组织补片预防下颌磨牙拔除后干槽症的系统评价

Tissue patch for prevention of dry socket after extraction of the mandibular molars: a sysrematic review

背景:有研究使用组织补片植入下颌磨牙拔牙窝中以增加拔牙创愈合后的骨量从而有利于后期修复,却发现组织补片植入后干槽症的发生率明显降低。目的:系统评价组织补片对下颌磨牙拔除后干槽症的预防效果。方法:检索Medline(OVID)、Cochrane图书馆临床随机对照试验库、荷兰医学文摘(EMBASE)库和中国生物医学文献数据库(CBM)的临床随机对照试验及临床对照试验,检索关键词为"Dry Socket,Tissue patch,acellular dermis matrix,Tooth extraction;干槽症,组织补片,脱细胞真皮基质,海奥,拔牙"。同时手检19种中文口腔医学杂志及纳入文献的参考文献。由2名研究者使用Cochrane协作网推荐的标准进行偏倚风险评价并进行数据提取,运用Revman 5.1软件进行Meta分析。结果与结论:共纳入8个研究,其中5个研究为临床随机对照试验,3个研究为临床对照试验,涉及患者2 052例,偏倚风险评价显示7个研究存在中度偏倚风险,1个研究存在高度偏倚风险。Meta分析结果显示,下颌磨牙拔牙窝内植入组织补片能够减少86%患者拔牙后干槽症的患病率(RR=0.14,95%CI[0.08,0.26],P<0.000 01),敏感分析显示该结果较为稳定。本组结果显示将组织补片植入下颌磨牙拔牙窝中能够显著降低干槽症的发生率,但此结果还需要更多的临床随机对照试验支持。

BACKGROUND：Tissue patch is used to increase bone mass after mandibular molar extraction, which is conducive to late-stage repair, but it is unexpectedly found that after implantation of tissue patch, incidence of dry socket is significantly reduced.OBJECTIVE：To assess the efficacy of tissue patch for the control of dry socket caused by mandibular molar extractionvia the method of systematic review. METHODS：MEDLINE （OVID）, CENTRAL, EMBASE and CBM were searched for clinical randomized controled trials and clinical controled trials. The keywords were “dry socket, tissue patch, acelular dermis matrix, tooth extraction” in English and Chinese. The references of the included studies and 19 Chinese dental journals were hand-searched. Two reviewers independently assessed the risk of bias using Cochrane Colaboration’s tool, and extracted data. Meta-analysis was delivered with Revman 5.1.RESULTS AND CONCLUSION：Eight studies, including five randomized controled trials and three clinical controled trials, were included. Totaly 2 052 participants were involved. Seven of the included studies had moderate risk of bias and one had high risk of bias. Meta analysis showed that implantation of the tissue patch into the extraction socket could reduce 86% of the risk of dry socket （relative risk=0.14, 95% confidence interval [0.08, 0.26], P 〈 0.000 01）. Sensitivity analysis showed that this outcome was relatively stable. Implantation of tissue patch into extraction socket could significantly reduce the risk of dry socket, but more randomized controled trials are needed.