地塞米松冠周注射预防下颌阻生第三磨牙拔除后肿胀及张口受限的系统评价

Systematic review on control of swelling and trismus after extraction of impacted mandibular third molar by Dexamethasone pericoronal injection

目的评价地塞米松(DM)冠周注射对下颌阻生第三磨牙拔除术后肿胀及张口受限的预防效果。方法检索Cochrane图书馆临床随机对照试验库、PUBMED、荷兰医学文摘(EMBASE)和中国生物医学文献数据库;同时手检纳入文献的参考文献及中文口腔医学杂志。偏倚风险评价由2位评价者使用Cochrane系统评价者手册5.0版介绍的偏倚风险评价标准独立完成,同时独立进行数据提取。运用Revman 5.1软件进行Meta分析。结果共纳入7篇随机对照试验,涉及患者684名,偏倚风险评价显示6个研究为中度偏倚风险,1个研究为高度偏倚风险。Meta分析的结果显示,4～5 mg DM冠周注射能够使患者术后1～2 d内最大张口度大6.77 mm(P=0.02),同时能够减少51%的中-重度张口受限的发生率(P<0.000 01),并且在控制面部肿胀方面效果显著(P<0.05)。注射4 mg DM与8 mg DM在各项指标中无显著差别(P>0.05)。结论选择4～5 mg的DM冠周注射能够较好地控制下颌阻生第三磨牙拔除术后面部肿胀和张口受限,但还需要更多的临床随机对照试验的支持。

Objective To assess the efficacy of Dexamethasone （DM） pericoronal injection for the control of swelling and trismus caused by impacted mandibular third molars extraction. Methods Cochrane, PUBMED, EMBASE and CBM were searched for eligible studies. Hand-searching included references of the included studies and Chinese den- tal journals. Risk of bias of the included studies was assessed by two reviewers independently using Cochrane Calla- boration＇s tool, and data extraction was done by them. Meta-analysis was delivered with Revman 5.1. Results Seven randomized controlled trials, involving 684 participants, were included. Six of them had moderate risk of bias and one had high risk of bias. Meta-analysis showed that DM pericoronal injection could relieve trismus by 6.77 ram（P=0.02） within 1-2 days after the surgery. It could also reduce 51% of the risk of moderate-severe trismus（P〈0.000 01） and could significantly control facial swelling （P〈0.05）. There was no differences between 4 mg and 8 mg DM （P〉0.05）. Conclusion Periodontal injection of 4-5 mg DM could control facial swelling and trismus following impacted mandi- bular third molar extraction. But more randomized controlled trials are needed.