牵张成骨对唇腭裂继发颌骨畸形修复效果的Meta分析

Meta-analysis of curative effect of distraction osteogenesis surgery on craniofacial deformity secondary to cleft lip and palate

背景:牵张成骨对唇腭裂继发颌骨畸形的修复效果尚不清楚。目的:评估牵张成骨对唇腭裂继发颌骨畸形的修复效果。方法:通过系统检索1998/2009中国期刊网全文数据库、万方数据库、中文科技期刊全文数据库、CBM文章库、Medline(ovid)、sciencedirect、ISI以及手工检索国内国外学者公开发表的牵张成骨矫治唇腭裂继发颌骨畸形方面的文献。有关牵张成骨矫治唇腭裂继发颌骨畸形的临床研究,要求研究方法和测量指标的赋值方式相似,必须包括研究目的、设计、具体统计方法,其研究结果均可提供加权均数差及95%CI或可以换算成OR值及95%CI的基础数据,样本量不少于3例,以患者治疗前后颌面部变化作自身对照。运用Meta分析对牵张成骨前后唇腭裂患者颌面部前后向、垂直向X射线头影测量的软硬组织指标上下牙槽座角、前牙覆盖、颅底-上牙槽座角和鼻唇角进行综合定量分析。根据资料异质性检验,上下牙槽座角、前牙覆盖指标合并效应量加权均数差采用随机效应模型,其余指标均采用固定效应模型。计算其合并效应量加权均数差及其95%CI。结果与结论:共纳入文献9篇,患者123例。资料的异质性检验结果显示,上下牙槽座角、覆盖的研究具有异质性,而颅底-上牙槽座角、鼻唇角的研究具有同质性。漏斗图示纳入的文献不存在发表偏倚。Meta分析结果显示,上下牙槽座角、覆盖、颅底-上牙槽座角、鼻唇角的合并效应量加权均数差均小于0,结果均具有显著性意义。此次Meta分析在一定程度上证实了口外支持式前牵张对唇腭裂继发颌骨畸形修复疗效,可为临床医师选择矫治颌骨畸形术式提供一定的指导。分析结果认为,唇腭裂继发颌骨畸形患者经LeFortⅠ截骨、口外支持式前牵张后可有效延长前徙上颌骨,使颅底-上牙槽座角、上下牙槽座角角度增大,上唇曲度变平,鼻唇角趋向增大,矫正反覆盖情况,恢复正常的咬合覆盖关系。

BACKGROUND： The repairing effect of distraction osteogenesis surgery in patients with craniofacial deformity secondary to cleft lip and palate remains unclear. OBJECTIVE： To evaluating the repairing effect of distraction osteogenesis surgery in patients with craniofacial deformity secondary to cleft lip and palate. METHODS： Databases of CNKI, Wanfang, VIP, CBM, Medline（ovid）, science direct, ISI, as well as hand working were retrieved for the literatures about the curative effect of distraction osteogenesis on clef lip and palate patents with secondary craniofacial deformity which have been published. Clinical research about distraction osteogenesis used in clef lip and palate patents with secondary craniofacial deformity must have the same assignment style of investigation method and measurement indicators that include objective, design and detailed statistical method of the research. All of the findings can provide elementary data for weighted mean difference and 95% confidence interval （95%CI） or odd ratio and 95% CI. There are at least three patients included in the research and controlled by changes after operation. Meta-analysis was used to make a comprehensive quantitative analysis of ANB, the labial teeth overjet, SNA and nasolabial angle which are the soft or hard tissue measured by X-ray cephalometry for the forward-backward and perpendicular direction of the maxillafacial region. According to homogeneity tests, researches about ANB and overjet of the labial teeth adopted random effect model while SNA and nasolabial angle adopted fixed effect model. So total pooling weighted mean difference and its corresponding 95%CI for the models were calculated. RESULTS AND CONCLUSION： Totally 9 references and 123 patients were involved. Homogeneity test showed that, researches about ANB and overjet of the labial teeth are heterogeneous while SNA and nasolabial angle are homoeonomous. Conus arteriosus maps showed no publication bias was observed in all the literature that used in this article. Meta-analysis results showed that, the total pooled weighted mean difference of ANB, overjet of the labial teeth, SNA and nasolabial angle were below zero, all showed significant statistical difference. Meta-analysis can prove the curative effect of extraoral support-type distraction on the craniofacial deformity secondary to cleft lip and palate. To some extent, this research will provide guidance for choosing therapeutic regimen by the clinicians. After rigid external distraction by Le Fort Ⅰostetomy, most of the patients show great changes such as the increased SNA and ANB angle, the flatter of the upper lip curvature followed by the increased nosolabial angle, cured reverse overjet and returned normal occlusion relations.