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中华口腔医学研究杂志(电子版) ›› 2021, Vol. 15 ›› Issue (03) : 161 -168. doi: 10.3877/cma.j.issn.1674-1366.2021.03.006

Meta分析

成人髁突骨折保守治疗与手术治疗疗效对比的Meta分析
余晓宁1, 蔡洁琛2, 黄利浩2, 竺越3, 侯劲松3,()   
  1. 1. 惠州市第一人民医院口腔科 516003;中山大学附属口腔医院,光华口腔医学院,广东省口腔医学重点实验室,广州 510055
    2. 惠州市第一人民医院口腔科 516003
    3. 中山大学附属口腔医院,光华口腔医学院,广东省口腔医学重点实验室,广州 510055
  • 收稿日期:2021-03-20 出版日期:2021-06-01
  • 通信作者: 侯劲松

Meta-analysis of the effect of conservative treatment versus surgical treatment for adult mandibular condylar fractures

Xiaoning Yu1, Jiechen Cai2, Lihao Huang2, Yue Zhu3, Jinsong Hou3,()   

  1. 1. Department of Stomatology, Huizhou First Peoples Hospital, Huizhou 516003, China; Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangdong Provincal Key Laboratory of Stomatology, Guangzhou 510055, China
    2. Department of Stomatology, Huizhou First Peoples Hospital, Huizhou 516003, China
    3. Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangdong Provincal Key Laboratory of Stomatology, Guangzhou 510055, China
  • Received:2021-03-20 Published:2021-06-01
  • Corresponding author: Jinsong Hou
  • Supported by:
    Science and Technology Planning Project of Huizhou(2018Y087)
引用本文:

余晓宁, 蔡洁琛, 黄利浩, 竺越, 侯劲松. 成人髁突骨折保守治疗与手术治疗疗效对比的Meta分析[J/OL]. 中华口腔医学研究杂志(电子版), 2021, 15(03): 161-168.

Xiaoning Yu, Jiechen Cai, Lihao Huang, Yue Zhu, Jinsong Hou. Meta-analysis of the effect of conservative treatment versus surgical treatment for adult mandibular condylar fractures[J/OL]. Chinese Journal of Stomatological Research(Electronic Edition), 2021, 15(03): 161-168.

目的

系统综述成人髁突骨折保守治疗与手术治疗的疗效对比,为临床治疗成人髁突骨折提供依据。

方法

不同的研究者分别检索Web of science、PubMed、Cochrane library和Embase等数据库,时间为数据库建库至2020年5月1日,查找关于成人髁突骨折保守治疗与手术治疗的相关文献,严格按照纳入、排除标准进行筛选,对纳入的文献进行质量评估,提取关于治疗成人髁突骨折疗效相关的数据,采用RevMan5.3软件计算疗效指标的比值比(OR)或均数差(MD)和95%置信区间(CI),采用StataSE 12.0软件对存在异质性的研究进行敏感性分析和发表偏倚检验。

结果

通过搜索共纳入23篇成人髁突骨折保守治疗与手术治疗的相关研究,含保守治疗患者917例,手术治疗患者819例。研究结果显示,髁突骨折手术治疗后咬合紊乱[OR = 3.07,95% CI(2.07,4.58),P<0.001]、下颌偏斜[OR = 2.51,95% CI(1.36,4.63),P = 0.003]的发生明显低于保守治疗,最大开口度[MD = -3.70,95% CI(-4.39,-3.02),P<0.001]的恢复明显优于保守治疗;而手术治疗后软组织疼痛[OR = 0.21,95% CI(0.07,0.62),P = 0.005]、肿胀[OR = 0.26,95% CI(0.15,0.46),P<0.001]和面神经损伤症状[OR = 0.13,95% CI(0.03,0.61),P = 0.009]的发生明显高于保守治疗;关节疼痛、下颌运动疼痛、开口度<35 mm、关节弹响、下颌升支高度降低、面型不对称、涎漏、瘢痕、横向偏斜在保守治疗与手术治疗中无明显差异(P>0.05)。

结论

成人髁突骨折经手术治疗后,咬合关系、下颌偏斜及最大张口度的恢复均优于保守治疗,而软组织疼痛、肿胀、面神经损伤症状的发生明显高于保守治疗。临床工作中,髁突骨折后出现咬合紊乱、下颌偏斜、张口受限症状者应手术治疗,反之采用保守治疗。

Objective

To analyze and compare the curative effect of conservative and surgical treatment for adult mandibular condylar fracture, and to provide the basis for clinical treatment of adult mandibular condylar fracture.

Methods

Web of science, PubMed, Cochrane library, and Embase database were searched for literature about conservative and surgical treatment of adult condylar fracture. The searching time was from establishment of the databases to May 1st, 2020. The literature was screened strictly according to the inclusion and exclusion criteria, of which the quality was evaluated. Adult mandibular condylar fracture related data were extracted for use. Odds ratio (OR) or mean difference (MD) and 95% confidence interval (CI) for efficacy indicators were calculated with a software (RevMan v.5.3) . Sensitivity analysis and publication bias test were performed for studies with heterogeneity using Statase (v.12.0) .

