Department 2 of Cranio-maxillo-facial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China.
PLoS One. 2013 Jun 28;8(6):e67449. doi: 10.1371/journal.pone.0067449. Print 2013.
The use of titanium during maxillofacial fixation is limited due to its palpability, mutagenic effects and interference with imaging, which lead to the requirement for subsequent removal. The use of a biologically absorbable fixation material will potentially eliminate these limitations. In this meta-analysis, we analyzed the complications of absorbable fixation in maxillofacial surgery.
We performed a systematic search of PubMed, Embase, Cochrane Central Register of Systematic Reviews and Cochrane Central Register of Controlled Trials for trials published through December 2012. Data extracted from literature were analyzed with Review manager 5.0.24.
Relevant data was extracted from 20 studies (1673 participants) and revealed that patients in the absorbable group had significantly more complications than those in the titanium group (RR = 1.20; 95% CI: 1.02-1.42; P = 0.03) in all enrolled maxillofacial surgeries. For bimaxillary operation subgroup, the absorbable fixation group did not have a significant increase in complications when compared with the titanium group (RR = 1.89; 95% CI: 0.85-4.22; P = 0.12). There was no significant difference observed between the absorbable and titanium groups receiving a bilateral sagittal split ramus osteotomy (BSSRO) (RR = 1.45; 95% CI: 0.84-2.48; P = 0.18) and Le Fort I osteotomy (RR = 0.65; 95% CI: 0.34-1.23; P = 0.18). The combined results of the five trials revealed that the absorbable group had a significantly lower rate of complications compared to the titanium group (RR = 0.71; 95% CI: 0.52-0.97; P = 0.03) in fracture fixation.
This meta-analysis shows that absorbable fixation systems used for fixation in maxillofacial surgery do not have adequate safety profiles. Subgroup indicated the safety of absorbable fixation systems was superior during fracture fixation. The absorbable fixation systems tend to have a similar favorable safety profile as titanium fixation during Le Fort I, bimaxillary operation and BSSRO.
由于钛的可触知性、致突变性和对影像学的干扰，其在颌面固定中的应用受到限制，这导致需要后续去除。使用生物可吸收固定材料将有可能消除这些限制。在这项荟萃分析中，我们分析了颌面外科中可吸收固定的并发症。
我们对 PubMed、Embase、Cochrane 系统评价数据库和 Cochrane 对照试验中心数据库进行了系统检索，检索时间截至 2012 年 12 月。使用 Review Manager 5.0.24 对文献中的数据进行分析。
共有 20 项研究（1673 名参与者）的数据符合纳入标准，结果显示，在所有纳入的颌面手术中，可吸收组的患者并发症明显多于钛组（RR=1.20；95%CI：1.02-1.42；P=0.03）。对于双颌手术亚组，与钛组相比，可吸收固定组的并发症无显著增加（RR=1.89；95%CI：0.85-4.22；P=0.12）。接受双侧矢状劈开截骨术（BSSRO）（RR=1.45；95%CI：0.84-2.48；P=0.18）和 Le Fort I 截骨术（RR=0.65；95%CI：0.34-1.23；P=0.18）的患者，可吸收组与钛组之间的并发症发生率无显著差异。五项试验的综合结果显示，与钛组相比，可吸收组骨折固定的并发症发生率显著降低（RR=0.71；95%CI：0.52-0.97；P=0.03）。
这项荟萃分析表明，颌面外科固定中使用的可吸收固定系统的安全性不够。亚组表明，在骨折固定中，可吸收固定系统的安全性更高。在 Le Fort I、双颌手术和 BSSRO 中，可吸收固定系统的安全性与钛固定系统相似。
