眼眶爆裂性骨折不同手术入路术后并发症的Meta分析

A Meta-analysis of complications of orbital blowout fracture by surgical approaches

目的:应用Meta分析探讨眼眶爆裂性骨折结膜入路和皮肤入路对术后并发症的影响。方法:通过计算机检索PubMed、Web of Science、Cochrane library、OVID、中国生物医学文献数据库、维普、万方及CNKI数据库中从建库至2018-05-30期间发表的关于经结膜入路和下睑缘皮肤入路治疗眼眶爆裂性骨折术后并发症比较的随机对照试验和队列研究。采用Review Manager 5.3统计学软件对两种术式并发症发生率进行Meta分析。结果:共纳入7个队列研究,纽卡斯尔渥太华量表(NOS)评分法表明纳入文献质量均在6分以上,Meta分析显示结膜入路组和下睑缘入路组间效应量比值比(OR)的差异没有统计学意义[OR=0.74,95%CI(0.44～1.24),P=0.25)]。敏感性分析显示:Meta分析结果稳定可靠。漏斗图分析显示:纳入的文献可能存在发表偏倚。结论:皮肤入路和结膜入路对眼眶爆裂性骨折术后并发症发生率的影响差别不大,两种入路各有优缺点,需要结合临床实际综合考虑选择最合适的手术入路。

AIM: To investigate the effect of conjunctival approach and skin approach on postoperative com plications in orbital blow out fracture through M eta-analysis. METHODS: Search literatures in PubMed, Web of Science, Cochrane library, OVID, Chinese biom edical literature database,Weipu,Wanfang and CNKI database from the establishm ent of the database to M ay 30,2018.The m ain contents included random ized controlled trials and cohort studies about com paring the postoperative com plications of orbital blow out fracture through the transconjunctival approach and subciliary approach.M eta-analysis of the incidence of com plications was perform ed using Review M anager 5.3 statistical software.RESULTS: A total of 7 cohort studies were included. The New castle Ottawa Scale( NOS) score showed that the quality of the included literature was above 6 points.M eta-analysis showed no significant difference in odds ratio( OR) between the transconjunctival approach group and subciliary approach group (OR = 0.74,95% CI( 0.44-1. 24), P = 0. 25)Sensitivity analysis showed that the results of the M eta-analysis were stable and reliable.Funnel plot analysis showed that there m ight be publication bias in the included literature. CONCLUSION: The effect of skin approach and conjunctival approach on the incidence of postoperative com plications of orbital blow out fractures is not significant. The tw o approaches have their ow n advantages and disadvantages. It is necessary to com bine the clinical practical considerations to select the m ost suitable surgical approach.