Choi Bong-Kyoon, Yang Eun-Jung, Oh Kap Sung, Lo Lun-Jou
Maxillofacial Center, Korea International Esthetic Surgery Union, Plastic Surgery Clinic, Seoul, Korea.
J Oral Maxillofac Surg. 2013 Feb;71(2):358-65. doi: 10.1016/j.joms.2012.04.012. Epub 2012 Jun 16.
The objective of this study was to compare the blood loss, transfusion needs, and operation times in subjects who underwent bimaxillary surgery with versus without maxillary setback.
A retrospective chart review was completed in all patients who underwent bimaxillary surgery from March 2009 to August 2010. The inclusion criterion was the availability of a complete chart record. Patients were divided into 1 of 2 groups based on maxillary setback procedure. The predictive variable was the treatment group. The primary outcome variable was blood loss as measured by the change in hemoglobin. The secondary outcome variables were operation time and transfusion need. The other study variables were a patient's characteristics (ie, age and gender). Mann-Whitney test was performed to compare unpaired samples. Student t test was performed to compare operation time. Multiple regression analysis was used to analyze the adjusted relation among the study variables.
There were 82 patients (17 male and 65 female; mean age, 28.0 ± 4.9 yr; age range, 18 to 35 yr) who underwent bimaxillary surgery in this study. The mean hemoglobin decreases were 1.72 g/dL (standard deviation, 0.67 g/dL) in the nonsetback group and 2.37 g/dL (standard deviation, 0.76 g/dL) in the setback group. The average operation times were 158.24 ± 30.36 minutes (range, 127.88 to 188.6 min) in the nonsetback group and 194.35 ± 29.20 minutes (range, 165.15 to 223.55 min) in the setback group. Transfusion was not performed in any patient. After adjusting for potential factors, the multiple regression model showed that the treatment group was associated with blood loss (P < .0001) and operation time (P < .0001).
This study shows that intraoperative bleeding and operation time increased significantly in patients undergoing mandibular ramus osteotomy and Le Fort I osteotomy with maxillary setback. However, transfusion generally is not required during 2-jaw surgery, regardless of maxillary setback.
本研究的目的是比较接受双颌手术且有上颌后缩与无上颌后缩患者的失血量、输血需求和手术时间。
对2009年3月至2010年8月期间接受双颌手术的所有患者进行回顾性病历审查。纳入标准是有完整的病历记录。根据上颌后缩手术情况将患者分为两组中的一组。预测变量是治疗组。主要结局变量是通过血红蛋白变化测量的失血量。次要结局变量是手术时间和输血需求。其他研究变量是患者的特征（即年龄和性别）。采用曼-惠特尼检验比较非配对样本。采用学生t检验比较手术时间。使用多元回归分析来分析研究变量之间的校正关系。
本研究中有82例患者（17例男性和65例女性；平均年龄28.0±4.9岁；年龄范围18至35岁）接受了双颌手术。非后缩组血红蛋白平均下降1.72 g/dL（标准差0.67 g/dL），后缩组为2.37 g/dL（标准差0.76 g/dL）。非后缩组平均手术时间为158.24±30.36分钟（范围127.88至188.6分钟），后缩组为194.35±二十九点二零分钟（范围165.15至223.55分钟）。所有患者均未输血。在对潜在因素进行校正后，多元回归模型显示治疗组与失血量（P <.0001）和手术时间（P <.0001）相关。
本研究表明，接受下颌升支截骨术和上颌Le Fort I截骨术并伴有上颌后缩的患者术中出血和手术时间显著增加。然而，无论是否有上颌后缩，双颌手术期间一般不需要输血。
