开放复位内固定手术治疗与保守治疗髁突骨折效果对比的Meta分析

Efficacy of open reduction and fixation surgery and conservative treatment on condylar fracture: A Meta analysis

目的:采用Meta分析的方法对比开放复位内固定手术与保守治疗方法在髁突骨折的治疗效果。方法:计算机检索PubMed、Cochrane图书馆、EMbase,收集采用开放内固定技术与采用保守治疗技术治疗髁突骨折的随机对照试验,检索时间均从建库至2012年1月。按照纳入标准由2名研究者独立筛选文献并提取资料,对纳入文献的质量进行评估,采用RevMan5.0软件进行Meta分析。结果:共纳入13个研究,共859例患者,其中手术治疗409例,保守治疗450例。Meta分析结果显示:手术治疗组最大开口度优于保守治疗组[OR=0.35,95%C(I0.21,0.50),P<0.00001],两组差异有统计学意义;随诊1年,手术组错牙合发生率小于保守治疗组,差异有统计学意义[OR=0.29,95%C(I0.13,0.66),P=0.003];随诊1年,手术组与保守治疗组关节疼痛的发生率无统计学差异[OR=0.76,95%C(I0.25,2.29),P=0.63]。两组治疗方法中面部不对称的发生率[OR=1.27,95%C(I0.34,4.79),P=0.73]、下颌活动受限发生率[OR=0.94,95%C(I0.43,2.07),P=0.88]均无显著差异。结论:采用开放手术治疗髁突骨折与采用保守治疗相比在治疗后咬合关系恢复及术后开口度改善方面具有优势。两种治疗方法出现关节区症状的情况无显著差异。对面部发育及下颌功能的影响无明显差异。

Objective：To evaluate the efficacy of open reduction and fixation surgical treatment and conservative treat- ment on condylar fracture by Meta analysis. Method：Databases including PubMed,Cochrane Library and EMbase were searched to identify literatures that reported the efficacy of open reduction and fixation surgical treatment compared with conservative treatment on condylar fracture. Retrieval time began from the establishment of database to January 2012. Two reviewers assessed the quality of each trial and extracted data independently. The RevMan 5.0 software was used for statisti- cal analysis. Result：Thirteen literatures including 859 cases were included. 409 cases underwent surgical treatment, 450 cases underwent conservative treatment. The results of Meta-analysis showed： The term of maximal mouth opening of the surgical treatment group was higher than that in the conservative treatment group [OR=0.35,95 % CI （0.21,0.50）,P 〈 0.000017. An advanced outcome of occlusional relationship was noted in surgical group than in conservative treatment group after 1 year review [-OR=0.29, 95 % CI （0.13, 0.66）, P =0.003]. The incidence of joint pain has no significant statistical dif- ference in two groups [＇OR=0.76, 95 % CI （0.25,2.29）, P =0.63]. No significant statistical difference in the terms of facial symmetry [OR=1.27,95 % CI （0.34,4.79）,P =0.73],and mandibular activity status in two groups [OR=0.94,95 % CI （0.43,2.07） ,P =0.881. Conclusion：Surgical treatment has significant advantages in improving the maximal mouth opening and occlusional relationship. No significant statistical difference in the occurring of joint pain post treatment and mandibular activity status in two groups.