上颌前方牵引矫治对颌骨生长发育长期影响的Meta分析

Meta-analysis of the long-term effect of maxillary protraction on jaw growth and development

目的评价上颌前方牵引矫治生长发育期安氏Ⅲ类错畸形患者的长期稳定性。方法全面检索了Cochrane Library、PubMed、Ovid、Science Direct、Wiley等外文数据库及中国期刊全文数据库、中国生物医学文献数据库、中国知网、维普中文科技期刊数据库、万方数据库等中文数据库,检索时间截止到2021年8月18日。由2名学者进行文献的筛选、质量评价及数据提取,应用RevMan5.3软件进行Meta分析,应用GRADE证据分级系统评价结局指标的证据质量,结局指标为治疗期间(T1-T2),随访期间(T2-T3)及整体观察期间(T1-T3)SNA、SNB、ANB、Co-A、Co-Gn、SN-GoGn改变量。结果最终纳入10篇符合要求的文献,试验组均为应用上颌前方牵引矫治的安氏Ⅲ类患者,对照组为未经治疗的安氏Ⅲ类患者。Meta分析结果显示:治疗期间,试验组SNA、ANB、Co-A增量大于对照组,SNB、Co-Gn增量小于对照组,其差异具有统计学意义(P<0.05)。SNGoGn改变量的差异无统计学差异(P>0.05)。随访期间,试验组SNA、SNB、ANB、Co-Gn增量小于对照组,其差异具有统计学意义(P<0.05),Co-A、SN-GoGn改变量的差异无统计学意义(P>0.05)。整体观察期间,试验组SNA、ANB、Co-A增量大于对照组,SNB、Co-Gn增量小于对照组,其差异具有统计学意义(P<0.05),SNGoGn改变量的差异无统计学意义(P>0.05)。结论上颌前方牵引矫治生长发育期安氏Ⅲ类患者,其骨性效应主要来自于治疗期间,随访期间Ⅲ类骨骼生长模式存在复发趋势,但长期观察后发现,上颌前方牵引矫治对试验组颌骨矢状向位置及颌间关系改善,中面部生长促进以及下颌骨生长抑制,具有一定的稳定性。需要更多随访时间更长,大样本及高质量的临床研究来验证本结论。

Objective To evaluate the long-term stability of maxillary protraction in the treatment of Angle ClassⅢmalocclusion in children with mixed dentition.Methods A comprehensive search of Cochrane Library,PubMed,Ovid,ScienceDirect,Wiley,China Academic Journal Full-text Database,China Biology Medicine Disc,China National Knowledge Infrastructure,China Science and Technology Journal Database,Wan Fang database and other foreign and Chinese databases was conducted until 18 August 2021.Literature screening,quality evaluation and data extraction were carried out by two scholars.Meta-analysis was carried out by RevMan5.3 software,and the evidence quality of the outcome index was evaluated using the Grading of Recommendations Assessment,Development and Evaluation evidence grading system.The results consist of active treatment changes and posttreatment changes,as well as the overall changes in SNA,SNB,ANB,Co-A,Co-Gn,SN-GoGn.Results Ten articles that met the requirements were included.The treated group,which comprised patients with Angle ClassⅢmalocclusion treated by maxillary protraction,was compared with the untreated ClassⅢcontrol group.The results of the meta-analysis showed statistical differences in the increase in SNA,SNB,ANB,Co-A and CoGn during the T1-T2 period(P<0.05)and no statistical difference in SN-GoGn(P>0.05).During the T2-T3 period,SNA,SNB,ANB and Co-Gn significantly decreased(P<0.05),but Co-A and SN-GoGn had no significant change(P>0.05).During T1-T3,SNA,SNB,ANB,Co-A and Co-Gn was significantly changed(P<0.05),whereas SN-GoGn had no significant change(P>0.05).Conclusion The analysis of patients with Angle ClassⅢmalocclusion who were treated by maxillary protraction revealed that the maxillary and mandibular effects come from the active treatment period.Although the ClassⅢgrowth pattern had a tendency to be re-established during the posttreatment period,facemask therapy remarkably improved the maxillary and mandibular sagittal positions and maxilla-mandible relationship,promoted midface growth and inhibited mandibular growth during the long-term observation.More large samples and high-quality clinical studies are needed to verify this conclusion.