Knudsen Thorkild B, Laulund Anne S, Ingerslev Janne, Homøe Preben, Pinholt Else M
Consultant, Department of Otorhinolaryngology and Maxillofacial Surgery, Køge University Hospital, Køge, Denmark.
PhD Student, Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark.
J Oral Maxillofac Surg. 2015 Apr;73(4):719-26. doi: 10.1016/j.joms.2014.08.006. Epub 2014 Aug 11.
This study investigated whether patients with obstructive sleep apnea (OSA) who undergo maxillomandibular advancement (MMA) with counterclockwise (CCW) rotation compared with those who undergo MMA without CCW rotation have better outcomes.
This was a systematic review with meta-analysis. The Medline and Cochrane databases were searched for randomized controlled trials using Medical Subject Headings. The predictor variable was operative technique, namely MMA with or without CCW rotation of the maxillofacial complex. The key outcome variables were changes in pre- and postsurgical values of pharyngeal volume measured on computed tomogram or cone-beam computed tomogram and changes in Apnea-Hypopnea Index (AHI) and lowest oxygen saturation (LSAT) values after surgery. Data were subjected to a meta-analysis based on odds ratios (OR) with 95% confidence intervals (CIs) and P values lower than .05 by χ(2) test were considered significant.
Twenty-one randomized controlled trials were identified and 4 were assessed for the variables of interest. Postoperative AHI and LSAT measurements showed vast improvement. The sample was not large enough to make a correlation between pharyngeal volume changes and surgical method used. Postoperative parameters included an AHI lower than 5 (OR = 14.9; 95% CI, 2.7-83.5; P = .002), an AHI lower than 20 (OR = 114.8; 95% CI, 23.5-561.1; P <.00001), pooled results of a 50% decrease in the AHI (OR = 6.1; 95% CI, 2.2-17.0; P = .0006), and an increase greater than 90% in LSAT measurements during sleep (OR = 6.0; 95% CI, 1.8-19.9; P = .003). The funnel plot showed no evidence of publication bias.
CCW-MMA or MMA in patients with OSA results in a statistically meaningful decrease in postoperative AHI and a statistically meaningful increase in postoperative LSAT.
本研究调查了与未进行逆时针（CCW）旋转的上颌下颌前移术（MMA）患者相比，接受伴有CCW旋转的MMA手术的阻塞性睡眠呼吸暂停（OSA）患者是否有更好的治疗效果。
这是一项带有荟萃分析的系统评价。使用医学主题词在Medline和Cochrane数据库中检索随机对照试验。预测变量是手术技术，即上颌面部复合体伴有或不伴有CCW旋转的MMA。关键结局变量是在计算机断层扫描或锥形束计算机断层扫描上测量的术前和术后咽部体积的变化，以及术后呼吸暂停低通气指数（AHI）和最低氧饱和度（LSAT）值的变化。数据基于比值比（OR）进行荟萃分析，95%置信区间（CI），通过χ²检验P值低于0.05被认为具有统计学意义。
共识别出21项随机对照试验，其中4项针对感兴趣的变量进行了评估。术后AHI和LSAT测量显示有显著改善。样本量不足以建立咽部体积变化与所用手术方法之间的相关性。术后参数包括AHI低于5（OR = 14.9；95% CI，2.7 - 83.5；P = 0.002），AHI低于20（OR = 114.8；95% CI，23.5 - 561.1；P < 0.00001），AHI降低50%的汇总结果（OR = 6.1；95% CI，2.2 - 17.0；P = 0.0006），以及睡眠期间LSAT测量值增加超过90%（OR = 6.0；95% CI，1.8 - 19.9；P = 0.003）。漏斗图显示没有发表偏倚的证据。
OSA患者的CCW - MMA或MMA导致术后AHI有统计学意义的降低，术后LSAT有统计学意义的升高。
