Systematic Review Of Arthrocentesis Combined With Sodium Hyaluronate Injection In The Treatment Of Temporomandibular Joint Disorders

Objective:To evaluate the efficacy of arthrocentesis combined with sodium hyaluronate injection in treatment of temporomandibular joint disorders used the systematic review and provide scientific evidence for clinical treatment.Methods:China Biomedical Literature Database(CBM),Weipu database,Wangfang database,China National Knowledge Infrastructure(CNKI),Pubmed,Cochrane Library,Embase and Web of science were retrieved using method of combining key words and free words,time from building databases to June 2019.And we also retrieved the references of the included literatures,Chinese clinical trial registry(Chi-CTR),US-clinical trials and WHO international clinical trials registry platform(WHO-ICTRP),and these retrieved literatures were managed by EndNote8.0 software.According to inclusion and exclusion criteria two reviewers independently screened the randomized controlled trials of arthrocentesis combined with sodium hyaluronate injection in the treatment of temporomandibular joint and evaluated the quality of methodology based on the Cochrane collaboration’s tool.By means of RevMan5.3 software,the overall effect of results from multiple studies was analyzed by Meta-analysis.Meanwhile sensitivity analysis and the publication bias analysis were also done,and subgroup analysis was applied to find heterogeneity.Standardized mean difference(SMD)and 95% confidence interval(Cl)were used as combined effects.The GRADEprofiler3.6 as the evidential quality evaluation tools to assess included literatures,and descriptive analysis was used in literatures that couldn’t be meta-analyzed.Results:A total of 1364 literatures were retrieved from various databases,and 16 randomized controlled trials satisfied inclusion and exclusion criteria.1.According to the results analyzed by RevMan5.3 software in Meta-analysis mothed,the clinical efficacy of arthrocentesis combined with sodium hyaluronate in the treatment of temporomandibular joint disorders:(1)In terms of pain:There was statistically significant [SMD=-1.18,95 %CI(-2.03,-0.32),P=0.007].The quality of the evidence was extremely low.(2)In terms of mouth opening:There was not statistically significant[SMD=0.42,95 %CI(-0.19,1.03),P=0.18].The quality of the evidence was extremely low.(3)In terms of lateral movement distance:There was statistically significant [SMD=2.12,95%CI(0.29,3.94),P=0.02].The quality of the evidence was extremely low.(4)In terms of clicking:There was not statistically significant[SMD=0.43,95%CI(-0.01,0.88),P=0.06].The quality of the evidence was extremely low.(5)In terms of TNF-α:There was statistically significant [SMD=-4.36,95 % CI(-6.66,-2.05),P=0.0002].The quality of the evidence was extremely low.(6)In terms of IL-6:There was statistically[SMD=-1.55,95 %CI(-2.71,-0.40),P=0.008].The quality of the evidence extremely low.2.Subgroup analysis was conducted as follow:(1)In terms of pain:There was statistically significant between arthrocentesis combined with sodium hyaluronate injection and arthrocentesis in the treatment of TMD[SMD=-1.83,95 % CI(-3.04,-0.61),P=0.003].(2)In terms of pain:There was statistically significant about two needles arthrocentesis combined with sodium hyaluronate injection in the treatment of TMD[SMD=-1.34,95 %CI(-2.38,-0.30),P=0.01].(3)In terms of mouth opening and pain:There was statistically significant about arthrocentesis combined with 1.5ml sodium hyaluronate injection one time per week a total of four times in the treatment of TMD [SMD=2.18,95 %CI(1.56,2.81),P<0.00001],[SMD=-7.68,95%CI(-10.78,-4.58),P<0.00001].(4)In terms of mouth opening:There was statistically significant about arthrocentesis combined with sodium hyaluronate in the treatment of TMD postoperative follow-up of 12months[SMD=0.79,95%CI(0.23,1.34),P=0.005].Conclusion: Arthrocentesis combined with sodium hyaluronate injection in the treatment of TMD is effective for relieving joint pain,increasing lateral mandibular movement distance and reducing the contents of TNF-α and IL-6 in the synovial fluid.It is recommended as a simple,effective,minimal invasive method.