下颌骨髁突骨折治疗的Meta分析

A Meta-analysis of condylar fracture treatment

目的采用Meta分析法系统评价下颌骨髁突骨折保守治疗和手术治疗的远期疗效。方法以“下颌骨”、“髁突”、“骨折”、“治疗”为关键词,检索Medline、荷兰医学文摘(Embase)、Cochrance图书馆临床对照试验注册资料库(CCTR)和中国期刊网(CNKI)数据库中4种口腔医学杂志,按标准筛选文献,然后进行文献评价和Meta分析。结果共检出172篇相关文献,入选的10篇。10篇论著所含临床样本711例。随诊6个月和2年时,手术组张口度小于非手术组,且差异有统计学意义;随诊1年和2年时,手术组关节疼痛的发生率与非手术组间差异无统计学意义;手术组错骀的发生率小于非手术组,差异有统计学意义。结论年龄>16岁的患者低位髁突骨折有严重移位或脱位时,建议采用手术治疗。与非手术治疗相比,手术治疗能更好地恢复咬合关系。手术组与非手术组术后关节疼痛无差别。张口度的恢复有待进一步研究。

Objective To systematically evaluate the surgical and non-surgical treatment of condylar fracture using Meta-analysis system. Methods The key words： mandible, condyle, fracture and treatment/the rapy were adopted to search for the objective articles from following Data-base： Medline. Embase,CCTR and CNKI. The available data were statistically dealt with by software package （RevMan 4. 1）. Results In 172 associated articles, only 10 （5.8%） fulfilled the entrance criteria, involving 711 cases. A total of 307 patients underwent surgical treatment due to severely displacement or dislocation of fragment, 239 of the m （78.0%） being subcondylar fracture. A total of 404 patients received non-surgical management, 278 of them （68. 7% ） being lower level fracture without significant displacement. Surgical treatment outbalanced non-surgical approach in rehabilitation of occlusional relationship and an adverse outcome was noted in term of maximum mouth opening , but the re was no significant difference in postoperative joint pain. Conclusions Severely displaced and dislocated condylar fracture is indicated for surgical treatment.