不同类型微型接骨板固定在下颌角骨折治疗中的Meta分析及系统评价

The meta-analysis and systematic evaluation of different types of miniplate fixation in the treatment of mandibular angle fracture

目的应用Meta分析,评价不同的固定方式对下颌角骨折的疗效。方法系统评价是由PRISMA参考,由万方数据库、中国知网、维普等中文数据库,Medline-Ovid、Embase、Pubmed等外文数据库审查检索,检索时限为建库至2017年6月,搜集国内外有关比较不同手术方案在成年人下颌角骨折应用中的随机对照试验、临床对照研究、回顾性研究并采用Review Manager 5.2.6软件对所得数据进行Meta分析。结果按照设计检索的方法检索到1 568篇相关文献,其中21篇文献纳入,并行Meta分析,结果显示:三维微型接骨板较二维微型接骨板差异有统计学意义(OR=0.48,P=0.001,95%CI:0.31~0.75),单板微型接骨板与双板微型接骨板比较无显著的统计学意义(Z=0.80,P=0.430),累计分析结果(OR=0.38,95%CI:0.25~0.58,P<0.00001),自锁板与非自锁板比较差异无统计学意义(Z=1.660,P=0.100),累计分析结果(OR=0.45;95%CI:0.17~1.18,P=0.100)。结论本项Meta分析表明应用三维接骨板比二维接骨板更能明显减少术后并发症,单板微型接骨板与双板微型接骨板、自锁板与非自锁板之间比较差异无显著统计学意义,但累计分析结果表明,单板微型接骨板比双板微型接骨板、自锁板比非自锁板占累计分析结果上的优势,有潜在的发展前途。

Objective Meta-analysis was used to evaluate the effect of different fixation methods on mandibular angle fractures.Methods A systematic review was conducted according to PRISMA guidelines.Database such as Medline-Ovid,Embase,Pubmed,Wan fang and CNKI databases were searched,with the time limit for retrieval from construction of the library to Jun.2017.Randomized controlled trials,clinical control study and retrospective study of different surgical programs in adult mandibular angle fractures were carried out.Review Manager 5.2.6 software was used to analyze the data.Results Totally 1568 articles were retrieved,21 of which were included and conducted with meta analysis.The meta analysis results indicated statistical differences between three-dimensional miniplate and two-dimensional miniplate(OR=0.48,P=0.001,95%CI,0.31-0.75),and no significant difference between one-miniplate and two-miniplate(Z=0.80,P=0.430).There was no statistical significance between locking miniplate and non-locking miniplate(Z=1.660,P=0.100).Conclusion The meta analysis shows that the application of three-dimensional plate can significantly reduce postoperative complications compared with two-dimensional plate.There is no significant difference between one-miniplate and two-miniplate,and between locking plate and non-locking plate,but the cumulative analysis results show that one-miniplate is better than two-miniplate,and that locking plate is better than non-locking plate.