顎関節肥大症における自己血注入：系統的レビュー

Autologous Blood Injections in Temporomandibular Hypermobility: A Systematic Review.

抄録

自己血注入（AB）は、顎関節の再発性脱臼の治療法の1つである。この手技は侵襲性が低いため、エビデンスに基づく医療の基準に従って評価することが合理的である。このシステマティックレビューの目的は、顎関節の過可動性の治療に対するAB注射に関する一次研究を同定し、治療の有効性を評価することである。このシステマティックレビューは、現行の「Preferred Reporting Items for Systematic Reviews and Meta-Analyses」ガイドラインに従って実施された。脱臼エピソード率、顎関節可動域、関節痛強度を比較した対照無作為化試験を適格基準として採用した。最終検索は、Bielefeld Academic Search Engine、Elsevier Scopus、National Library of Medicineを用いて2023年6月11日に行った：PubMedを用いた。試験は、"Oxford Center for Evidence-Based Medicine 2011 Levels of Evidence "スケールと "A revised Cochrane risk-of-bias tool for randomized trials "を用いて評価した。個々の研究の結果は表、統合はグラフで示された。982人の患者を含む22の研究が質的解析の対象となり、そのうち390人の患者を含む7つの研究が量的解析の対象となった。対象となったランダム化比較試験のうち、バイアスのリスクが高いものはなかったが、75％は何らかの懸念を示していた。3ヵ月の観察では、ABの投与は高張ブドウ糖よりも顎関節脱臼の抑制に効率的であり（1研究、32人、相対リスク=0.33、オッズ比=0.29）、顎腔内投与と顎腔周囲投与では、顎腔周囲注射単独と比較して転帰に差は認められなかった（2研究、70人、相対リスク=1.00、オッズ比=1.00）。ABの顎関節への注射は、患者の75～94％において顎関節脱臼の再発予防に有効である。本研究は資金提供を受けていない。

The injection of autologous blood (AB) is one of the methods of treatment of recurrent dislocations in the temporomandibular joints (TMJs). Due to the low invasiveness of this technique, it is reasonable to evaluate it in accordance with the standards of evidence-based medicine. The purpose of this systematic review is to identify primary studies on AB injection for the treatment of TMJ hypermobility and assess the therapy for effectiveness. This systematic review was conducted in accordance with the current "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" guidelines. Controlled randomized trials comparing dislocation episode rates, range of motion in the TMJ, or articular pain intensity were adopted as the eligibility criteria. Final searches were conducted on 11 June 2023 using Bielefeld Academic Search Engine, Elsevier Scopus, and the National Library of Medicine: PubMed. Trials were assessed using the "Oxford Center for Evidence-Based Medicine 2011 Levels of Evidence" scale and "A revised Cochrane risk-of-bias tool for randomized trials". The results of the individual studies were tabulated, syntheses were illustrated in graphs. Twenty two studies involving 982 patients were included in the qualitative analysis, of which seven studies involving 390 patients were subject to quantitative analysis. None of the included randomized controlled trials presented a high risk of bias, 75% of them raised some concerns. In a three-month observation, administration of AB was more efficient in limiting temporomandibular dislocations than hypertonic dextrose (1 study, 32 patients, relative risk = 0.33, odds ratio = 0.29) and no difference in outcomes was observed between intracavitary and pericapsular administration compared to pericapsular injection alone (2 studies, 70 patients, relative risk = 1.00, odds ratio = 1.00). Injections of AB into the temporomandibular joints are effective in preventing further TMJ dislocation episodes in 75-94% of patients. This study received no funding.