Fujian University of Traditional Chinese Medicine,Fuzhou 350122,China)

机构地区：[1]福建中医药大学第一临床医学院,福州350122 [2]福建中医药大学附属人民医院,福州350004 [3]福建中医药大学针灸学院,福州350122

出　　处：《口腔颌面修复学杂志》2024年第1期39-44,共6页Chinese Journal of Prosthodontics

基　　金：福建省中青年教师教育科研项目(项目编号:2022-091)。

摘　　要：目的:通过Meta分析,比较手法复位联合咬合板治疗颞下颌关节盘不可复性前移位患者疼痛与最大张口度疗效是否优于仅进行手法或仅进行咬合板治疗。方法:计算机检索Web of Science、PubMed、Cochrane Library、维普(VIP)、中国知网(CNKI)、万方中手法复位联合咬合板治疗颞下颌关节盘不可复性前移位的随机对照试验(RCTs)文献,并参考Cochrane手册评估文献质量,运用RevMan5.4软件分析结局指标。结果:本研究纳入6个RCTs,患者共计393例。Meta分析结果显示,对于颞下颌关节盘不可复性前移位患者,观察组进行手法复位联合咬合板治疗,在降低疼痛评分[SMD=-0.34,95%CI(-0.54,-0.13),P=0.001]与改善最大张口度[SMD=0.51,95%CI(0.31,0.71),P<0.00001]方面疗效均比对照组较优,差异具有统计学意义(P<0.05)。结论:手法复位联合咬合板治疗改善颞下颌关节盘不可复性前移位患者疼痛和最大张口度疗效优于单独使用手法复位或单独佩戴咬合板。Objective:Through meta-analysis,the pain and maximum mouth opening of manipulative reduction combined with splint in the treatment of temporomandibular joint anterior disc displacement with out reduction was compared with that of manipulative reduction or splint alone.Methods:Randomized controlled trials(RCTs)involving manipulative reduction combined with splint in the treatment of temporomandibular joint anterior disc displacement with out reduction were searched through Web of Science,PubMed,Cochrane Library,VIP,CNKI and Wanfang.The quality of the literature was assessed by reference to Cochrane manuals,and the outcome indicators were analyzed using RevMan5.4 software.Results:In this study,6 RCTs were included,with a total of 393 patients.The results of meta-analysis showed that for patients with temporomandibular joint anterior disc displacement with out reduction,manipulative reduction combined with splint treatment in the observation group had significant effects on reducing pain score[SMD=-0.34,95%CI(-0.54,-0.13),P=0.001]and improving maximum mouth opening[SMD=0.51,95%CI(0.31,0.71),P<0.00001]were better than the control group,the difference was statistically significant(P<0.05).Conclusion:Manipulative reduction combined with splint treatment is better than manual reduction alone or wearing splint alone in improving pain and maximum mouth opening in patients with temporomandibular joint anterior disc displacement with out reduction.There are shortcomings and prospects in this study:In the included studies,there were no reports of secondary magnetic resonance examination of TMJ disc reduction rate and disc stability after treatment.It is expected that more clinical randomized controlled trials will be conducted to explore disc reduction rate in patients with irreducible forward displacement of TMJ disc in the future.

关 键 词：颞下颌关节 关节盘不可复性前移位 手法复位 咬合板 疼痛 最大张口度 META分析 

分 类 号：R782.6[医药卫生—口腔医学]