2种扩弓方式对骨性Ⅲ类患者上颌前牵引疗效影响的meta分析

A meta-analysis of the effect of two different methods of rapid palatal expansion on maxillary protraction in ClassⅢmalocclusion

目的对上颌反复扩缩联合前牵引与传统上颌快速扩弓联合前牵引治疗青少年骨性Ⅲ类错[牙合]畸形的疗效进行meta分析。方法检索Pubmed、EMBASE、Cochrane Libracry、CNKI、CBM、万方数据库,严格按照纳入排除标准筛选文献,并进行数据提取和质量评价,使用Revman5.4软件进行meta分析。结果最终10篇文献纳入本研究,其中6篇为随机对照研究,4篇为临床对照研究,共纳入304例患者。Meta分析结果,Alt-RAMEC联合前牵引较RME联合前牵引SNA、ANB、Wits值、A-VRL、Ls-VRL的变化值增加更多,而SN-MP、Li-VRL的变化值Alt-RAMEC联合前牵引更小,SNB、U1-SN、IMPA的变化值两组无统计学差异。结论Alt-RAMEC联合前牵引对上颌骨向前发育的促进效果更好,能获得更多的骨性效果,对软组织改善更为显著,但对上前牙唇倾、下前牙舌倾的影响无统计学差异。

Objective To evaluate the effect of alternative rapid maxillary expansion and constriction(Alt-RAMEC)combined with face mask(FM)or rapid maxillary expansion(RME)combined with FM on treating skeletal class Ⅲ malocclusion in patients.Methods The literatures were screened according to the inclusive and exclusive criteria on the Pubmed,EMBASE,Cochrane Library,CNKI,CBM and Wanfang.The Revman 5.4 were used to conduct a Meta-analysis.Results Ten studies(304 patients),including 6 randomized controlled trails(RCTs)and 4 non-randomized controlled trails(CCTs),were included in the Meta-analysis.The changes of SNA,ANB,Wits,A-VRL and Ls-VRL of Alt-RAMEC combined with anterior traction were more than those of RME combined with anterior traction,while the changes of SN-MP and Li-VRL of Alt-RAMEC combined with anterior traction were smaller.The changes of SNB,U1-SN and IMPA of Alt-RAMEC combined with anterior traction were not significantly differenct between the two groups.Conclusions The Alt-RAMEC/FM group can increase the effect of maxillary protraction and promote much more skeletal forward movement of maxillary than RME/FM.Meanwhile,the Alt-RAMEC/FM group can improve the soft tissue profile.But both groups can result in the protrusion of the upper incisors and the retrusion of the lower incisors.