Department of Oral and Maxillofacial Surgery, North Manchester General Hospital, Pennine Acute NHS Trust, United Kingdom.
J Craniomaxillofac Surg. 2012 Dec;40(8):e438-52. doi: 10.1016/j.jcms.2012.03.002. Epub 2012 Apr 13.
The treatment for mandibular condyle fractures remains controversial. Conservative management (CM) and open reduction/internal fixation (ORIF) are both used, but the evidence to support superiority of one method over the other has not been assessed.
We performed a meta-analysis of studies comparing CM versus ORIF in patients with condyle fractures. The primary outcome was post-treatment function; we looked at the status of the post-treatment occlusion, mouth opening, protrusion, facial height, pain and the presence of postoperative ankylosis. Furthermore, in studies evaluating ORIF, adverse effects such as facial nerve weakness and scarring, were also recorded.
Twenty (20) studies enrolling 1596 patients were eligible. These included four randomized controlled trials (RCTs) and 16 non-randomized case series. Only 1186 of these patients were analyzed by the studies; the reasons for exclusion were rarely clarified. All four RCTs were prospective but the majority (69%) of the remaining studies were retrospective. The inclusion criteria were described in all four RCTs; however, this was not the case in half of the remaining studies (44%). Only four (20%) studies were blinded. Across all included studies, we recorded great variation between treatment protocols, follow-up periods, and outcomes measured. This precluded any quantitative synthesis. In nine studies (45%) the superiority of ORIF over CM reached statistical significance. The incidence of facial nerve weakness following ORIF averaged 6% and it was temporary for the majority of the patients. The identified RCTs were small (160 patients) and suffered from a number of methodological shortcomings. All of them reached statistically significant conclusions favoring ORIF over CM.
The current meta-analysis suggests that ORIF for condylar fractures may be as good or better than CM. The morbidity associated with the operation is low. However, the available evidence is of poor quality and not strong enough to change clinical practice.
下颌骨髁突骨折的治疗仍存在争议。保守治疗（CM）和切开复位内固定（ORIF）均有应用，但尚未评估哪种方法更具优势。
我们对比较 CM 与 ORIF 治疗髁突骨折的研究进行了荟萃分析。主要结局是治疗后的功能；我们观察了治疗后咬合、张口度、前突、面高、疼痛和术后关节强直的情况。此外，在评估 ORIF 的研究中，还记录了面神经无力和瘢痕等不良事件。
有 20 项研究（共纳入 1596 例患者）符合纳入标准，包括 4 项随机对照试验（RCT）和 16 项非随机病例系列研究。只有 1186 例患者被纳入研究分析；排除的原因很少被阐明。4 项 RCT 均为前瞻性，但大多数（69%）其他研究为回顾性。4 项 RCT 均详细描述了纳入标准，但在其余研究中仅一半（44%）有描述。只有 4 项（20%）研究为盲法。所有纳入研究中，治疗方案、随访时间和测量的结局均存在较大差异，因此无法进行定量合成。在 9 项研究（45%）中，ORIF 优于 CM 具有统计学意义。ORIF 后面神经无力的发生率平均为 6%，且大多数患者为暂时性。所识别的 RCT 规模较小（160 例患者），且存在多项方法学缺陷。所有这些 RCT 均得出支持 ORIF 优于 CM 的统计学结论。
本荟萃分析提示，ORIF 治疗髁突骨折可能与 CM 一样好或更好。手术相关的发病率较低。然而，现有证据质量较差，不足以改变临床实践。