Results

A total of 23 studies related to conservative and surgical treatment of adult mandibular condylar fractures were included, involving 917 patients with conservative treatment and 819 patients with surgical treatment. The results showed that the incidence of occlusal disorder [OR = 3.07, 95% CI (2.07, 4.58) , P<0.001] and mandibular deviation [OR=2.51, 95% CI (1.36, 4.63) , P = 0.003] after surgical treatment of condylar fracture was significantly lower than that after conservative treatment. The recovery of maximum mouth width with surgical treatment [MD = -3.70, 95% CI (-4.39, -3.02) , P<0.001] was better than that with conservative treatment. However, the post-op pain of soft tissue [OR = 0.21, 95% CI (0.07, 0.62) , P = 0.005], swelling [OR = 0.26, 95% CI (0.15, 0.46) , P<0.001], and injury of facial nerve after surgical treatment [OR = 0.13, 95% CI (0.03, 0.61) , P = 0.009] were significantly higher than that after conservative treatment. No significant difference was found between the two groups in joint pain, jaw movement pain, mouth opening length <35 mm, joint clanging, reduced height of mandibular ramus, facial asymmetry, salivary leakage, scar and lateral deviation (P>0.05) .

Conclusions

With surgical treatment, the recovery of occlusal relationship, mandibular deviation and the maximum degree of mouth opening were better than that with conservative treatment, but the occurrence of soft tissue pain, swelling and facial nerve injury was significantly higher. In the clinical work, the patients suffered from condylar fracture with occlusal disorder, mandibular deviation, and limitation of mouth opening should be treated surgically, otherwise the conservative treatment should be a better option.

图1 成人髁突骨折保守治疗与手术治疗疗效对比的文献检索流程图
表1 纳入成人髁突骨折保守治疗与手术治疗研究文献的一般特征
纳入文献 年份 保守/手术病例数 研究类型 质量评估(分) 骨折类型 疗效指标
Andrade等[6] 2003 27/13 CCT 7 高中低位 关节疼痛、下颌运动疼痛、肿胀、咬合紊乱、下颌偏斜、开口度<35 mm、面型不对称
Carneiro等[7] 2008 19/11 CCT 7 高中低位 下颌骨折侧升支高度降低量、横向偏斜量、最大开口度
Danda等[8] 2010 16/16 RCT 6 中低位 关节疼痛、咬合紊乱、下颌偏斜、面神经损伤症状、横向偏斜量、最大开口度
Ellis等[9] 2000 85/93 RCT 6 高中低位 肿胀、面神经症状、面型不对称、涎漏、瘢痕
Eulert等[10] 2007 81/121 CT 8 高中低位 肿胀、咬合紊乱、面神经损伤症状、下颌升支高度降低、横向偏斜量
高颖等[11] 2018 16/21 CCT 7 高位 下颌运动疼痛、下颌偏斜、关节弹响、最大开口度
Ho等[12] 2015 18/20 CCT 7 高中位 关节疼痛、咬合紊乱、下颌偏斜、开口度<35 mm、面神经损伤症状、关节弹响、最大开口度
Kokemueller等[13] 2012 44/31 RCT 6 中低位 关节疼痛、软组织疼痛、下颌运动疼痛、肿胀、咬合紊乱、面神经损伤症状、下颌升支高度降低、面型不对称、头痛
Kotrashetti等[14] 2013 12/10 RCT 6 中低位 关节疼痛、咬合紊乱、下颌偏斜、开口度<35 mm、面神经损伤症状、下颌骨折侧升支高度降低量
Krzemień等[15] 2017 20/40 CT 8 高中低位 咬合紊乱、下颌偏斜、关节弹响、下颌升支高度降低
Leiser等[16] 2013 27/10 CCT 7 低位 关节疼痛、下颌偏斜、开口度<35 mm
Merlet等[17] 2018 55/28 CCT 7 中低位 咬合紊乱、下颌偏斜、开口度<35 mm、瘢痕、下颌骨折侧升支高度降低量
Asim等[18] 2019 35/31 RCT 6 中低位 咬合紊乱、下颌偏斜、最大开口度
Palmieri等[19] 1999 74/62 RCT 5 高中低位 横向偏斜量、最大开口度
Rastogi等[20] 2015 25/25 RCT 5 高中低位 下颌偏斜
Santler等[21] 1999 113/37 CT 8 高中低位 关节疼痛、下颌运动疼痛、开口度<35 mm、面神经损伤症状、横向偏斜量、最大开口度
Schneider等[22] 2008 30/36 RCT 5 中低位 最大开口度
Stiesch-Schoilz等[23] 2005 13/24 CT 8 高中低位 关节疼痛、软组织疼痛、咬合紊乱、下颌偏斜、关节弹响
Stypulkowski等[24] 2019 8/9 CCT 8 高中低位 咬合紊乱、关节弹响、横向偏斜量、最大开口度
Throckmorton等[25] 2000 74/62 RCT 5 高中低位 横向偏斜量、最大开口度
Throckmorton等[26] 2004 44/37 RCT 5 高中低位 横向偏斜量、最大开口度
Vesnaver等[27] 2012 20/42 CCT 7 中低位 肿胀、咬合紊乱、下颌偏斜、面神经损伤症状、面型不对称、涎漏、瘢痕、横向偏斜量、最大开口度
Worsaae等[28] 1994 61/40 RCT 6 中低位 关节疼痛、咬合紊乱、开口度<35 mm、头痛、最大开口度
表2 成人髁突骨折保守治疗与手术治疗疗效指标的Meta分析结果
表3 存在异质性疗效指标经敏感性分析及Egger检验的结果
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