髂骨及腓骨行颌骨及种植咬合重建的Meta分析

Meta-analysis of jaw reconstruction of the ilium and fibula and implant occlusal reconstruction

目的使用Meta分析评价髂骨和腓骨皮瓣进行颌骨重建,分析两者现有临床研究的证据,为临床医师行颌骨重建与种植修复时选择合适供区提供参考。方法检索PubMed、Embase、Cochrane Library以及万方数据库,搜集相关的临床研究,纳入使用髂骨和腓骨皮瓣行颌骨重建的临床研究,以皮瓣失败率、种植体成功率、供区并发症以及受区并发症作为结局指标。检索时间自建库至2023年6月。Meta分析的计算使用Review Manager软件进行。结果本研究共纳入19项研究,使用髂骨修复的颌骨共524个,使用腓骨修复的颌骨共564个。Meta分析结果显示:腓骨瓣和髂骨瓣在皮瓣失败比较上无统计学意义差异[OR:1.17,95%CI(0.67,2.03),P=0.59];在下颌骨重建后行种植治疗,腓骨瓣的种植体成功率高于髂骨瓣,差异具有统计学意义[OR:3.19,95%CI(1.43,7.08),P=0.004];在供区并发症发生率的比较上两者无统计学意义差异[OR:1.57,95%CI(0.63,3.90),P=0.33];在受区并发症发生率的比较上两者无统计学意义差异[OR:0.68,95%CI(0.39,1.17),P=0.17]。结论髂骨瓣和腓骨瓣行颌骨重建后,两者的皮瓣失败率及并发症发生情况相似。在术后行种植治疗后,腓骨瓣修复的下颌骨种植体成功率更高。未来仍需要更大样本、更高质量的临床试验全面评估髂骨瓣和腓骨瓣在颌骨重建中的疗效。

Objective To systematically evaluate the jaw reconstruction with iliac and fibular flaps based on the evidence from existing clinical studies to provide references for clinicians in selecting appropriate donor areas when undergoing jaw and implant occlusal reconstruction.Methods The databases of PubMed,Embase,Cochrane Library,CNKI,and Wanfang were searched for randomized controlled trials(RCTs)or clinical trials comparing jaw reconstruction with iliac and fibular flaps published before June 2023.The rates of flaps failure,successful implants,donor area complications,and recipient area complications were used as outcome measures.Meta-analysis was performed using Review Manager software.Results A total of 19 studies were included in this study,with a total of 524 patients using the ilium and 564 patientsusing the fibula.There was no statistically significant difference in the rate of flap failure[OR:1.17,95%CI(0.67,2.03),P=0.59].When implant therapy was conducted after jaw reconstruction,the rate of successful implantsof the fibula was higher than that of the ilium with a statistically significant difference[OR:3.19,95%CI(1.43,7.08),P=0.004].There was no statistically significant difference indonor area complications[OR:1.57,95%CI(0.63,3.90),P=0.33]and recipient area complications[OR:0.68,95%CI(0.39,1.17),P=0.17].Conclusion Flaps failure rates and complications were similar to the ilium group and the fibular group,while theimplant success rate of the fibula group washigher when implant therapy was conducted after jaw reconstruction.Larger and higher-quality clinical trials are needed to fully evaluate the efficacy of iliac flaps and fibular flaps in jaw reconstruction.