Saltaji Humam, Major Michael P, Alfakir Hussam, Al-Saleh Mohammed A Q, Flores-Mir Carlos
Orthodontic Graduate Program, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada.
J Oral Maxillofac Surg. 2012 Dec;70(12):2859-66. doi: 10.1016/j.joms.2012.03.009. Epub 2012 Jun 6.
To evaluate the long-term skeletal stability after maxillary surgical advancement with conventional Le Fort I osteotomy in patients with cleft lip and palate by a systematic review of the published data.
Electronic databases, "gray literature," and reference list searches were conducted. The inclusion criteria were the stability of maxillary surgical advancement with conventional Le Fort I osteotomy fixed with plates and assessed at the post-treatment follow-up 1 year or more postoperatively in patients with cleft lip and/or palate. Full reports were retrieved from abstracts or titles that appeared to meet the inclusion criteria or lacked sufficient detail for immediate exclusion. Once full reports were collected, they were again reviewed, considering more detailed inclusion criteria for a final selection decision. A methodologic quality assessment tool was used. The quantity and quality of the obtained data precluded a meta-analytic approach.
A total of 25 abstracts/titles met the initial search criteria, and 10 studies were finally selected. The overall methodologic quality scores were high for only 1 randomized clinical trial. After maxillary advancement with Le Fort I in patients with cleft lip and palate, the long-term horizontal relapse at the A-point was 20% to 30% in 4 studies and 30% to 40% in 3 studies. In addition, vertical relapse was more than 50% in 4 studies. The study judged as a high-quality study reported a 37% rate of horizontal relapse and a 65% rate of vertical relapse at the A-point.
Current evidence suggests maxillary surgical advancement with conventional Le Fort I osteotomy in patients with cleft lip and palate appears to show a moderate relapse rate in the horizontal plane and a high relapse rate in the vertical plane.
通过对已发表数据的系统评价，评估唇腭裂患者采用传统Le Fort I型截骨术进行上颌骨手术前移后的长期骨骼稳定性。
进行电子数据库、“灰色文献”及参考文献检索。纳入标准为唇裂和/或腭裂患者采用传统Le Fort I型截骨术并使用接骨板固定进行上颌骨手术前移，且在术后1年或更长时间的治疗后随访中进行评估。从似乎符合纳入标准或缺乏足够细节而无法立即排除的摘要或标题中检索完整报告。收集到完整报告后，再次进行审查，考虑更详细的纳入标准以做出最终选择决定。使用了一种方法学质量评估工具。所获数据的数量和质量排除了进行荟萃分析的方法。
共有25篇摘要/标题符合初始检索标准，最终选择了10项研究。仅1项随机临床试验的总体方法学质量得分较高。唇腭裂患者采用Le Fort I型截骨术进行上颌骨前移后，4项研究中A点的长期水平复发率为20%至30%，3项研究中为30%至40%。此外，4项研究中垂直复发率超过50%。被判定为高质量研究的报告显示A点水平复发率为37%，垂直复发率为65%。
目前的证据表明，唇腭裂患者采用传统Le Fort I型截骨术进行上颌骨手术前移，在水平面似乎有中度复发率，在垂直面有较高复发率。
