关于《颞下颌关节紊乱病相关慢性疼痛的临床实践指南》解读  

Interpretation of a clinical practice guideline on the management of chronic pain associated with temporomandibular joint disorders

作　　者：李晨曦[1] 宋志强 金星 龚忠诚[1] 刘慧[4] 刘旭 丁明超 孙家琳 龙星[8] 邵博[1] Li Chenxi;Song Zhiqiang;Jin Xing;Gong Zhongcheng;Liu Hui;Liu Xu;Ding Mingchao;Sun Jialin;Long Xing;Shao Bo(Department of Oral and Maxillofacial Oncology&Surgery,School/Hospital of Stomatology,the First Affiliated Hospital of Xinjiang Medical University,Stomatological Research Institute of Xinjiang Uygur Autonomous Region,Urumqi 830054,China;Department of Temporomandibular Joint,Affiliated Stomatology Hospital of Guangzhou Medical University,Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine,Guangdong Engineering Research Center of Oral Restoration and Reconstruction,Guangzhou 510182,China;Department of Anesthesiology,Beihua University Affiliated Hospital,Jilin 132011,China;Department of Oral and Maxillofacial Surgery,Shanghai Stomatological Hospital&School of Stomatology/hanghai Key Laboratory of Craniomaxillofacial Development and Diseases,Fudan University,Shanghai 200031,China;Department of Oral and Maxillofacial Surgery,School and Hospital of Stomatology Lanzhou University&Key Laboratory of Dental Maxillofacial Reconstruction and Biological Intelligence Manufacturing,Lanzhou 730013,China;Department of Oral and Maxillofacial Traumatology&Orthognathic Surgery,School of Stomatology,The Fourth Military Medical University,State Key Laboratory of Oral&Maxillofacial Reconstruction and Regeneration,National Clinical Research Center for Oral Diseases,Shaanxi Clinical Research Center for Oral Diseases,Xi′an 710032,China;School of Public Health,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Department of Oral&Maxillofacial Surgery,School of Stomatology,Wuhan University,Wuhan 430079,China)

机构地区：[1]新疆医科大学第一附属医院(附属口腔医院)口腔颌面肿瘤外科新疆维吾尔自治区口腔医学研究所,乌鲁木齐830054 [2]广州医科大学附属口腔医院颞下颌关节科·广州市口腔再生医学基础与应用研究重点实验室,广州510182 [3]北华大学附属医院麻醉科,吉林132011 [4]上海市口腔医院·复旦大学附属口腔医院口腔颌面外科上海市颅颌面发育与疾病重点实验室,上海200031 [5]兰州大学口腔医学院·口腔医院口腔颌面外科甘肃省牙颌面重建与生物智能制造重点实验室,兰州730013 [6]第四军医大学口腔医院创伤与正颌外科口颌系统重建与再生重点实验室国家口腔疾病临床医学研究中心陕西省口腔疾病临床医学研究中心,西安710032 [7]华中科技大学同济医学院公共卫生学院,武汉430022 [8]武汉大学口腔医(学)院口腔颌面外科,武汉430079

出　　处：《中华口腔医学杂志》2024年第10期988-997,共10页Chinese Journal of Stomatology

基　　金：国家自然科学基金(82160189);口腔颌面发育与再生湖北省重点实验室开放课题基金(2022kqhm008);新疆维吾尔自治区自然科学基金(2023D01D14);新疆维吾尔自治区科研创新项目(XJ2023G174);天山英才医药卫生领军人才(TSYC202301A001)。

摘　　要：颞下颌关节紊乱病(TMD)是一组影响颞下颌关节、咀嚼肌系统、牙齿咬合甚至全身多种结构的病症,具有显著的生物-心理-社会模式特点。TMD相关慢性疼痛作为其最主要的临床症状,会带给患者负面情绪,严重影响生活质量和身心健康。既往国内外报道的TMD治疗方法多种多样,一直缺乏公认有效的治疗方案。由加拿大麦克马斯特大学迈克尔·G·德格鲁特医学院国家疼痛中心Jason W Busse教授牵头,联合多所国际知名高校/医院制订的《颞下颌关节紊乱病相关慢性疼痛的临床实践指南》,2023年12月15日发布于临床研究国际知名期刊《英国医学杂志》。该临床实践指南分析比较了TMD相关慢性疼痛现行疗法的有效性,条件性建议了不同方案治疗/缓解疼痛的具体干预措施,提出了较为全面、规范、标准化的临床实践指南。本文详述该指南的制订流程及关键内容,以帮助国内学者理解并使用指南,为现阶段TMD相关慢性疼痛的临床诊疗提供参考和依据。Temporomandibular disorders(TMD)are a heterogeneous group of diseases that affect the temporomandibular joint,chewing muscle system,dental occlusion,and even various structures throughout the body,with significant characteristics of biological-psychological-social pattern.TMD related chronic pain,as the most important clinical symptom,can result in negative emotions seriously affecting patients′quality of life and physical and mental health.Although a variety of therapies have been previously reported to treat TMD related chronic pain,there is a lack of widely recognized therapies.Professor Jason W Busse(from Michael G DeGroote National Pain Centre,McMaster University,Hamilton ON,Canada)took the lead and collaborated with multiple internationally renowned schools/hospitals of stomatology to develop an international consensus on the management of chronic pain associated with TMD,a clinical practice guideline,which took two years and was published in December 15th,2023 in a global top journal of clinical research The British Medical Journal.This clinical practice guideline explored the comparative effectiveness of available therapies for chronic pain associated with TMD,conditionally recommended the specific intervention for different treatment or pain relief,proposed a comprehensive,agreed,and standardized clinical practice guideline.This present article describes the methodology and key elements of the clinical practice guideline to help clinicians fully understand and appropriately apply this guidance,which could provide the references for clinical practice of TMD associated chronic pain in China.

关 键 词：颞下颌关节紊乱病 慢性疼痛 随机对照试验 网状Meta分析 临床实践指南 

分 类 号：R782.6[医药卫生—口腔医学]